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Outcome With Immediate Direct Anastomosis of Recurrent Laryngeal Nerves Injured During Thyroidectomy

Authors
 Jong W. Hong  ;  Tai S. Roh  ;  Han-Su Yoo  ;  Hyun J. Hong  ;  Hong-Shik Choi  ;  Hang S. Chang  ;  Cheong S. Park  ;  Young S. Kim 
Citation
 LARYNGOSCOPE, Vol.124(6) : 1402-1408, 2014 
Journal Title
 LARYNGOSCOPE 
ISSN
 0023-852X 
Issue Date
2014
MeSH
Adult ; Aged ; Anastomosis, Surgical/methods ; Carcinoma, Papillary/pathology ; Carcinoma, Papillary/surgery ; Cohort Studies ; Female ; Follow-Up Studies ; Humans ; Iatrogenic Disease* ; Intraoperative Complications/diagnosis ; Intraoperative Complications/surgery* ; Laryngoscopy/methods* ; Male ; Middle Aged ; Phonation/physiology ; Reconstructive Surgical Procedures/methods ; Recurrent Laryngeal Nerve Injuries/etiology ; Recurrent Laryngeal Nerve Injuries/surgery* ; Retrospective Studies ; Thyroid Neoplasms/pathology ; Thyroid Neoplasms/surgery ; Thyroidectomy/adverse effects* ; Thyroidectomy/methods ; Time Factors ; Treatment Outcome ; Voice Quality
Keywords
Injured recurrent laryngeal nerve ; direct nerve anastomosis ; immediate nerve anastomosis
Abstract
OBJECTIVES/HYPOTHESIS: 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. STUDY DESIGN: 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. CONCLUSION: 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.
Full Text
http://onlinelibrary.wiley.com/doi/10.1002/lary.24450/abstract
DOI
10.1002/lary.24450
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Plastic and Reconstructive Surgery (성형외과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Otorhinolaryngology (이비인후과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Young Seok(김영석) ORCID logo https://orcid.org/0000-0002-0981-2107
Roh, Tai Suk(노태석) ORCID logo https://orcid.org/0000-0001-8681-159X
Park, Cheong Soo(박정수)
Yoo, Han Su(유한수)
Chang, Hang Seok(장항석) ORCID logo https://orcid.org/0000-0002-5162-103X
Choi, Hong Shik(최홍식)
Hong, Jong Won(홍종원) ORCID logo https://orcid.org/0000-0002-7762-0940
Hong, Hyun Jun(홍현준)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/98796
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