The Role of Primary Repair of the Recurrent Laryngeal Nerve during Thyroid/Parathyroid Surgery in Vocal Outcomes-A Systematic Review.

Recurrent laryngeal nerve (RLN) injury is a well and long-known complication of thyroid and parathyroid surgery that significantly affects the quality of life of patients. Despite the advances in surgical techniques and technology, it still occurs in clinical practice either as temporary paresis or as permanent paralysis of the corresponding vocal cord. The purpose of the current systematic review is to examine the value of intraoperative repair of the RLN in voice restoration. A systematic review of the existing literature was conducted using PubMed, Scopus, Cochrane Library, and Google Scholar databases according to the PRISMA guidelines. The systematic review resulted in 18 studies, which met the inclusion criteria. An improvement in phonatory function and voice quality was observed in all these studies after immediate RLN reconstruction (not always statistically significant). This improvement appears to be comparable to or even higher than that achieved with other methods of repair, and in some cases, the improvement approaches levels found in normal subjects. Intraoperative RLN reconstruction is not widely used in clinical practice, but the evidence so far makes it a viable and safe alternative to traditional techniques with better long-term results, as it prevents the occurrence of atrophy of the vocal cord and should be considered in the operating room if possible.