Role of immediate recurrent laryngeal nerve reconstruction in surgery for thyroid cancers with fixed vocal cords

Iwaki, Shinobu; Maeda, Tatsuyoshi; Saito, Miki; Otsuki, Naoki; Takahashi, Miki; Wakui, Emi; Shinomiya, Hirotaka; Morimoto, Koichi; Inoue, Hiroyuki; Masuoka, Hiroo; Miyauchi, Akira; Nibu, Ken‐ichi

doi:10.1002/hed.24627

Cited by 18 publications

(15 citation statements)

References 17 publications

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“…Additionally, the position of the paralyzed VF was improved due to laryngeal muscle reinnervation. Iwaki et al [ 33 ] evaluated pre-and postoperative VF positions in patients who underwent immediate RLN reconstruction surgery for unilateral RLNP caused by thyroid cancer. The paralyzed VF was fixed in the paramedian position preoperatively.…”

Section: Discussionmentioning

confidence: 99%

Optimal Management of the Unilateral Recurrent Laryngeal Nerve Involvement in Patients with Thyroid Cancer

Miyamaru

Murakami

Nishimoto

et al. 2021

Cancers

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We aimed to determine the optimal management of recurrent laryngeal nerve (RLN) involvement in thyroid cancer. We enrolled 80 patients with unilateral RLN involvement in thyroid cancer between 2000 and 2016. Eleven patients with preoperatively functional vocal folds (VFs) underwent sharp tumor resection to preserve the RLN (shaving group). Thirty-three patients underwent RLN reconstruction with RLN resection (reconstruction group). We divided the reconstruction group into two subgroups based on preoperative VF mobility (normal-reconstruction and paralyzed-reconstruction subgroups). In the cases where RLN reconstruction was difficult, phonosurgeries including arytenoid adduction (AA), with or without thyroplasty type I, or nerve muscle pedicle implantation with AA were performed later (phonosurgery group). We evaluated and compared vocal function among the evaluated periods and different groups. Postoperative vocal function in the shaving and normal-reconstruction subgroups was favorable. There were no significant differences between the two groups. In the paralyzed-reconstruction and phonosurgery groups, postoperative vocal function was significantly improved, and vocal function in the paralyzed-reconstruction subgroup was significantly better than that in the phonosurgery group. For optimal management of unilateral RLN involvement in thyroid cancer, first, sharp dissection should be performed, and if this is impossible, a simultaneous RLN reconstruction procedure should be adopted whenever possible.

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Section: Discussionmentioning

confidence: 99%

Optimal Management of the Unilateral Recurrent Laryngeal Nerve Involvement in Patients with Thyroid Cancer

Miyamaru

Murakami

Nishimoto

et al. 2021

Cancers

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“…End‐to‐end anastomosis is the simplest and most widely used method for immediate nerve transection. Immediate anastomosis of RLN can be carried out with the best satisfying patient outcomes 6,7 . However, it is not applicable in cases where the two stumps could not be identified or the nerve defect between the stumps is too far away.…”

Section: Discussionmentioning

confidence: 99%

“…Over the past few years, surgeons have explored different ways of anastomosis for RLN reconstruction. End‐to‐end anastomosis is the most commonly used approach 5,6 . Unfortunately, it is not an option in cases of long RLN segmentectomy because the tension between two stumps is too high that the stiches will tear.…”

Section: Introductionmentioning

confidence: 99%

A novel method to reconstruct right recurrent laryngeal nerve by transforming into nonrecurrent laryngeal nerve: The end‐to‐free vagal laryngeal branch end anastomosis

Tan

et al. 2021

Head & Neck

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The objective of this study is to demonstrate a novel method for the reconstruction of right recurrent laryngeal nerve (RLN) by transforming into nonrecurrent RLN: the end‐to‐free vagal laryngeal branch end anastomosis. Here we report a case of locally advanced thyroid carcinoma. The patient underwent radical thyroid surgery with inevitably partial RLN resection and immediate right RLN reconstruction at our institution. With the guidance of intraoperative neuromonitoring (IOMN), we completed a novel end‐to‐free vagal laryngeal branch end anastomosis. The whole procedure was deliberately monitored by IOMN. Surgeons can procure adequate free nerve for tension‐free anastomosis by transforming the right RLN into nonrecurrent nerve. Follow‐up laryngoscope showed improved adductory movement of the right arytenoid. The end‐to‐free vagal end anastomosis is an effective way to reconstruct segmental nerve resection of right RLN. Its long‐term postoperative result needs to be further warranted.

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“…In those cases, surgeons should consider additional surgery for voice improvement, including intraoperative RLN reinnervation and/or intra-or postoperative medialization laryngoplasty, such as IL, medialization thyroplasty (MT), or arytenoid adduction (AA) (key question 11) [119][120][121][122][123]. Reinnervation surgery has some distinct advantages over other medialization procedures: it is usually conducted in conjunction with thyroid surgery and does not require any preparation of additional instruments, surgical drapes, and implant materials; and it helps maintain muscle bulk and tension of the vocal folds after VFP [119,[124][125][126][127]. However, various forms of synkinetic reinnervation and aberrant reinnervation of abductor/adductor muscle fibers may appear during regeneration, which may worsen the voice quality after surgery.…”

Section: A C C E P T E D a R T I C L Ementioning

confidence: 99%

Care and Management of Voice Change in Thyroid Surgery: Korean Society of Laryngology, Phoniatrics and Logopedics Clinical Practice Guideline

Force

Ryu

Lee

et al. 2022

Clin Exp Otorhinolaryngol

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Voice change is a common complaint after thyroid surgery and has significant impacts on quality of life. The Korean Society of Laryngology, Phoniatrics, and Logopedics set up a task force team to establish guideline recommendations on education, care, and management related to thyroid surgery. The guideline recommendations include preoperative voice education, management of anticipated voice change during surgery, and comprehensive voice care after thyroid surgery, including in-depth information and up-to-date knowledge based on validated literature. The committee constructed 14 key questions (KQ) in three categories: preoperative (KQ1–2), intraoperative (KQ 3–8), and postoperative (KQ 9–14) management and developed 18 evidence-based recommendations. The Delphi survey reached an agreement on each recommendation. Detailed evidence profiles are presented for each recommendation. The level of evidence for each recommendation is classified into high, moderate, and low-quality. The recommendation

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Role of immediate recurrent laryngeal nerve reconstruction in surgery for thyroid cancers with fixed vocal cords

Cited by 18 publications

References 17 publications

Optimal Management of the Unilateral Recurrent Laryngeal Nerve Involvement in Patients with Thyroid Cancer

Optimal Management of the Unilateral Recurrent Laryngeal Nerve Involvement in Patients with Thyroid Cancer

A novel method to reconstruct right recurrent laryngeal nerve by transforming into nonrecurrent laryngeal nerve: The end‐to‐free vagal laryngeal branch end anastomosis

Care and Management of Voice Change in Thyroid Surgery: Korean Society of Laryngology, Phoniatrics and Logopedics Clinical Practice Guideline

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