MANAGEMENT OF THE RECURRENT LARYNGEAL NERVE IN SUSPECTED AND PROVEN THYROID-CANCER

Vocal cord paralysis occurs with and without infiltration of the recur rent laryngeal nerve. Patients with no paralysis may have recurrent la ryngeal nerve infiltration, We studied 262 patients with invasive thyr oid carcinoma and an additional 480 patients that we operated on, and we offer an approach to the management of the recurrent laryngeal nerv e during surgery for suspected or proven thyroid cancer, Because compl ete excision of papillary carcinoma with resection of the recurrent la ryngeal nerve did not improve survival over incomplete excision, we re commend incomplete excision of papillary carcinoma infiltrating a func tioning recurrent laryngeal nerve with postoperative I-131 and thyroid -stimulating hormone suppression. We observed (1) lymphoma and Reidel' s thyroiditis causing paralysis with infiltration of the recurrent lar yngeal nerve with recovery of function, (2) benign and malignant nodul es causing paralysis without infiltration of the recurrent laryngeal n erve with recovery of function, and (3) infiltration of the recurrent laryngeal nerve without paralysis in lymphoma, Graves' disease, and th yroiditis, In surgery for a suspicious nodule with paralysis, identify the recurrent laryngeal nerve, resect it if it is infiltrated by carc inoma, and preserve it if not infiltrated or if infiltrated by any pat hology besides carcinoma.