The Reconstruction of the Recurrent Laryngeal Nerve after the Combined Resection of the Recurrent Laryngeal Nerve and the Papillary Thyroid Cancer

ABSTRACT

BACKGROUND: The function of the recurrent laryngeal nerve might be normal even though there is some extent of cancer invasion. The recurrent laryngeal nerves are usually saved when the preoperative vocal function is normal. However, it is difficult to save a nerve with a minimal amount of remnant cancer tissue when the cancer invasion is deep and broad. In a such instance, combined resection of the recurrent nerve and reconstruction of the recurrent nerve could be considered if the postoperative recovery of the vocal function is acceptable. METHODS: We tried reconstruction of the recurrent laryngeal nerve with the ansa hypoglossi-recurrent nerve (n=6) and with direct end-to-end anastomosis (n=4). The postoperative vocal function of these patients were compared to that of 11 patients whose recurrent nerves were resected and left without reconstruction. RESULTS: The maximal comfortable phonation time of the reconstruction group was significantly longer (mean 11.4+/-3.8 sec) than that of the no reconstruction group (mean 6.9+/-3.2 sec). There was, however, no significant difference between the ansa hypoglossi-recurrent nerve anastomosis group (mean 11.5+/-4.5 sec) and the direct end-to-end anastomosis group (mean 11.3+/-3.0 sec). Median fixation of the vocal cord and no or minimal glottic gap were observed in the reconstructed group. On the other hand, in the no reconstruction group paramedian fixation of the vocal cord and a wider glottic gap were observed. CONCLUSIONS: We feel that the recovery of the vocal function after the reconstruction of the recurrent nerve is acceptable and is enough to try a combined resection of a recurrent nerve severely invaded by papillary thyroid cancer even though the pre operative vocal function is normal.