The Role of Immediate Recurrent Laryngeal Nerve Reconstruction for Thyroid Cancer Surgery

Abstract

Unilateral vocal fold paralysis (UVFP) is one of the most serious problems in conducting surgery for thyroid cancer. Different treatments are available for the management of UVFP including intracordal injection, type I thyroplasty, arytenoid adduction, and laryngeal reinnervations. The effects of immediate recurrent laryngeal nerve (RLN) reconstruction during thyroid cancer surgery with or without UVFP before the surgery were evaluated with videostroboscopic, aerodynamic, and perceptual analyses. All subjects experienced postoperative improvements in voice quality. Particularly, aerodynamic analysis showed that the values for all patients entered normal ranges in both patients with and without UVFP before surgery. Immediate RLN reconstruction has the potential to restore a normal or near-normal voice by returning thyroarytenoid muscle tone and bulk seen with vocal fold denervation. Immediate RLN reconstruction is an efficient and effective approach to the management of RLN resection during surgery for thyroid cancer.

Role of immediate recurrent laryngeal nerve reconstruction in surgery for thyroid cancers with fixed vocal cords

“…One year after surgery, all voice parameters of the fixed vocal cord group had improved over the preoperative findings, whereas most parameters of the mobile vocal cord group had improved to equal to the preoperative levels, as also reported in a previous study by Sanuki et al 9 As a result, the fixed vocal cord group had attained satisfactory voice qualities equivalent to those of the mobile vocal cord group in terms of various voice parameters. These results further support the idea that in patients with fixed vocal cord because of thyroid cancer, the RLN damaged by thyroid cancer may not be completely paralyzed but can still stimulate intrinsic laryngeal muscles to prevent atrophy of the vocal cords and is an equally good candidate for immediate RLN reconstruction just as the patients with mobile vocal cords.…”

A long‐term comparative prospective study between reinnervation and injection laryngoplasty

“…Medialization thyroplasty with or without arytenoid adduction is the principal treatment option for thyroidectomy‐related permanent unilateral VFP . However, medialization thyroplasty is a secondary open surgical procedure that requires a further external skin incision .…”

Thyroid Anatomy

“…If there is a nerve injury, different methods of recurrent nerve repair, such as microsuturing gluing and grafting, have been proposed [29]. Direct microsuture is preferable when the defect is no longer than 5 mm and the primary repair can be completed without tension [30]. After transection of RLN, immediate reconstruction could be performed by a direct, "end-to-end" anastomosis of neural stamps, by three to four perineural stitches of 7-0 nylon thread, using microsurgical instruments [31].…”