Nerve management: Invasive disease

Thyroid cancer which invades the recurrent laryngeal nerve (RLN) and/or visceral axis (esophagus, trachea, larynx) is rare, and the patient with invasion of the recurrent nerve may be completely asymptomatic. Several risk factors and clinical presentations should lead the clinician to perform a thorough and systematic preoperative clinical and radiologic workup, in order to diagnose invasive disease, plan surgery, and inform the patient as to possible consequences of surgery. The recommended preoperative workup of patients with suspected invasive disease will be discussed in this chapter, as well as the pathophysiology of nerve invasion and currently recognized risk factors. There are a number of key factors to consider when deciding intraoperatively to resect, sculpt, or preserve the RLN which are outlined in several algorithms suggested in this chapter.