title: Outcome with immediate direct anastomosis of recurrent laryngeal nerves injured during thyroidectomy.
abstract: OBJECTIVE
  Management of unrecognized recurrent laryngeal nerve injury typically entails delayed phonosurgical intervention and laryngeal reinnervation, but in cases of recognized injury, nerve anastomosis has been considered standard management. However, the well-organized outcome analysis of nerve anastomosis has been insufficient. We performed immediate direct anastomosis of recurrent laryngeal nerves injured during surgery for thyroid cancer, and subsequent patient outcomes were analyzed.
  
  
  METHODS
  A total 14 patients sustaining recurrent laryngeal nerve injury during thyroidectomy were recruited for the study. Patients undergoing immediate direct reparative anastomosis of the injured nerves constituted the test group, whereas the controls of group 2 (n = 4) did not.
  
  
  METHODS
  At follow-up, all patients submitted to rigid laryngoscopy at 3, 6, and 12 months postoperatively. Subjective and objective outcomes of the two groups were then compared.
  
  
  RESULTS
  At 12 months postoperatively, group 1 showed greater improvement in maximum phonation time, glottic gap scores, GRBAS (grade, roughness, breathiness, asthenia, and strain) scales, aspiration scoring, and Voice Handicap Index than controls of group 2. Moreover, group 1 showed an improvement in all five categories at 12 months postoperatively, compared with status at 3 months. None of the patients in group 1 showed laryngoscopic evidence of vocal cord atrophy.
  
  
  CONCLUSIONS
  In this study, patients undergoing immediate direct recurrent laryngeal nerve anastomosis demonstrated better phonation and perceptually rated voice quality than those who did not undergo repair.
  
  
  METHODS
  3b.
authors.affiliation: Department of Plastic & Reconstructive Surgery, Institute for Human Tissue Restoration, Seoul, Korea.
authors.forename: Jong W
authors.initials: JW
authors.lastname: Hong
authors.forename: Tai S
authors.initials: TS
authors.lastname: Roh
authors.forename: Han-Su
authors.initials: HS
authors.lastname: Yoo
authors.forename: Hyun J
authors.initials: HJ
authors.lastname: Hong
authors.forename: Hong-Shik
authors.initials: HS
authors.lastname: Choi
authors.forename: Hang S
authors.initials: HS
authors.lastname: Chang
authors.forename: Cheong S
authors.initials: CS
authors.lastname: Park
authors.forename: Young S
authors.initials: YS
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D002291:Carcinoma, Papillary / Q000473:pathology / Q000601:surgery; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007049:Iatrogenic Disease; D007431:Intraoperative Complications / Q000175:diagnosis / Q000601:surgery*; D007828:Laryngoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010699:Phonation / Q000502:physiology; D019651:Plastic Surgery Procedures / Q000379:methods; D061226:Recurrent Laryngeal Nerve Injuries / Q000209:etiology / Q000601:surgery*; D012189:Retrospective Studies; D013964:Thyroid Neoplasms / Q000473:pathology / Q000601:surgery; D013965:Thyroidectomy / Q000009:adverse effects* / Q000379:methods; D013997:Time Factors; D016896:Treatment Outcome; D014833:Voice Quality
keywords: Injured recurrent laryngeal nerve; direct nerve anastomosis; immediate nerve anastomosis