OP29 – Technique of Recurrent Laryngeal Nerve Liberation for Phonation Recovery

      Dzodic, Radan1, 2; Markovic, Ivan 1, 2; Santrac, Nada 2; Buta, Marko 2; Djurisic, Igor 2; Lukic, Silvana 3 1 Medical Faculty, University of Belgrade, Belgrade, Serbia 2 Surgical Oncology Clinic, Institute for Oncology and Radiology of Serbia, Belgrade, Serbia 3 Department of Pathology, Institute for Oncology and Radiology of Serbia, Belgrade, Serbia   Background: Recurrent laryngeal nerve (RLN) injury is a major complication in thyroid surgery. It occurs more frequent during operations and reoperations of thyroid cancer and recurrent goiter [1,2]. Techniques of nerve liberation and reconstruction can provide improvement in phonation, even complete voice recovery [3]. Purpose: The aim was to present experience with original technique of RLN liberations and analyze patients’ recovery after the procedure. Methods: From 2000 to 2017, we performed RLN liberation in 16 patients who had RLN paresis/paralysis on laryngoscopy after previous surgical treatment in another institution. Reoperations were performed 2 months to 16 years after RLN injury, by removing misplaced ligations, granulomas or adhesions from nerves [3]. After procedure, voice quality was assessed by qualitative scoring system [3] and laryngoscopy in 1st, 6th and 12th postoperative month. In recent two years we use intraoperative neuromonitoring to confirm good RLN function intraoperatively. Results: Majority of patients had oncological indication for reoperation. Four patients had reoperation for alleviating the symptoms of severe dysphonia or stridorous breathing. In two Two patients that had bilateral RLN paralysis we performed two-step surgery: 2 and 6 months after injury. RLN liberations provided complete voice recovery within three weeks in all patients. In 15 patients, score 4 on perceptual voice quality scale was achieved. One patient, who had RLN liberation 16 years after the injury, restored normal vocal cord movements on laryngoscopy (score 5). Discussion & Conclusion: RLN liberation enables patients with paresis/paralysis a significant improvement in phonation, even complete voice recovery.   References:
    1. Calo PG,  Pisano  G,  Medas  F  et  al. Risk  factors  in  reoperative   thyroid   surgery   for   recurrent   goitre:   our   experience. G Chir 2012; 33:335–338.
    2. Hayward NJ, Grodski S, Yeung M et al. Recurrent laryngeal nerve injury in thyroid surgery: a review. ANZ J Surg 2013; 83 (1-2): 15-21.
    3. Dzodic R, Markovic I, Santrac N, Buta M, Djurisic I, Lukic S. Recurrent laryngeal nerve liberations and reconstructions: a single institution experience. World J Surg. 2016;40(3):644-651.


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