title: Immediate recurrent laryngeal nerve reconstruction and vocal outcome.
abstract: OBJECTIVE
  The objective of this prospective study was to assess the long-term effects of immediate reconstruction of the recurrent laryngeal nerve (RLN) during thyroid cancer extirpation on postoperative phonatory function.
  
  
  METHODS
  The subjects were 22 patients with advanced thyroid cancer who underwent resection of the primary lesion and involved RLN. RLN paralysis was seen in 12 patients preoperatively and involvement of the RLN was noted intraoperatively in 10. Immediate reconstruction of the RLN was performed on eight patients using the great auricular nerve and one underwent direct anastomosis of the RLN stumps (group I). Nine patients opted not to have phonosurgical procedures (group II). The remaining four had arytenoid adduction immediately after cancer extirpation (group III). Phonatory function (stroboscopy, maximum phonation time [MPT], mean airflow rate [MFR], harmonics-to-noise ratio [HNR], jitter, and shimmer) was followed for at least 9 months.
  
  
  RESULTS
  Minimal or no glottal gap during phonation was observed in six patients in group I, whereas the patients in group II had a large gap along the entire fold. HNR, MPT, and MFR were significantly better in group I (17.7 +/- 3.6 dB, 15.1 +/- 6.3 s, and 100 +/- 32 mL/s, respectively) than in group II (12.1 +/- 2.9 dB, 5.4 +/- 3.1 s, and 430 +/- 207 mL/s, respectively). Patients in group III had a gap of varying degrees along the membranous fold. Although HNR, shimmer, and MPT in group III were comparable to group I, the other parameters were less favorable than in group I.
  
  
  CONCLUSIONS
  Immediate RLN reconstruction at the time of thyroid cancer extirpation can provide excellent postoperative phonatory function.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kumamoto University, Kumamoto, Japan.
authors.forename: Eiji
authors.initials: E
authors.lastname: Yumoto
authors.forename: Tetsuji
authors.initials: T
authors.lastname: Sanuki
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Kumai
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D003389:Cranial Nerve Diseases / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010699:Phonation; D011183:Postoperative Complications; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000379:methods*; D012009:Recurrent Laryngeal Nerve / Q000503:physiopathology / Q000601:surgery*; D018709:Statistics, Nonparametric; D013964:Thyroid Neoplasms / Q000601:surgery; D016896:Treatment Outcome; D014826:Vocal Cord Paralysis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D014833:Voice Quality