Preservation of the recurrent laryngeal nerves in thyroid and parathyroid reoperations

Background. The recurrent la laryngeal nerve (RLN) is vulnerable to injury in thyroid and parathyroid reoperations because of the presence of scar tis sue and displacement of the nerve from its normal position. Methods, Since 1993, we have peformed 132 reoperations for recurrence of th yroid or parathyroid carcinoma (102 cases), persistent hyperparathyroidism (21 cases), and recurrent gaiter (9 cases), One or both RLNs were identifie d in all cases (208 nerves). Exposure of the nerve was accomplished by a la teral approach (159 nerves), a low anterior approach (41 nerves), or the id entification of the nerve between the larynx and the upper pole of the thyr oid in parathyroid reoperations (8 nerves). Dissection was then done while the nerve was kept in view at all times. Results. Preoperatively, unilateral vocal cord paralysis was noted in 6 pat ients. Resection of a functioning RLN encased with a tumor was intentionall y carried out in 5 patients. The RLNs were identified and preserved in all other cases. Among these 121 patients, transient hoarse ness lasting up to a month occurred in 12 patients. Conclusions. Careful identification and exposure of the RLN through a previ ously undissected area can be done safely in thyroid and parathyroid reoper ations and resulted in no permanent recurrent nerve injuries in our experie nce.