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Current Concepts in the Management of Unilateral Recurrent Laryngeal Nerve Paralysis after Thyroid Surgery

Departments of Otolaryngology and Head and Neck Surgery (D.M.H.), Surgical Oncology (J.-P.T.), and Nuclear Medicine and Endocrine Tumors (S.L., E.B., M.S.), Institut Gustave Roussy, 94805 Villejuif, France; and Department of Otolaryngology and Head and Neck Surgery (D.F.B.), European Hospital Georges Pompidou, 75015 Paris, France

Address all correspondence and requests for reprints to: Dana M. Hartl, Department of Otolaryngology and Head and Neck Surgery, Institut Gustave Roussy, rue Camille Desmoulins, 94805 Villejuif Cédex, France. E-mail: hartl{at}igr.fr.

Objective: This study was designed to provide an update on the pathophysiological concepts and patient management in a common complication of thyroid surgery, unilateral recurrent laryngeal nerve paralysis (URLNP).

Method: Recent publications in physiology and head and neck surgery were reviewed.

Results: Even for experienced surgeons, URLNP may occur after thyroid surgery, especially for thyroid cancer and in case of reoperation. URLNP is frequently well tolerated but may be life threatening by inducing aspiration pneumonia. Permanent URLNP may decrease quality of life by decreasing voice quality and increasing vocal effort. Spontaneous recovery of vocal function, with or without full recovery of vocal fold motion, may occur due to spontaneous axonal regrowth or other neurological phenomena. In the last decade, several surgical techniques have been developed to treat aspiration and poor voice quality due to URLNP by medialization of the paralyzed vocal fold. These techniques are simple, have a low complication rate, and are highly efficient in eliminating aspiration and improving voice quality and quality of life.

Conclusions: The voice and swallowing handicap caused by URLNP may be efficiently treated by safe and simple techniques. The possibility to improve the quality of life should be proposed to all patients with symptomatic URLNP.

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