J.Jpn. Surg. Soc.. 82(1): 22-33, 1981

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Original article

CLINICAL AND EXPERIMENTAL STUDIES OF RECURRENT LARYNGEAL NERVE PARALYSIS
PART 1. CLINICAL STUDY NO. 1) Relation between Thyroid Surgery and Recurrent Laryngeal Nerve Paralysis
－Significance of Neurorrhaphy－

During the past six years, 557 patients have undergone operation for thyroid gland at the 2nd Department of Surgery, Hiroshima University School of Medicine. Of the 557, 547 were examined using indirect laryngoscope prior to and after surgery at the Department of Oto-Rhino-Laryngology. The incidence of pre-and post surgical vocal cord paralysis as wel as the time required for restoration of vocal cord function and the results of neurorrhaphy are reported.
1) Pre-surgical vocal cord paralysis was noted in 62 patients of whom 60 had malignant thyroid tumor and 2 had benign thyroid tumor.
2) Vocal cord paralysis developed in 69 patients after operation. Of this number, this finding was observed in 41 although the recurrent laryngeal nerve had not been severed, while there were 28 in whom the nerve had been severed. In the latter, there was papillary adenocarcinoma infiltration of the nerve.
3) Most of those in whom the recurrent laryngeal nerve had not been severed recovered within six months after the operation. However there were several patients who required between seven and ten months for recovery.
4) End to end anastomosis of the recurrent laryngeal nerve was performed in 7 in whom the nerve had been severed. Although functional restoration in those who underwent neurorrhaphy was insufficient, the affected vocal cord were not atrophied and moreover hoarseness were almost restored to normal. On the other hand, in those in whom there was severance of the recurrent laryngeal nerve, findings of atrophy were noted and hoarseness persisted. In conclusion, it is felt that if the recurrent laryngeal nerve has been severed, neurorrhaphy should be attempted.

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