Intraoperative reinnervation of the recurrent laryngeal nerve during thyroid surgery

  • Background 
    The incidence of permanent recurrent laryngeal nerve (RLN) paralysis after thyroid surgery has been reported to be 2-3%.The advantages of intraoperative repair of RLN (IORRLN) with ansa cervicalis or vagus nerve are that these techniques provide vocal fold bulk and tone, it is an effective and replicable procedure, facilitates voice and swallowing rehabilitation as well as not compromising future treatments.
     
    Patients and methods 
    Retrospective chart review including all patients treated with IORRLN.Microanastomosis using 3-4 sutures 9 S&T ® were performed.All patients were referred to the speech and language therapy for voice rehabilitation.Voice outcome were evaluated with GRBAS score VHI score.
     
    Results 
    A total of 292 thyroid and parathyroid cancer surgeries were performed.Six IORRLN were performed on 5 patients from July 2015 to July 2018 (one patient had bilateral IRLNR).Three patients had locally invasive thyroid cancer, one had parathyroid carcinoma and one patient suffered from a complex anatomical intrathoracic goitre and a papillary microcarcinoma.The mean age was 60.6 years.Fifty per cent of the procedures were performed on the affected side with no other postoperative complications observed.During the first postoperative visit, 60% of patients described their voice as excellent, while 20% complained of not being able to sing.Patients demonstrated a median GRBAS scoring(0-4)of G-1;R-1;B-0.5;A-0;S-0.5 and a mean VHI score(0-120)of 4.5.
     
    Conclusion 
    IORRLN is an effective and easy procedure with promising results that should be considered during thyroid surgery when RLN has to be resected.The IORRLN should be considered whenever possible in cases of locally invasive thyroid cancer or unexpected injury of the RLN.

 

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