Surgical treatment of unilateral laryngeal paralysis by selective reinnervation in thyroid surgery

Abstract

State of the problem: One of the complications in thyroid surgery is a lesion of RLN which can be bilateral with a violation of respiratory function of the larynx and unilateral, in which the first priority is a violation of vocal function of the larynx. The most effective treatment for paralysis of the larynx is the method of laryngeal reinnervation, which can be non-selective, which is usually used in unilateral laryngeal paralysis and promotes reinnervation of both abductors and laryngeal adductors. Selective reinnervation is selectively focuses on the reinnervation of individual target muscles, so it is more often used in bilateral laryngeal paralysis. But despite this, it was used in unilateral laryngeal paralysis during surgery on the thyroid gland during intentional resection of the anterior branch of RLN with partial invasion of its tumour process. Aim: evaluation of the results of surgical treatment unilateral laryngeal paralysis by the method selective reinnervation in thyroidectomy. Materials and Methods: clinical case results of patient A. 15 years old with papillary thyroid cancer and metastases to regional lymph nodes of the neck (T4aN1M0) with absence disorders of laryngeal motility before surgery were analyzed. Examination of the larynx and voice examination were performed before surgery, 2-3 days and 6,12 months after surgery. Changes of laryngoscopic images and evaluation of the Indicators: maximum pho- nation time, fundamental frequency, noise to harmonic ratio, Jitter (loc), Shimmer (loc), Voice Handicap Index-30 (VHI-30), completed version of Jacobcon B. Results: Considering extralaryngeal bifurcation of the recurrent laryngeal nerve (RLN) and invasion of the tumor into the adductive branch of RLN on the left, its dissection was performed and end-to-end neuroanastomosis was formed, completed is selective laryngeal reinnervation. In the immediate postoperative period, patients complained of voice disorders. Study of voice parameters corresponded to severe voice disorders. Partial resumption of the mobility of the larynx and voice function was after 6 months. The signs of the laryngoscopic picture and the spectral analysis of the voice corresponded to the indicators before the operation after 12 months Сonclusions 1. Primary selective reinnervation of the larynx can be used to treat unilateral laryngeal paralysis under the following conditions: extralaryngeal branching of the recurrent laryngeal nerve (bifurcation), lesion of only one of its branches, which will provide sufficient coaxiality to perform anastomosis "end-to-end" and preservation electrical integrity of another branch. 2. This method allows you to restore the motility of the denervated vocal folds and the main indicators of the voice. 3. Given only one clinical case of treatment of unilateral laryngeal paralysis by selective reinnervation, this technique needs further study and refinement.