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The role of immediate recurrent laryngeal nerve reconstruction for thyroid cancer surgery.

Sanuki T, Yumoto E, Minoda R, Kodama N - J Oncol (2010)

Bottom Line: Different treatments are available for the management of UVFP including intracordal injection, type I thyroplasty, arytenoid adduction, and laryngeal reinnervations.All subjects experienced postoperative improvements in voice quality.Immediate RLN reconstruction has the potential to restore a normal or near-normal voice by returning thyroarytenoid muscle tone and bulk seen with vocal fold denervation.

View Article: PubMed Central - PubMed

Affiliation: Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kumamoto University, 1-1-1 Honjo, Kumamoto 860-8556, Japan.

ABSTRACT
Unilateral vocal fold paralysis (UVFP) is one of the most serious problems in conducting surgery for thyroid cancer. Different treatments are available for the management of UVFP including intracordal injection, type I thyroplasty, arytenoid adduction, and laryngeal reinnervations. The effects of immediate recurrent laryngeal nerve (RLN) reconstruction during thyroid cancer surgery with or without UVFP before the surgery were evaluated with videostroboscopic, aerodynamic, and perceptual analyses. All subjects experienced postoperative improvements in voice quality. Particularly, aerodynamic analysis showed that the values for all patients entered normal ranges in both patients with and without UVFP before surgery. Immediate RLN reconstruction has the potential to restore a normal or near-normal voice by returning thyroarytenoid muscle tone and bulk seen with vocal fold denervation. Immediate RLN reconstruction is an efficient and effective approach to the management of RLN resection during surgery for thyroid cancer.

No MeSH data available.


Related in: MedlinePlus

Free nerve graft. Supraclavicular nerves was used to fill the defect (allow). T: trachea, CA: common carotid artery. SC: supraclavicular nerve, CC: cricoid cartilage.
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fig1: Free nerve graft. Supraclavicular nerves was used to fill the defect (allow). T: trachea, CA: common carotid artery. SC: supraclavicular nerve, CC: cricoid cartilage.

Mentions: The immediate RLN reconstruction was done at the time of surgery for primary or recurrent thyroid cancer. The ends of the severed RLN were anastomosed directly when possible. When the defect was longer than 5 mm, a free nerve graft taken from the transverse cervical nerve, supraclavicular nerve, or ansa cervicalis was used to fill the defect (Figure 1). When the proximal stumps of the RLN could not be utilized for nerve repair, ansa cervicalis to RLN anastomosis was performed. The ipsilateral ansa cervicalis was identified on the surface of the internal jugular vein, and its branches to the sternohyoid muscles were dissected. The major branch or usually the branch common to these branches was transected, and the proximal end was anastomosed to the distal stump of the RLN. Most commonly, the ipsilateral ansa cervicalis was used for reinnervation. In one case (Patient no. 7) suffering from recurrent disease, due to loss of the ipsilateral ansa cervicalis nerve in the excessive cicatricial tissue, the contralateral ansa cervicalis was used. In Patient no. 2, thyroid cancer has invaded the distal portion of the RLN at the Berry ligament. We resected the RLN at the entrance of the larynx. The inferior pharyngeal constrictor muscle was divided along the lateral edge of the thyroid cartilage in order to find the distal stump of the RLN. The stumps were anastomosized with the supraclavicular nerve. The anastomosis was usually made with three, or sometimes four, stitches of 8–0 or 9–0 nylon thread using microsurgical instruments with an operation microscope or a surgical magnifying glass.


The role of immediate recurrent laryngeal nerve reconstruction for thyroid cancer surgery.

Sanuki T, Yumoto E, Minoda R, Kodama N - J Oncol (2010)

Free nerve graft. Supraclavicular nerves was used to fill the defect (allow). T: trachea, CA: common carotid artery. SC: supraclavicular nerve, CC: cricoid cartilage.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2902149&req=5

fig1: Free nerve graft. Supraclavicular nerves was used to fill the defect (allow). T: trachea, CA: common carotid artery. SC: supraclavicular nerve, CC: cricoid cartilage.
Mentions: The immediate RLN reconstruction was done at the time of surgery for primary or recurrent thyroid cancer. The ends of the severed RLN were anastomosed directly when possible. When the defect was longer than 5 mm, a free nerve graft taken from the transverse cervical nerve, supraclavicular nerve, or ansa cervicalis was used to fill the defect (Figure 1). When the proximal stumps of the RLN could not be utilized for nerve repair, ansa cervicalis to RLN anastomosis was performed. The ipsilateral ansa cervicalis was identified on the surface of the internal jugular vein, and its branches to the sternohyoid muscles were dissected. The major branch or usually the branch common to these branches was transected, and the proximal end was anastomosed to the distal stump of the RLN. Most commonly, the ipsilateral ansa cervicalis was used for reinnervation. In one case (Patient no. 7) suffering from recurrent disease, due to loss of the ipsilateral ansa cervicalis nerve in the excessive cicatricial tissue, the contralateral ansa cervicalis was used. In Patient no. 2, thyroid cancer has invaded the distal portion of the RLN at the Berry ligament. We resected the RLN at the entrance of the larynx. The inferior pharyngeal constrictor muscle was divided along the lateral edge of the thyroid cartilage in order to find the distal stump of the RLN. The stumps were anastomosized with the supraclavicular nerve. The anastomosis was usually made with three, or sometimes four, stitches of 8–0 or 9–0 nylon thread using microsurgical instruments with an operation microscope or a surgical magnifying glass.

Bottom Line: Different treatments are available for the management of UVFP including intracordal injection, type I thyroplasty, arytenoid adduction, and laryngeal reinnervations.All subjects experienced postoperative improvements in voice quality.Immediate RLN reconstruction has the potential to restore a normal or near-normal voice by returning thyroarytenoid muscle tone and bulk seen with vocal fold denervation.

View Article: PubMed Central - PubMed

Affiliation: Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kumamoto University, 1-1-1 Honjo, Kumamoto 860-8556, Japan.

ABSTRACT
Unilateral vocal fold paralysis (UVFP) is one of the most serious problems in conducting surgery for thyroid cancer. Different treatments are available for the management of UVFP including intracordal injection, type I thyroplasty, arytenoid adduction, and laryngeal reinnervations. The effects of immediate recurrent laryngeal nerve (RLN) reconstruction during thyroid cancer surgery with or without UVFP before the surgery were evaluated with videostroboscopic, aerodynamic, and perceptual analyses. All subjects experienced postoperative improvements in voice quality. Particularly, aerodynamic analysis showed that the values for all patients entered normal ranges in both patients with and without UVFP before surgery. Immediate RLN reconstruction has the potential to restore a normal or near-normal voice by returning thyroarytenoid muscle tone and bulk seen with vocal fold denervation. Immediate RLN reconstruction is an efficient and effective approach to the management of RLN resection during surgery for thyroid cancer.

No MeSH data available.


Related in: MedlinePlus