doi:10.1007/s00423-024-03323-x...
Springer
Medicine & Public Health
2024
5/1/2024
Purpose Treating an infiltration of the recurrent laryngeal nerve (RLN) by thyroid carcinoma remains a subject of ongoing debate.
Therefore, this study aims to provide a novel strategy for intraoperative phenosurgical management of RLN infiltrated by thyroid carcinoma.
Methods Forty-two patients with thyroid carcinoma infiltrating the RLN were recruited for this study and divided into three groups.
Group A comprised six individuals with medullary thyroid cancer who underwent RLN resection and arytenoid adduction.
Group B consisted of 29 differentiated thyroid cancer (DTC)patients who underwent RLN resection and ansa cervicalis (ACN)-to-RLN anastomosis.
Group C included seven patients whose RLN was preserved.
Results The videostroboscopic analysis and voice assessment collectively indicated substantial improvements in voice quality for patients in Groups A and B one year post-surgery.
Additionally, the shaving technique maintained a normal or near-normal voice in Group C one year post-surgery.
Conclusion The new intraoperative phonosurgical strategy is as follows: Resection of the affected RLN and arytenoid adduction is required in cases of medullary or anaplastic carcinoma, regardless of preoperative RLN function.
Suppose RLN is found infiltrated by well-differentiated thyroid cancer (WDTC) during surgery, and the RLN is preoperatively paralyzed, we recommend performing resection the involved RLN and ACN-to-RLN anastomosis immediately during surgery.
If vocal folds exhibit normal mobility preoperatively, the MACIS scoring system is used to assess patient risk stratification.
When the MACIS score > 6.99, resection of the involved RLN and immediate ACN-to-RLN anastomosis were performed.
RLN preservation was limited to patients with MACIS scores ≤ 6.99.
Peng, Jieying,Zhu, Guanghao,Gao, Yingna,Song, Xianmin,Yu, Haojun,Huang, Rushi,Chen, Mengjie,Jiang, Yafei,Sun, Guodong,Li, Meng,Zheng, Hongliang,Wang, Wei, 2024, New strategy for intraoperative phonosurgical management of recurrent laryngeal nerve infiltrated by thyroid carcinoma, Springer