Intraoperative neural injury management: Transection and segmental defects

Akira Miyauchi, Catherine F. Sinclair, Dipti Kamani, Whitney Liddy, Gregory W. Randolph

Research output: Chapter in Book/Report/Conference proceedingChapterpeer-review

2 Scopus citations


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.

Original languageEnglish
Title of host publicationThe Recurrent and Superior Laryngeal Nerves
PublisherSpringer International Publishing
Number of pages6
ISBN (Electronic)9783319277271
ISBN (Print)9783319277257
StatePublished - 27 May 2016


  • Ansa cervicalis
  • Ansa cervicalis-rln anastomosis
  • Direct anastomosis
  • Free nerve grafting
  • Maximum phonation time
  • Phonation efficiency index
  • Phonatory function
  • Recurrent laryngeal nerve
  • Vocal cord paralysis


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