Outcome with immediate direct anastomosis of recurrent laryngeal nerves injured during thyroidectomy

Authors

  • Jong W. Hong MD,

    1. Department of Plastic & Reconstructive Surgery, Institute for Human Tissue Restoration, Seoul, Korea
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  • Tai S. Roh MD, PhD,

    1. Department of Plastic & Reconstructive Surgery, Institute for Human Tissue Restoration, Seoul, Korea
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  • Han-Su Yoo MD,

    1. Department of Plastic & Reconstructive Surgery, Institute for Human Tissue Restoration, Seoul, Korea
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  • Hyun J. Hong MD,

    1. Department of Otorhinolaryngology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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  • Hong-Shik Choi MD, PhD,

    1. Department of Plastic & Reconstructive Surgery, Institute for Human Tissue Restoration, Seoul, Korea
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  • Hang S. Chang MD, PhD,

    1. Department of Thyroid Cancer Clinic, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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  • Cheong S. Park MD, PhD,

    1. Department of Thyroid Cancer Clinic, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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  • Young S. Kim MD

    Corresponding author
    1. Department of Thyroid Cancer Clinic, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
    • Send correspondence to Young Seok Kim, MD, Department of Plastic & Reconstructive Surgery, Institute for Human Tissue Restoration, Gangnam Severance Hospital, Yonsei University, College of Medicine, 211 Eonjuro, Gangnam-gu, Seoul, Republic of Korea. 135-720. E-mail: psyskim@yuhs.ac

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  • The authors have no funding, financial relationships, or conflicts of interest to disclose.

Abstract

Objectives/Hypothesis

Management of unrecognized recurrent laryngeal nerve injury typically entails delayed phonosurgical intervention and laryngeal reinnervation, but in cases of recognized injury, nerve anastomosis has been considered standard management. However, the well-organized outcome analysis of nerve anastomosis has been insufficient. We performed immediate direct anastomosis of recurrent laryngeal nerves injured during surgery for thyroid cancer, and subsequent patient outcomes were analyzed.

Study Design

A total 14 patients sustaining recurrent laryngeal nerve injury during thyroidectomy were recruited for the study. Patients undergoing immediate direct reparative anastomosis of the injured nerves constituted the test group, whereas the controls of group 2 (n = 4) did not.

Methods

At follow-up, all patients submitted to rigid laryngoscopy at 3, 6, and 12 months postoperatively. Subjective and objective outcomes of the two groups were then compared.

Results

At 12 months postoperatively, group 1 showed greater improvement in maximum phonation time, glottic gap scores, GRBAS (grade, roughness, breathiness, asthenia, and strain) scales, aspiration scoring, and Voice Handicap Index than controls of group 2. Moreover, group 1 showed an improvement in all five categories at 12 months postoperatively, compared with status at 3 months. None of the patients in group 1 showed laryngoscopic evidence of vocal cord atrophy.

Conclusion

In this study, patients undergoing immediate direct recurrent laryngeal nerve anastomosis demonstrated better phonation and perceptually rated voice quality than those who did not undergo repair.

Level of Evidence

3b. Laryngoscope, 124:1402–1408, 2014

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