Intraoperative neural injury management: Transection and segmental defects

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.