Comparison of vocal outcome following two different procedures for immediate RLN reconstruction

Abstract

The objective of this study was to compare time-dependent improvements in phonatory function and stroboscopic findings following two different procedures for immediate reconstruction of the recurrent laryngeal nerve (RLN) during neck tumor extirpation. Seventeen patients with neck tumors, consisting of advanced thyroid cancer (n = 15), metastatic neck lymph nodes from other malignant lesions (n = 2), underwent resection of the primary lesion and involved RLN. Immediate RLN reconstruction by either: (1) ansa cervicalis nerve (ACN) to RLN anastomosis (n = 8); or (2) placement of the great auricular nerve (GAN) between the cut ends of the RLN (n = 9) was performed from 2000 to 2011. Phonatory function [maximum phonation time, mean airflow rate (MFR), jitter, and shimmer) and stroboscopic findings (regularity, amplitude, and glottal gap) were examined at 1, 6, and 12 months postoperatively. Stroboscopic findings were assessed by two otolaryngologists and one speech pathologist. There were no significant differences in any parameter for either phonatory function or stroboscopic findings between ACN and GAN with the exception of jitter and shimmer, in which ACN was superior to GAN at 1 month postoperatively. All parameters improved significantly between 1 and 12 months postoperatively for both phonatory function and stroboscopic findings (P < 0.05). Either method of immediate RLN reconstruction at the time of neck tumor extirpation (i.e., ACN or GAN) provided both excellent long-term postoperative phonatory function and stroboscopic findings, and there was little difference in vocal outcome between the two procedures.

Guidelines for the Management of Unilateral Vocal Fold Paralysis From the Korean Society of Laryngology, Phoniatrics and Logopedics

“…Primary intraoperative RLN reinnervation is theoretically an ideal approach for improving voice due to UVFP. Intraoperative RLN reinnervation, in which neurorrhaphy is performed between the distal RLN and intact proximal RLN (primary reanastomosis or greater auricular nerve [GAN] free grafts) or other intact nerves, including the ansa cervicalis (ansa-RLN) and hypoglossal nerve (hypoglossal-RLN) during the surgical procedure, may prevent progressive loss of thyroarytenoid muscle tension and bulk [ 139 ]. By using this procedure at the time of surgery, subsequent medialization procedures may be avoided.…”

A narrative review of current therapies in unilateral recurrent laryngeal nerve injury caused by thyroid surgery

“…However, other nerves are available when the ACN is hard to obtain or unsuitable. There were no significant differences between the great auricular nerve (GAN) reconstruction with the RLN and ACN to RLN anastomosis in a previous study (29). A follow-up study about the of 237 cases with ACN reinnervation showed that phonatory function could be normal after nerve-grafting (23).…”

Immediate Intraoperative Repair of the Recurrent Laryngeal Nerve in Thyroid Surgery

“…Table I summarizes the outcomes of the characteristics and outcomes of papers published reporting IIORRLN (Table I). Kumai et al, specifically found no differences on the type of anastomoses when comparing FNG and ARA 49 . And furthermore Yoshioka et al, found no differences in outcomes between all four main types of reconstruction DA, FN, ARA, and VRA 28 .…”