{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T11:07:37Z","timestamp":1792062457343,"version":"4.4.0"},"reference-count":52,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2020,10,29]],"date-time":"2020-10-29T00:00:00Z","timestamp":1603929600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Laryngoscope"],"published-print":{"date-parts":[[2021,6]]},"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>Recurrent laryngeal nerve (RLN) injury is a recognized risk during thyroid and parathyroid surgery and can result in significant morbidity. The aim of this review paper is to consider the optimal approach to the immediate intraoperative repair of the RLN during thyroid surgery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A PubMed literature search was performed from inception to June 2020 using the following search strategy: immediate repair or repair recurrent laryngeal nerve, repair or reinnervation recurrent laryngeal nerve and immediate neurorraphy or neurorraphy recurrent laryngeal nerve.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Methods of immediate intraoperative repair of the RLN include direct end\u2010to\u2010end anastomosis, free nerve graft anastomosis, ansa cervicalis to RLN anastomosis, vagus to RLN anastomosis, and primary interposition graft. Techniques of nerve repair include micro\u2010suturing, use of fibrin glue, and nerve grafting. Direct micro\u2010suture is preferable when the defect can be repaired without tension. Fibrin glue has also been proposed for nerve repair but has been criticized for its toxicity, excessive slow reabsorption, and the risk of inflammatory reaction in the peripheral tissues. When the proximal stump of the RLN cannot be used, grafting could be done using transverse cervical nerve, supraclavicular nerve, vagus nerve, or ansa cervicalis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Current evidence is low\u2010level; however, it suggests that when the RLN has been severed, avulsed, or sacrificed during thyroid surgery it should be repaired intraoperatively. The immediate repair has on balance more advantages than disadvantages and should be considered whenever possible. This should enable the maintenance of vocal cord tone, better and prompter voice recovery and avoidance of aspiration. <jats:italic>Laryngoscope<\/jats:italic>, 131:1429\u20131435, 2021<\/jats:p><\/jats:sec>","DOI":"10.1002\/lary.29204","type":"journal-article","created":{"date-parts":[[2020,10,29]],"date-time":"2020-10-29T10:40:06Z","timestamp":1603968006000},"page":"1429-1435","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":44,"title":["Immediate Intraoperative Repair of the Recurrent Laryngeal Nerve in Thyroid Surgery"],"prefix":"10.1002","volume":"131","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5410-1566","authenticated-orcid":false,"given":"Ricard","family":"Sim\u00f3","sequence":"first","affiliation":[{"name":"Department of Otorhinolaryngology Head and Neck Surgery Guy's and St Thomas' Hospital NHS Foundation Trust, King's College London  London United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iain J.","family":"Nixon","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology Head and Neck Surgery Edinburgh Royal Infirmary  Edinburgh United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aleix","family":"Rovira","sequence":"additional","affiliation":[{"name":"Guy's and St Thomas' Hospital NHS Foundation Trust  St Thomas' Street Guy's Hospital SE1 9RT United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincent","family":"Vander Poorten","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology Head and Neck Surgery University Hospitals Leuven  Leuven Belgium"},{"name":"Department of Oncology Section Head and Neck Oncology  Leuven Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5563-8840","authenticated-orcid":false,"given":"Alvaro","family":"Sanabria","sequence":"additional","affiliation":[{"name":"Department of Surgery Universidad de Antioquia, Hospital Universitario San Vicente Fundacion, CEXCA Centro de Excelencia en Enfermedades de Cabeza y Cuello  Medellin Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Zafereo","sequence":"additional","affiliation":[{"name":"Head and Neck Surgery MD Anderson Cancer Center  Houston Texas U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dana M.","family":"Hartl","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology Head and Neck Surgery Thyroid Surgery Unit, Institute Gustave Roussy  Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luiz P.","family":"Kowalski","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology Head and Neck Surgery A.C. Camargo Cancer Center, Faculty of Medicine, University of Sao Paulo  Sao Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5373-9181","authenticated-orcid":false,"given":"Gregory W.","family":"Randolph","sequence":"additional","affiliation":[{"name":"Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology Massachusetts Eye and Ear Infirmary  Boston Massachusetts U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2765-5413","authenticated-orcid":false,"given":"Dipti","family":"Kamani","sequence":"additional","affiliation":[{"name":"Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology Massachusetts Eye and Ear Infirmary  Boston Massachusetts U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashok R.","family":"Shaha","sequence":"additional","affiliation":[{"name":"Department of Head and Neck 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