title: Recurrent Laryngeal Nerve Liberations and Reconstructions: A Single Institution Experience.
abstract: BACKGROUND
  Recurrent laryngeal nerve (RLN) palsy rates vary from 0.5 to 10%, even 20% in thyroid cancer surgery. The aim of this paper was to present our experience with RLN liberations and reconstructions after various mechanisms of injury.
  
  
  METHODS
  Patients were treated in our institution from year 2000 to 2015. First group (27 patients) had large benign goiters, locally advanced thyroid/parathyroid carcinomas, or incomplete previous surgery of malignant thyroid disease. Second group (5 patients) had reoperations due to RLN paralysis on laryngoscopy. Liberations and reconstructions of injured RLNs were performed.
  
  
  RESULTS
  Surgical exploration of central compartment enabled identification of the RLN injury mechanism. Liberations were performed in 11 patients, 2 months to 16 years after RLN injury, by removing misplaced ligations. Immediate or delayed (18 months to 23 years) RLN reconstructions were performed in 21 patients, by direct suture or ansa cervicalis-to-RLN anastomosis (ARA). RLN liberation provided complete voice recovery within 3 weeks in all patients. Patients with direct sutures had better phonation 1 month after reconstruction. Improved phonation was observed 2-6 months after ARA in 43% of patients.
  
  
  CONCLUSIONS
  Vocal cords do not regain normal movement once being paralyzed after RLN transection, but they restore tension during phonation by reconstruction. Nerve liberation is a useful method which enables patients with RLN paresis/paralysis a significant improvement in phonation, even complete voice recovery. Reinnervation of vocal cords, using one of the mentioned techniques, should be a standard in thyroid and parathyroid surgery, with aim to improve quality of patient's life.
authors.affiliation: School of Medicine, University of Belgrade, Belgrade, Serbia.|Surgical Oncology Clinic, Institute for Oncology and Radiology of Serbia, Pasterova 14, 11000, Belgrade, Serbia.
authors.forename: Radan
authors.initials: R
authors.lastname: Dzodic
authors.affiliation: School of Medicine, University of Belgrade, Belgrade, Serbia.|Surgical Oncology Clinic, Institute for Oncology and Radiology of Serbia, Pasterova 14, 11000, Belgrade, Serbia.
authors.forename: Ivan
authors.initials: I
authors.lastname: Markovic
authors.affiliation: Surgical Oncology Clinic, Institute for Oncology and Radiology of Serbia, Pasterova 14, 11000, Belgrade, Serbia. santrac.nada@gmail.com.
authors.forename: Nada
authors.initials: N
authors.lastname: Santrac
authors.affiliation: Surgical Oncology Clinic, Institute for Oncology and Radiology of Serbia, Pasterova 14, 11000, Belgrade, Serbia.
authors.forename: Marko
authors.initials: M
authors.lastname: Buta
authors.affiliation: Surgical Oncology Clinic, Institute for Oncology and Radiology of Serbia, Pasterova 14, 11000, Belgrade, Serbia.
authors.forename: Igor
authors.initials: I
authors.lastname: Djurisic
authors.affiliation: Department of Pathology, Institute for Oncology and Radiology of Serbia, Belgrade, Serbia.
authors.forename: Silvana
authors.initials: S
authors.lastname: Lukic
mesh_terms: D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007828:Laryngoscopy / Q000379:methods; D008297:Male; D019651:Plastic Surgery Procedures / Q000379:methods*; D012009:Recurrent Laryngeal Nerve / Q000601:surgery*; D061226:Recurrent Laryngeal Nerve Injuries / Q000150:complications / Q000601:surgery*; D013964:Thyroid Neoplasms / Q000601:surgery*; D013965:Thyroidectomy / Q000009:adverse effects*; D016896:Treatment Outcome; D014826:Vocal Cord Paralysis / Q000209:etiology / Q000601:surgery*; D055815:Young Adult