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Management of Nerve Sacrifice with Thyroidectomy

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Decision Making in Vocal Fold Paralysis

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Abstract

Permanent postoperative recurrent laryngeal nerve paralysis after thyroid surgery is a feared complication that occurs in up to 3% of primary surgeries and can be as high as 2–30% in revision surgery. Multiple steps can be taken to optimize patient outcomes both in the cases of intentional and unintentional recurrent laryngeal nerve sacrifice. Preoperative workup for planning of possible reconstruction, intraoperative decision-making on immediate reconstructive options, and postoperative rehabilitation are all integral aspects of complete care for these patients. In particular, reanastomosis, reinnervation, and early temporizing vocal fold injection augmentation are discussed as options for patients with recurrent laryngeal nerve paralysis after thyroidectomy.

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References

  1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA Cancer J Clin. 2018;68(1):7–30.

    Article  Google Scholar 

  2. Hayward NJ, Grodski S, Yeung M, Johnson WR, Serpell J. Recurrent laryngeal nerve injury in thyroid surgery: a review. ANZ J Surg. 2013;83(1–2):15–21.

    Article  Google Scholar 

  3. Abadin SS, Kaplan EL, Angelos P. Malpractice litigation after thyroid surgery: the role of recurrent laryngeal nerve injuries, 1989–2009. Surgery. 2010;148(4):718–22; discussion 22–3.

    Article  Google Scholar 

  4. Pitoia F, Miyauchi A. 2015 American Thyroid Association guidelines for thyroid nodules and differentiated thyroid cancer and their implementation in various care settings. Thyroid. 2016;26(2):319–21.

    Article  Google Scholar 

  5. Kamani D, Darr EA, Randolph GW. Electrophysiologic monitoring characteristics of the recurrent laryngeal nerve preoperatively paralyzed or invaded with malignancy. Otolaryngol Head Neck Surg. 2013;149(5):682–8.

    Article  Google Scholar 

  6. Chen W, Lei J, You J, Lei Y, Li Z, Gong R, et al. Predictive factors and prognosis for recurrent laryngeal nerve invasion in papillary thyroid carcinoma. Onco Targets Ther. 2017;10:4485–91.

    Article  Google Scholar 

  7. Fischer Isseroff T, Pitman MJ. Optimal management of acute recurrent laryngeal nerve injury during thyroidectomy. Curr Otorhinolaryngol Rep. 2013;1(3):163–70.

    Article  Google Scholar 

  8. Sanuki T, Yumoto E, Minoda R, Kodama N. The role of immediate recurrent laryngeal nerve reconstruction for thyroid cancer surgery. J Oncol. 2010;2010:846235.

    Article  Google Scholar 

  9. Fundakowski CE, Hales NW, Agrawal N, Barczynski M, Camacho PM, Hartl DM, et al. Surgical management of the recurrent laryngeal nerve in thyroidectomy: American head and neck society consensus statement. Head Neck. 2018;40(4):663–75.

    Article  Google Scholar 

  10. Yumoto E, Sanuki T, Kumai Y. Immediate recurrent laryngeal nerve reconstruction and vocal outcome. Laryngoscope. 2006;116(9):1657–61.

    Article  Google Scholar 

  11. Wang W, Chen D, Chen S, Li D, Li M, Xia S, et al. Laryngeal reinnervation using ansa cervicalis for thyroid surgery-related unilateral vocal fold paralysis: a long-term outcome analysis of 237 cases. PLoS One. 2011;6(4):e19128.

    Article  CAS  Google Scholar 

  12. Crumley RL. Laryngeal synkinesis: its significance to the laryngologist. Ann Otol Rhinol Laryngol. 1989;98(2):87–92.

    Article  CAS  Google Scholar 

  13. Crumley RL. Laryngeal synkinesis revisited. Ann Otol Rhinol Laryngol. 2000;109(4):365–71.

    Article  CAS  Google Scholar 

  14. Chou FF, Su CY, Jeng SF, Hsu KL, Lu KY. Neurorrhaphy of the recurrent laryngeal nerve. J Am Coll Surg. 2003;197(1):52–7.

    Article  Google Scholar 

  15. Ezaki H, Ushio H, Harada Y, Takeichi N. Recurrent laryngeal nerve anastomosis following thyroid surgery. World J Surg. 1982;6(3):342–6.

    Article  CAS  Google Scholar 

  16. Zheng H, Zhou S, Chen S, Li Z, Cuan Y. An experimental comparison of different kinds of laryngeal muscle reinnervation. Otolaryngol Head Neck Surg. 1998;119(5):540–7.

    Article  CAS  Google Scholar 

  17. Taylor AS. Surgical trauma of the recurrent laryngeal nerve with restoration of function. Ann Surg. 1924;80(4):606–7.

    Article  CAS  Google Scholar 

  18. Crumley RL, Izdebski K. Voice quality following laryngeal reinnervation by ansa hypoglossi transfer. Laryngoscope. 1986;96(6):611–6.

    Article  CAS  Google Scholar 

  19. Crumley RL. Update: ansa cervicalis to recurrent laryngeal nerve anastomosis for unilateral laryngeal paralysis. Laryngoscope. 1991;101(4 Pt 1):384–7; discussion 8.

    Article  CAS  Google Scholar 

  20. Miyauchi A, Inoue H, Tomoda C, Fukushima M, Kihara M, Higashiyama T, et al. Improvement in phonation after reconstruction of the recurrent laryngeal nerve in patients with thyroid cancer invading the nerve. Surgery. 2009;146(6):1056–62.

