Recurrent Laryngeal Nerve Liberations and Reconstructions: A Single Institution ExperienceReport as inadecuate




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World Journal of Surgery

, Volume 40, Issue 3, pp 644–651

First Online: 09 November 2015

Abstract

BackgroundRecurrent laryngeal nerve RLN palsy rates vary from 0.5 to 10 %, even 20 % in thyroid cancer surgery.
The aim of this paper was to present our experience with RLN liberations and reconstructions after various mechanisms of injury.

MethodsPatients were treated in our institution from year 2000 to 2015.
First group 27 patients had large benign goiters, locally advanced thyroid-parathyroid carcinomas, or incomplete previous surgery of malignant thyroid disease.
Second group 5 patients had reoperations due to RLN paralysis on laryngoscopy.
Liberations and reconstructions of injured RLNs were performed.

ResultsSurgical exploration of central compartment enabled identification of the RLN injury mechanism.
Liberations were performed in 11 patients, 2 months to 16 years after RLN injury, by removing misplaced ligations.
Immediate or delayed 18 months to 23 years RLN reconstructions were performed in 21 patients, by direct suture or ansa cervicalis-to-RLN anastomosis ARA.
RLN liberation provided complete voice recovery within 3 weeks in all patients.
Patients with direct sutures had better phonation 1 month after reconstruction.
Improved phonation was observed 2–6 months after ARA in 43 % of patients.

ConclusionsVocal cords do not regain normal movement once being paralyzed after RLN transection, but they restore tension during phonation by reconstruction.
Nerve liberation is a useful method which enables patients with RLN paresis-paralysis a significant improvement in phonation, even complete voice recovery.
Reinnervation of vocal cords, using one of the mentioned techniques, should be a standard in thyroid and parathyroid surgery, with aim to improve quality of patient’s life.

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Author: Radan Dzodic - Ivan Markovic - Nada Santrac - Marko Buta - Igor Djurisic - Silvana Lukic

Source: https://link.springer.com/article/10.1007/s00268-015-3305-0



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