What Is the Best Approach to Repair of Recurrent Laryngeal Nerve Injured During Thyroid Surgery?

by Linda Kossoff •

What is the optimal approach to the immediate intraoperative repair of the recurrent laryngeal nerve (IIORRLN) injured during thyroid surgery?

BOTTOM LINE

Although current evidence is low level, the IIORRLN that has been injured during thyroid surgery has on balance more advantages than disadvantages and should be considered whenever possible.

BACKGROUND: Injury to the recurrent laryngeal nerve (RLN) during surgery impacts on the patient’s ability to phonate, breathe, and swallow. RLN injury can be recognized intraoperatively via intraoperative nerve monitoring (IONM) or diagnosed postoperatively by fiberoptic laryngoscopy. Either way, there is little information relating to how injured nerves should be managed.

STUDY DESIGN: Systematic review.

SETTING: Department of Otorhinolaryngology–Head and Neck Surgery, Guy’s and St Thomas’ Hospital NHS Foundation Trust, King’s College London, United Kingdom.

SYNOPSIS: To determine the optimal approach to the IIORRLN during thyroid surgery, researchers conducted a literature search of the PubMed database for terms related to repair, reinnervation, or neurorrhaphy of the RLN. Their resulting review references recently produced guidelines by the American Head and Neck Society, the International Consensus on management of RLN, and the International Neuromonitoring Study Group that address the optimal management of the RLN during thyroid surgery. The organizations incorporated surgical, laryngoscopic, and neural electro-physiological data focusing the use of the IONM into these guidelines. The researchers reviewed 13 studies in regard to IIORRLN. Overall, they characterized the available literature as limited; however, they concluded that current evidence advocates that when RLN transection is identified or nerve resection becomes necessary, an intraoperative attempt should be made to perform an IIORRLN, and neural repair with a microsuture technique enables the maintenance of vocal cord tone, better and prompt voice recovery, and aspiration avoidance. Evidence showed that, on balance, IIORRLN has more advantages than disadvantages in comparison with a delayed repair and should be performed whenever possible. Authors cited the limitations of the current literature as a limitation to this study.

CITATION: Simó R, Nixon IJ, Rovira A, et al. Immediate intraoperative repair of the recurrent laryngeal nerve in thyroid surgery. Laryngoscope. 2021;131:1429-1435.