Voice Quality after Recurrent Laryngeal Nerve Resection and Primary Reconstruction

Abstract

Objective: Evaluate clinician and patient perception of voice quality in patients who have undergone resection of the recurrent laryngeal nerve (RLN) and primary operative reconstruction with anastomosis or nerve graft during thyroid surgery.

Method: Prospective observational study of 9 patients who underwent primary operative reconstruction of the RLN by the senior author from 2002 to present. Outcome measures included: 1) speech pathologist perception of voice scored using the GRBAS scale, 2) patient perception of voice assessed by the Voice Handicap Index (VHI) questionnaire, and 3) visual laryngeal analysis from videostroboscopy examinations.

Results: The RLN was reconstructed with primary anastomosis (4), free nerve graft (3), or vagus-RLN anastomosis (2). Seven patients had voice samples and videostroboscopy examinations obtained at a minimum of nine months from surgery. Six were judged to have slight disturbance of voice based on overall Grade scoring (G = 1). Five rated their voice normal or with a mild degree of severity on the VHI questionnaire (score range, 8-29). Laryngeal analysis revealed the immobile vocal fold in the median, physiologic phonating position with preserved bulk, recovered tension, and glottic closure during phonation. Two patients less than 9 months from surgery had expected severe self perceived voice quality.

Conclusion: Primary anastomosis, free nerve grafting, and vagus-RLN anastomosis are viable options for RLN reconstruction. VHI scores are comparable to VHI scores of patients who have undergone silastic medialization laryngoplasty. Patients who undergo resection and immediate reconstruction of the RLN are able to regain self-perceived functional and pleasing voices.