A CASE OF RECURRENT LARYNGEAL NERVE RECONSTRUCTION WITH CONTRALATERAL ANSA CERVICALIS

Abstract

A 76-year-old woman was seen at the hospital because of a left anterior neck tumor. Physical examination revealed a 7.5×4.5cm hard mass in the left lobe of her thyroid. Based on the findings of the aspiration biopsy cytology, the tumor was diagnosed as papillary carcinoma of the thyroid. A subtotal thyroidectomy and a modified radical neck dissection were performed (T4, Ex2, Nla). Because the huge tumor and the metastatic lymph nodes invaded the left recurrent laryngeal nerve, the nerve was sacrificed. We could not anastomose the recurrent laryngeal nerve directly because the proximal edge of the nerve could not be identified. Furthermore, we could not use the left ansa cervicalis for the reconstruction because of its condition. So we anastomosed the distal stump of left recurrent laryngeal narve to the right ansa cervicalis which was brought up by passed in front of the trachea. After the operation, hoarseness due to unilateral vocal cord paralysis was observed. But her voice was improved gradually. Five mouths later, the patient was satisfied with her voice. Recurrent laryngeal nerve reconstruction with contralateral ansa cervicalis was effective for the improvement of the phonation of the patient who underwent recurrent nerve severance.