Immediate Intraoperative Microsurgical Repair of the Recurrent Laryngeal Nerve: A Fifteen-Year Institutional Experience

Abstract Background  Recurrent laryngeal nerve (RLN) injury carries significant morbidity. Microsurgical repair of the RLN has proven promising for enhancing patient recovery of vocal function; however, data remains limited. Methods  This retrospective cohort study included patients who underwent RLN repair from 2007 to 2022. Demographics and medical history were collected. The location and etiology of RLN injury, as well as the repair technique, were collected. Follow-up data were collected at the initial postoperative visit, at 6 months and at 1 year. Hoarseness was classified as mild, moderate, or severe. Of patients who underwent nasopharyngolaryngoscopy (NPL) following repair, the glottic gap was measured. Vocal interventions performed were also recorded. This study utilized descriptive statistical methods. Results  Eleven patients underwent RLN repair. All patients underwent immediate repair. Fifty-four percent ( n  = 6) of RLN injuries resulted from tumor inflammation or nerve encasement. Eighty-two percent ( n  = 9) underwent direct RLN coaptation, 9% ( n  = 1) underwent vagus-RLN anastomosis, and 9% ( n  = 1) underwent an interposition nerve graft. Technical success was 100%. Seventy-three percent ( n  = 8) required otolaryngology referral, and of those, 50% ( n  = 4) required intervention. At initial evaluation, 91% ( n  = 10) suffered from mild to severe hoarseness, and of patients who underwent NPL, all had a glottic gap. At 1 year, 82% of patients ( n  = 9) improved to having mild to no appreciable hoarseness. Of the patients who underwent NPL, 62% ( n  = 5) had closure of the glottic gap. Conclusion  Patients undergoing repair of the RLN following injury showed excellent recovery of vocal function and resolution of glottic gap at 1 year.