Long-Term Outcomes of Recurrent Laryngeal Nerve Repair/Reconstruction in Oncological Settings

Abstract

Vocal cord paralysis results from involvement of the recurrent laryngeal nerve (RLN), either before the surgery or following excision. Coaptation of the resected edges utilising microsurgical techniques is the most promising therapeutic strategy available for RLN excision. The RLN can be repaired by direct epineural coaptation or using nerve grafts adhering to recommended microsurgical techniques. This article aims to convey our experience with RLN resections/injuries and their subsequent effects. We assessed the RLN repairs that our institute had completed from April 2018 to September 2023(5 years and 5 months) including follow-up of minimum 1 year. The Functional Oral Intake Scale (FOSI) was applied to assess dysphagia, aspiration risk, and glottic gap by laryngoscopy, and GRBAS (Grade, Roughness, Breathiness, Asthenia, Strain) comprised the basis for the assessment of voice quality by speech specialists. Surgical technique included using 9–0 Ethilon either for primary repair or for repair with a nerve graft. Ten patients were included in the study; six (60%) of them were male with the median age of 32 years. At 12-month follow-up, only 10% (n = 1) was found to have dysphagia. Only 10% (n = 1) had a mild harsh voice. This same patient was the only patient to show a minimal remnant glottic gap. Ten percent (n = 1) patient showed B/l cord mobility at 12 months, while 30% (n = 3) showed flickering movements of the affected vocal cord. In all the patients, the opposite vocal cord was found to be compensating. Thus, immediate repair of RLN is helpful along with the general physiological adaptation of vocal cords to improve phonation and reduce aspiration and dysphagia risks, thus helping to improve the quality of life. The right procedure should choose from the armoury after careful intraoperative assessment.