Non-selective laryngeal reinnervation in thyroid surgery

Abstract

Aim. To evaluate the results of the voice disorders correction in unilateral abduction paralysis of larynx by the anastomosis “ansa cervicalis – recurrent laryngeal nerve” during primary and repeated thyroid surgery.Materials and methods. Surgical non-selective laryngeal reinnervation (primary, delayed) by anastomosis “ansa cervicalis – recurrent laryngeal nerve” was performed in 49 patients with abduction paralysis of larynx, 45 of whom had ipsilateral and 4 contralateral anastomosis. In the pre- and postoperative periods, all patients underwent indirect laryngoscopy, video laryngoscopy using a Karl Storz fibrolaryngoscope with archiving in the original database, voice spectral analysis and survey using the VHI-30 questionnaire (a modified version).The follow-up period was from 1 to 3 years, an average of 12–18 months.Results. Analysis of the videolaryngoscopic picture results in the postoperative period in the main group showed a significant improvement in spatial location of moving elements of the larynx both within the group (P < 0.01) and in comparison with patients who underwent conservative treatment of laryngeal phonatory dysfunction. Voice spectral analysis and VHI-30 score also improved significantly (P < 0.01) and did not statistically differ from patients with normal laryngeal phonatory function (P > 0.05). With the successful non-selective laryngeal reinnervation, a medialization of paralyzed vocal cord was noted, which significantly improved the phonatory function of larynx, but did not restore its mobility.Conclusions. The method of non-selective laryngeal reinnervation by the anastomosis “ansa cervicalis – recurrent laryngeal nerve” is an effective method for correcting phonatory disorders in unilateral abduction paralysis of the larynx during primary and repeated thyroid surgery and can improve the voice function of the larynx to almost normal state without negative changes in the external respiration function.