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CC BY-NC-ND 4.0 · J Reconstr Microsurg Open 2023; 08(01): e32-e37
DOI: 10.1055/a-2004-0113
Original Article

Immediate Intraoperative Microsurgical Repair of the Recurrent Laryngeal Nerve: A Fifteen-Year Institutional Experience

J Reed McGraw
1   Division of Plastic Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
,
Corey M. Bascone
1   Division of Plastic Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
,
Ivan A. Jaimez
1   Division of Plastic Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
,
Carlos E. Barrero
1   Division of Plastic Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
,
Joshua Fosnot
1   Division of Plastic Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
,
Douglas L. Fraker
2   Division of Endocrine and Oncologic Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
,
Stephen J. Kovach III
1   Division of Plastic Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
› Author Affiliations Funding None.
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Abstract

Background Recurrent laryngeal nerve (RLN) injury carries significant morbidity. Microsurgical repair of the RLN has proven promising for enhancing patient recovery of vocal function; however, data remains limited.

Methods This retrospective cohort study included patients who underwent RLN repair from 2007 to 2022. Demographics and medical history were collected. The location and etiology of RLN injury, as well as the repair technique, were collected. Follow-up data were collected at the initial postoperative visit, at 6 months and at 1 year. Hoarseness was classified as mild, moderate, or severe. Of patients who underwent nasopharyngolaryngoscopy (NPL) following repair, the glottic gap was measured. Vocal interventions performed were also recorded. This study utilized descriptive statistical methods.

Results Eleven patients underwent RLN repair. All patients underwent immediate repair. Fifty-four percent (n = 6) of RLN injuries resulted from tumor inflammation or nerve encasement. Eighty-two percent (n = 9) underwent direct RLN coaptation, 9% (n = 1) underwent vagus-RLN anastomosis, and 9% (n = 1) underwent an interposition nerve graft. Technical success was 100%. Seventy-three percent (n = 8) required otolaryngology referral, and of those, 50% (n = 4) required intervention. At initial evaluation, 91% (n = 10) suffered from mild to severe hoarseness, and of patients who underwent NPL, all had a glottic gap. At 1 year, 82% of patients (n = 9) improved to having mild to no appreciable hoarseness. Of the patients who underwent NPL, 62% (n = 5) had closure of the glottic gap.

Conclusion Patients undergoing repair of the RLN following injury showed excellent recovery of vocal function and resolution of glottic gap at 1 year.

Keywords

laryngeal nerve - nerve repair - thyroid


Publication History

Received: 23 June 2022

Accepted: 29 September 2022

Accepted Manuscript online:
28 December 2022

Article published online:
16 March 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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