A method to repair the recurrent laryngeal nerve during thyroidectomy

A method to repair the recurrent laryngeal nerve during thyroidectomy

Can J Surg 2018;61(4):278-282 | PDF

Angela Gurrado, MD, PhD; Alessandro Pasculli, MD; Angela Pezzolla, MD; Giovanna Di Meo, MD; Maria L Fiorella, MD, PhD; Rocco Cortese, SP; Nicola Avenia, MD; Mario Testini, MD

Summary

Vocal cord palsy (VCP) is one of the most frequent complications following thyroidectomy. We evaluated the outcomes of intraoperative reconstruction of the recurrent laryngeal nerve (RLN). Of 917 patients who underwent thyroid surgery in a single high-volume general surgery ward between 2000 and 2015, 12 (1.3%) were diagnosed with RLN injury and were retrospectively categorized into 2 groups: group A (n = 5), with intraoperative evidence of iatrogenic transection or cancer invasion of the RLN, and group B (n = 7), with postoperative confirmation of VCP. In group A, immediate microsurgical primary repair of the RLN was performed. Postoperative assessment included subjective ratings (aspiration and voice quality improvement) and objective ratings (perceptual voice quality according to the grade, roughness, breathiness, asthenia and strain [GRBAS] scale, and direct laryngoscopy). In group A, roughness, breathiness and strain were significantly lower at 9 months than at 3 months (p < 0.05). Although larger, multicentre studies are needed, the results suggest potentially excellent postoperative phonatory function after immediate RLN reconstruction.


Presented as a poster at the American Head and Neck Society 9th International Conference on Head and Neck Cancer, Seattle, Wash., July 16–20, 2016.

Accepted Dec. 4, 2017

Acknowledgement: The authors thank Claudia Ventrelli for English revision of the manuscript.

Affiliations: From the Unit of Endocrine, Digestive, and Emergency Surgery, Department of Biomedical Sciences and Human Oncology (Gurrado, Pasculli, Di Meo, Testini), the Unit of Laparoscopic Surgery, Department of Emergency and Organ Transplantation, (Pezzolla), the Unit of Otorhinolaryngology, Department of Biomedical Sciences, Neurosciences and Sense Organs (Fiorella) and the Unit of Physical Medicine and Rehabilitation, Department of Neurological and Psychiatric Sciences (Cortese), University Medical School “A Moro” of Bari, Bari, Italy; and the Unit of Endocrine Surgery, Department of Surgical Sciences, Radiology and Dentistry, Santa Maria Hospital of Terni, University of Perugia, Perugia, Italy (Avenia).

Competing interests: None declared.

Contributors: All authors contributed substantially to the conception, writing and revision of this article and approved the final version for publication.

DOI: 10.1503/cjs.010317

Correspondence to: M. Testini, Unit of Endocrine, Digestive, and Emergency Surgery, Department of Biomedical Sciences and Human Oncology, University Medical School “A. Moro” of Bari, Policlinico, Piazza Giulio Cesare, 11, 70124 Bari, Italy, mario.testini@uniba.it