Endocrine Abstracts

Introduction: Recurrent laryngeal nerve (RLN) dysfunction is a major complication in thyroid surgery, caused commonly by thermal damage, transection or misplaced ligations. It can also be caused by RLN distension by thyroid tumors or thyroid goiter. Permanent paralysis decreases significantly quality of life and should be treated. Some surgical techniques can provide improvement in phonation, even complete recovery. The aim of this study was to analyze usefulness of RLN liberation technique in patients with RLN paresis/paralysis of various origins, based on symptoms improvement and laryngoscopy.

Materials & methods: From 2000 to 2018, 19 patients with RLN paresis/paralysis on laryngoscopy had RLN liberation as a part of thyroid surgery for various indications. If RLN dysfunction was caused by nerve distension over the enlarged thyroid lobe, the nerve was liberated during primary surgery from the lobe and repositioned. If RLN dysfunction was a consequence of previous surgery, misplaced ligation or postoperative adhesions were removed from the nerve, with its preservation. If patients had bilateral RLN paralysis, RLN liberation was performed in a two-step surgery, to avoid the risk for tracheostoma. Patient’s recovery was assessed by laryngoscopy and qualitative scoring scale (QSS) at 4 time points: preoperatively, in 1st, 6th and 12th postoperative month. This original Dzodic’s liberation technique was first reported in 2008 and published in World J Surg in 2016.

Results: One patient with RLN paralysis due to distension by a large follicular adenoma restored normal vocal cord mobility after lobectomy with RLN liberation (score 5 on QSS). In remaining 18 patients RLN liberation was done in a reoperation 2 months to 16 years after primary surgery – in 12 of them thyroid cancer was a primary surgical indication, in 6 reoperation was performed for alleviating the symptoms of severe dysphonia or stridorous breathing. Fifteen patients with redo surgeries scored 4 on QSS. Three patients with RLN liberation 6 months, 3 and 16 years after primary surgery restored normal vocal cord mobility on laryngoscopy (score 5 on QSS).

Conclusion: The original Dzodic’s technique of RLN liberation, accompanied by phono-rehabilitation, enables patients with RLN paresis/paralysis a significant improvement in phonation, even complete voice recovery. It is possible to achieve complete vocal cord mobility many years after RLN injury.