Treatment of Vocal Cord Paralysis After Direct Laryngeal Nerve Injury During Surgery

This protocol addresses idiopathic vocal cord paralysis that arises when the laryngeal nerve sustains direct injury in the course of a surgical procedure. Recognising and acting on the injury intraoperatively defines the management window this protocol is designed for.

When direct laryngeal nerve injury is confirmed during surgery, immediate intervention is indicated before wound closure. The presence of this intraoperative injury determines both the urgency and the nature of the appropriate response, and is the defining factor that this protocol addresses.

The protocol specifies intraoperative surgical re-innervation as the primary avenue when direct nerve injury is identified. Where re-innervation is not achievable in the operative setting, alternative surgical approaches are outlined. The complete selection criteria, technique hierarchy, and decision pathway are contained in the full protocol.