Treatment of Post-surgical Vocal Cord Paralysis from Direct Recurrent Laryngeal Nerve Injury During Surgery
Direct injury to the recurrent laryngeal nerve (RLN) during a surgical procedure represents a specific and time-sensitive cause of post-surgical vocal cord paralysis. The intraoperative nature of the injury shapes the interventions that are appropriate and available.
The underlying cause is direct recurrent laryngeal nerve injury occurring during the surgical procedure. Recognising this at the time of surgery is clinically significant, as it opens specific intraoperative management pathways.
The structured protocol for this scenario centres on intraoperative nerve repair approaches and, where applicable, surgical procedures aimed at restoring voice. Nerve re-innervation is the primary consideration when direct RLN injury is identified; surgical voice medialization represents an additional option within the protocol.
Full procedural selection criteria, technique sequence, and complete regimen are available via the protocol below.The primary aim is improvement of voice outcomes. When nerve re-innervation is performed, the procedure typically requires approximately 3–6 months to become effective postoperatively.
References
Intraoperative RLN re-innervation, including primary re-anastomosis or ansa cervicalis-to-RLN neurorrhaphy, should be considered if direct laryngeal nerve injury occurs during the surgical procedure (strong recommendation, moderate-quality evidence).
Surgical medialization procedures indicate injection laryngoplasty, medialization thyroplasty and/or arytenoid adduction.
However, intraoperative RLN re-innervation may take about 3–6 months to become effective; thus, the voice initially worsens after the procedure due to denervation.
DOI: 10.21053/ceo.2020.00409
View source ↗