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. 2020 Dec;9(6):2017-2025.
doi: 10.21037/gs-20-633.

Clinical observation of end-to-end neuroanastomosis in the treatment of complete injury of the unilateral recurrent laryngeal nerve

Runzhang Wu  1 , Chaojie Zhang  1 , Huiling Wang  1 , Meiliang Li  2 , Shanshan Lei  1 , Jie Zeng  1 , Jie He  1
Affiliations

Clinical observation of end-to-end neuroanastomosis in the treatment of complete injury of the unilateral recurrent laryngeal nerve

Runzhang Wu et al. Gland Surg. 2020 Dec.

Abstract

Background: Complete injury of the recurrent laryngeal nerve (RLN) is a serious complication of thyroid surgery. Increasingly researches focus on the voice recovery of patients with RLN injury. This paper studied the effect of immediate end-to-end neuroanastomosis after complete injury of the unilateral RLN during thyroid surgery on postoperative vocal function.

Methods: Thirteen patients who underwent end-to-end neuroanastomosis for the treatment of complete injury of the unilateral RLN caused by thyroid surgery in Hunan Provincial People's Hospital between October 2009 and January 2020 were selected. The basic information, cause of RLN injury, postoperative voice recovery, recovery time, and subjective assessment of voice by auditory perception results (Grade, Roughness, Breathiness, Asthenia, and Strain, the GRBAS score) of the patients were recorded.

Results: Among the 13 cases with RLN injury, the cause of RLN injury in 10 cases was transection by sharp instruments, and the voice was recovered one day after the operation. The cause of RLN injury in one case was suture of the RLN branch, and the voice was recovered one day after the operation. The cause of RLN injury in two cases was thermal injury, and the times for voice recovery after end-to-end neuroanastomosis were 3 and 4 months. The patients with a GRBAS score of 0 or 1 recovered their voice one day after the operation. The GRBAS score reached 1 in the two thermal injury cases, with voice recovery at 3 and 4 months after surgery. By 6 months, the voice recovery rate of the patients was 100%.

Conclusions: After complete injury of the unilateral RLN, immediate end-to-end anastomosis of the RLN can maximally preserve the postoperative vocal function of patients.

Keywords: Recurrent laryngeal nerve injury (RLN injury); neuroanastomosis; thyroid surgery.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/gs-20-633). All author report grants from Projects of Hunan Provincial Health and Family Planning Commission, outside the submitted work. The authors have no other conflicts of interest to declare.

Figures

Figure 1
Figure 1
A completely resected RLN. RLN, recurrent laryngeal nerve.
Figure 2
Figure 2
Anastomotic RLN. RLN, recurrent laryngeal nerve.
Figure 3
Figure 3
A degenerated and necrotic RLN stump (HE staining, magnification: 15×): cell degeneration, edema, and decreased nuclear staining of the nerve stump are evident. HE, hematoxylin-eosin. RLN, recurrent laryngeal nerve.
Figure 4
Figure 4
A normal RLN stump (HE staining, magnification: 15×). HE, hematoxylin-eosin. RLN, recurrent laryngeal nerve.
Figure 5
Figure 5
Excised RLN lesions. RLN, recurrent laryngeal nerve.
See this image and copyright information in PMC

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