No3-4(5) 2022
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DOI 10.37219/2528-8253-2022-3-51 |
Naumenko OM, Tarasenko MV, Bolgov MYu
Surgical treatment of unilateral laryngeal paralysis by selective
reinnervation in thyroid surgery |
Naumenko Alexander N.
Bogomolets National Medical University, Kiev, Ukraine
First vice-rector for scientific and pedagogical work and postgraduate
education
Doctor of Medical Sciences, Professor
E-mail: Naumenko@nmu.ua
https://orcid.org/0000-0002-9001-7580
Tarasenko Maksym V.
Bogomolets National Medical University, Kiev, Ukraine
Candidate of Medical Sciences, Associate Professor
ORCID: http://orcid.org/0000-0002-4991-9910
Bolgov Mykhailo Yu.
State institute V.P. Komissarenko Institute of endocrinology and metabolism
of the National academy of medical science of Ukraine
Department of endocrine surgery
Leading Researcher
Doctor of Medical Sciences, Professor
https://orcid.org/0000-0002-9011-9982 |
Abstract
State of the problem: One of the complications in thyroid surgery is
a lesion of RLN which can be bilateral with a violation of respiratory
function of the larynx and unilateral, in which the first priority is a
violation of vocal function of the larynx. The most effective treatment for
paralysis of the larynx is the method of laryngeal reinnervation, which can
be non-selective, which is usually used in unilateral laryngeal paralysis
and promotes reinnervation of both abductors and laryngeal adductors.
Selective reinnervation is selectively focuses on the reinnervation of
individual target muscles, so it is more often used in bilateral laryngeal
paralysis. But despite this, it was used in unilateral laryngeal paralysis
during surgery on the thyroid gland during intentional resection of the
anterior branch of RLN with partial invasion of its tumour process.
Aim: evaluation of the results of surgical treatment unilateral
laryngeal paralysis by the method selective reinnervation in thyroidectomy.
Materials and Methods: clinical case results of patient A. 15 years
old with papillary thyroid cancer and metastases to regional lymph nodes of
the neck (T4aN1M0) with absence disorders of laryngeal motility before
surgery were analyzed. Examination of the larynx and voice examination were
performed before surgery, 2-3 days and 6,12 months after surgery. Changes of
laryngoscopic images and evaluation of the Indicators: maximum pho-
nation time, fundamental frequency, noise to harmonic ratio, Jitter (loc),
Shimmer (loc), Voice Handicap Index-30 (VHI-30), completed version of
Jacobcon B.
Results: Considering extralaryngeal bifurcation of the recurrent
laryngeal nerve (RLN) and invasion of the tumor into the adductive branch of
RLN on the left, its dissection was performed and end-to-end
neuroanastomosis was formed, completed is selective laryngeal reinnervation.
In the immediate postoperative period, patients complained of voice
disorders. Study of voice parameters corresponded to severe voice disorders.
Partial resumption of the mobility of the larynx and voice function was
after 6 months. The signs of the laryngoscopic picture and the spectral
analysis of the voice corresponded to the indicators before the operation
after 12 months
Сonclusions
1. Primary selective reinnervation of the larynx can be used to treat
unilateral laryngeal paralysis under the following conditions:
extralaryngeal branching of the recurrent laryngeal nerve (bifurcation),
lesion of only one of its branches, which will provide sufficient coaxiality
to perform anastomosis "end-to-end" and preservation electrical integrity of
another branch.
2. This method allows you to restore the motility of the denervated vocal
folds and the main indicators of the voice.
3. Given only one clinical case of treatment of unilateral laryngeal
paralysis by selective reinnervation, this technique needs further study and
refinement. |
Keywords
thyroid gland, recurrent laryngeal nerve, laryngeal reinnervation,
thyroidectomy, spectral analysis of voice, laryngeal paralysis. |
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