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

• Published in: The Laryngoscope 2014-06, Vol.124 (6), p.1402-1408
• Main Authors: Hong, Jong W., Roh, Tai S., Yoo, Han-Su, Hong, Hyun J., Choi, Hong-Shik, Chang, Hang S., Park, Cheong S., Kim, Young S.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Anastomosis, Surgical - methods; Carcinoma, Papillary - pathology; Carcinoma, Papillary - surgery; Cohort Studies; direct nerve anastomosis; Female; Follow-Up Studies; Humans; Iatrogenic Disease; immediate nerve anastomosis; Injured recurrent laryngeal nerve; Intraoperative Complications - diagnosis; Intraoperative Complications - surgery; Laryngoscopy - methods; Male; Middle Aged; Phonation - physiology; Reconstructive Surgical Procedures - methods; Recurrent Laryngeal Nerve Injuries - etiology; Recurrent Laryngeal Nerve Injuries - surgery; Retrospective Studies; Speech disorders; Thyroid Neoplasms - pathology; Thyroid Neoplasms - surgery; Thyroidectomy - adverse effects; Thyroidectomy - methods; Time Factors; Treatment Outcome; Voice Quality
• ISSN: 0023-852X; 1531-4995
• DOI: 10.1002/lary.24450

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