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The Recurrent and Superior Laryngeal Nerves pp 253–258Cite as

Intraoperative Neural Injury Management: Transection and Segmental Defects

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Abstract

Patients who have undergone a transection or segmental resection of the recurrent laryngeal nerve (RLN) suffer from hoarseness, reduced phonation time, and aspiration. These injuries can be repaired with a direct anastomosis of the transected nerve ends, free nerve grafting to fill the defect, or an ansa cervicalis-to-RLN anastomosis. Reports have indicated that following nerve reconstruction, patients’ voices typically improve, although the vocal cords remain immobile through misdirected regeneration. Despite this, reinnervated vocal cords demonstrate less muscular atrophy. Voice recovery can be obtained regardless of preoperative vocal cord status, age, or gender when nerve reconstruction is performed with a variety of reconstruction modality techniques.

The RLN may be transected accidentally during thyroid or neck surgery, or unintentionally during dissection of the nerve in dense scar. A segment of the nerve may be resected during thyroid cancer surgery. Thyroid cancer often invades the RLN, causing vocal cord paralysis. In most of these cases, the segment of the nerve involving the tumor must be resected. Since reconstruction of the RLN during the thyroid surgery is optimal, all thyroid surgeons should be familiar with different reconstruction techniques.

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Author information

Authors and Affiliations

  1. Department of Surgery, Kuma Hospital, 8-2-35 Shimoyamate-dori, Chuo-ku, Kobe, Hyogo, 650-0011, Japan

    Akira Miyauchi M.D., PhD

  2. Department of Otolaryngology—Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Catherine F. Sinclair F.R.A.C.S., B.M.B.S., B.Sc.

  3. Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology—Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA

    Dipti Kamani M.D., Whitney Liddy M.D. & Gregory W. Randolph M.D.

  4. The Claire and John Bertucci Endowed Chair in Thyroid Surgery Oncology, Harvard Medical School, Boston, MA, USA

    Gregory W. Randolph M.D.

  5. Department of Surgery, Endocrine Surgery Service, Massachusetts General Hospital, Boston, MA, USA

    Gregory W. Randolph M.D.

Authors
  1. Akira Miyauchi M.D., PhD
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  2. Catherine F. Sinclair F.R.A.C.S., B.M.B.S., B.Sc.
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  3. Dipti Kamani M.D.
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  4. Whitney Liddy M.D.
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  5. Gregory W. Randolph M.D.
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Corresponding author

Correspondence to Akira Miyauchi M.D., PhD .

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Editors and Affiliations

  1. The Claire and John Bertucci Endowed Cha, Harvard Medical School, Boston, Massachusetts, USA

    Gregory W. Randolph

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© 2016 Springer International Publishing Switzerland

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Miyauchi, A., Sinclair, C.F., Kamani, D., Liddy, W., Randolph, G.W. (2016). Intraoperative Neural Injury Management: Transection and Segmental Defects. In: Randolph, G. (eds) The Recurrent and Superior Laryngeal Nerves. Springer, Cham. https://doi.org/10.1007/978-3-319-27727-1_21

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  • DOI: https://doi.org/10.1007/978-3-319-27727-1_21

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-27725-7

  • Online ISBN: 978-3-319-27727-1

  • eBook Packages: MedicineMedicine (R0)

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