Abstract
Recurrent laryngeal nerve (RLN) injury in thyroid surgery is the most common postoperative complication, causing breathy hoarseness and decreasing phonation time and significantly impairing the patient’s quality of life in daily conversation. In this study, we experienced two cases of immediate intraoperative repair of the recurrent nerve, including ansa cervicalis to RLN anastomosis. Case 1 was a 75-year-old woman whose chief complaint was a right cervical mass without preoperative hoarseness. She was diagnosed with papillary thyroid carcinoma (cT2N1bM0, Stage II), and the total thyroidectomy with right lymph nodes dissection (D2a) was performed. During the cervical dissection, the right recurrent nerve was resected along with the lymph nodes because it was firmly attached to the metastatic lymph nodes. At that time, anastomosis of the ansa cervicalis and RLN was performed. Case 2 was a 66-year-old woman whose chief complaint was hoarseness. She was diagnosed with papillary thyroid carcinoma (cT4aN0M0, Stage III) and underwent left thyroid lobectomy and left cervical dissection (D1). During thyroid tumor resection, the left RLN was tightly attached to the tumor and resected, so the ansa cervicalis and RLN were anastomosed immediately. Case 1 had a maximal phonation time (MPT) of 29 seconds at 6 months after the surgery, and Case 2 had a MPT of 40 seconds at 9 months after the surgery. Immediate nerve repair of the RLN by ansa cervicalis is simple and effective in improving the prognosis of voice function.
Acknowledgment:
The authors thank Dr. Akira Miyauchi for special advice in the 2024 meeting of the American Thyroid Association.
Portions of these data were previously published in Thyroid, Vol. 34, No. S1, Late Breaking Oral Abstracts: https://doi.org/10.1089/thy.2024.59731.lb.abstract.
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