Optimal Management of the Unilateral Recurrent Laryngeal Nerve Involvement in Patients with Thyroid Cancer

Abstract

We aimed to determine the optimal management of recurrent laryngeal nerve (RLN) involvement in thyroid cancer. We enrolled 80 patients with unilateral RLN involvement in thyroid cancer between 2000 and 2016. Eleven patients with preoperatively functional vocal folds (VFs) underwent sharp tumor resection to preserve the RLN (shaving group). Thirty-three patients underwent RLN reconstruction with RLN resection (reconstruction group). We divided the reconstruction group into two subgroups based on preoperative VF mobility (normal-reconstruction and paralyzed-reconstruction subgroups). In the cases where RLN reconstruction was difficult, phonosurgeries including arytenoid adduction (AA), with or without thyroplasty type I, or nerve muscle pedicle implantation with AA were performed later (phonosurgery group). We evaluated and compared vocal function among the evaluated periods and different groups. Postoperative vocal function in the shaving and normal-reconstruction subgroups was favorable. There were no significant differences between the two groups. In the paralyzed-reconstruction and phonosurgery groups, postoperative vocal function was significantly improved, and vocal function in the paralyzed-reconstruction subgroup was significantly better than that in the phonosurgery group. For optimal management of unilateral RLN involvement in thyroid cancer, first, sharp dissection should be performed, and if this is impossible, a simultaneous RLN reconstruction procedure should be adopted whenever possible.

The Effect of Hemithyroidectomy in Papillary Thyroid Carcinoma with an Exclusive Involvement of the Recurrent Laryngeal Nerve: A Retrospective Study with a Propensity Score-Matched Analysis

“…The anatomic position of the RLN in relation to the thyroid gland puts it at risk of being affected by disease processes. Due to its unique anatomy, the RLN is the second most commonly invaded structure by primary or metastatic thyroid cancer [ 7 , 34 ]. Approximately 33% to 61% of locally invasive thyroid tumors demonstrate an RLN invasion [ 8 , 9 , 10 , 35 ].…”

Pathological Analysis of Encased Resected Recurrent Nerves in Locally Invasive Thyroid Cancer

“…This finding justifies partial layer resection as described by Nishida et al when possible, preserving all or part of the nerve axons [ 34 ]. This type of nerve preservation, when possible, has been shown to provide better vocal results than nerve grafting or phonosurgery [ 35 , 36 ].…”