    Article  Google Scholar 

  21. Miyauchi A, Matsusaka K, Kihara M, Matsuzuka F, Hirai K, Yokozawa T, et al. The role of ansa-to-recurrent-laryngeal nerve anastomosis in operations for thyroid cancer. Eur J Surg. 1998;164(12):927–33.

    Article  CAS  Google Scholar 

  22. Lorenz RR, Esclamado RM, Teker AM, Strome M, Scharpf J, Hicks D, et al. Ansa cervicalis-to-recurrent laryngeal nerve anastomosis for unilateral vocal fold paralysis: experience of a single institution. Ann Otol Rhinol Laryngol. 2008;117(1):40–5.

    Article  Google Scholar 

  23. Paniello RC, Edgar JD, Kallogjeri D, Piccirillo JF. Medialization versus reinnervation for unilateral vocal fold paralysis: a multicenter randomized clinical trial. Laryngoscope. 2011;121(10):2172–9.

    Article  Google Scholar 

  24. Banneheka S. Anatomy of the ansa cervicalis: nerve fiber analysis. Anat Sci Int. 2008;83(2):61–7.

    Article  Google Scholar 

  25. Chhetri DK, Berke GS. Ansa cervicalis nerve: review of the topographic anatomy and morphology. Laryngoscope. 1997;107(10):1366–72.

    Article  CAS  Google Scholar 

  26. Wang W, Chen S, Chen D, Xia S, Qiu X, Liu Y, et al. Contralateral ansa cervicalis-to-recurrent laryngeal nerve anastomosis for unilateral vocal fold paralysis: a long-term outcome analysis of 56 cases. Laryngoscope. 2011;121(5):1027–34.

    Article  Google Scholar 

  27. Sulica L, Rosen CA, Postma GN, Simpson B, Amin M, Courey M, et al. Current practice in injection augmentation of the vocal folds: indications, treatment principles, techniques, and complications. Laryngoscope. 2010;120(2):319–25.

    PubMed  Google Scholar 

  28. Young VN, Smith LJ, Sulica L, Krishna P, Rosen CA. Patient tolerance of awake, in-office laryngeal procedures: a multi-institutional perspective. Laryngoscope. 2012;122(2):315–21.

    Article  Google Scholar 

  29. Mallur PS, Rosen CA. Office-based laryngeal injections. Otolaryngol Clin North Am. 2013;46(1):85–100.

    Article  Google Scholar 

  30. Achkar J, Song P, Andrus J, Franco R Jr. Double-bend needle modification for transthyrohyoid vocal fold injection. Laryngoscope. 2012;122(4):865–7.

    Article  Google Scholar 

  31. Amin MR. Thyrohyoid approach for vocal fold augmentation. Ann Otol Rhinol Laryngol. 2006;115(9):699–702.

    Article  Google Scholar 

  32. Friedman AD, Burns JA, Heaton JT, Zeitels SM. Early versus late injection medialization for unilateral vocal cord paralysis. Laryngoscope. 2010;120(10):2042–6.

    Article  Google Scholar 

  33. Yung KC, Likhterov I, Courey MS. Effect of temporary vocal fold injection medialization on the rate of permanent medialization laryngoplasty in unilateral vocal fold paralysis patients. Laryngoscope. 2011;121(10):2191–4.

    Article  Google Scholar 

  34. Angelov DN, Ceynowa M, Guntinas-Lichius O, Streppel M, Grosheva M, Kiryakova SI, et al. Mechanical stimulation of paralyzed vibrissal muscles following facial nerve injury in adult rat promotes full recovery of whisking. Neurobiol Dis. 2007;26(1):229–42.

    Article  Google Scholar 

  35. Lindsay RW, Heaton JT, Edwards C, Smitson C, Vakharia K, Hadlock TA. Daily facial stimulation to improve recovery after facial nerve repair in rats. Arch Facial Plast Surg. 2010;12(3):180–5.

    Article  Google Scholar 

  36. Munin MC, Rosen CA, Zullo T. Utility of laryngeal electromyography in predicting recovery after vocal fold paralysis. Arch Phys Med Rehabil. 2003;84(8):1150–3.

    Article  Google Scholar 

  37. Statham MM, Rosen CA, Smith LJ, Munin MC. Electromyographic laryngeal synkinesis alters prognosis in vocal fold paralysis. Laryngoscope. 2010;120(2):285–90.

    PubMed  Google Scholar 

  38. Smith LJ, Rosen CA, Niyonkuru C, Munin MC. Quantitative electromyography improves prediction in vocal fold paralysis. Laryngoscope. 2012;122(4):854–9.

    Article  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Otolaryngology-Head and Neck Surgery, New York Presbyterian Hospital of Columbia and Cornell, New York, NY, USA

    Apoorva Tewari Ramaswamy

  2. Department of Otolaryngology/Head & Neck Surgery, Columbia University Medical Center, New York, NY, USA

    Michael J. Pitman

Authors
  1. Apoorva Tewari Ramaswamy
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  2. Michael J. Pitman
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Corresponding author

Correspondence to Michael J. Pitman .

Editor information

Editors and Affiliations

  1. NYU Swallowing Disorders Center, New York University, New York, NY, USA

    Milan R. Amin

  2. USC Voice Center, University of Southern California, Los Angeles, CA, USA

    Michael M. Johns

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Ramaswamy, A.T., Pitman, M.J. (2019). Management of Nerve Sacrifice with Thyroidectomy. In: Amin, M., Johns, M. (eds) Decision Making in Vocal Fold Paralysis. Springer, Cham. https://doi.org/10.1007/978-3-030-23475-1_5

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  • DOI: https://doi.org/10.1007/978-3-030-23475-1_5

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-23474-4

  • Online ISBN: 978-3-030-23475-1

  • eBook Packages: MedicineMedicine (R0)

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