{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T15:33:33Z","timestamp":1787067213425,"version":"build-2736575974"},"reference-count":12,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,6,9]],"date-time":"2022-06-09T00:00:00Z","timestamp":1654732800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:p>Thyroid cancer often invades the recurrent laryngeal nerve (RLN), causing vocal cord paralysis. In such patients, the invaded portion of the RLN usually needs to be resected through curative surgery. We attempt to preserve the nerve by performing sharp dissection in such cases. During nerve dissection, an intraoperative nerve monitoring system helps identify the course of the RLN in the fibrous tissue around the tumor or even within the tumor, and also helps evaluate the nerve integrity. Because of extensive dissection, the preserved RLN may become much thinner than its original thickness. We refer to this procedure as \u201cpartial layer resection\u201d of the RLN. In our cases, although the dissected RLNs became thinner, we found that vocal cord function recovered in most patients. If the RLN is fully involved by thyroid cancer or response of the vocal cord against electric stimulation to the RLN is lost, we resect the portion of the RLN together with the tumor and repair it using one of the reconstruction techniques. When a unilateral RLN is resected, the vocal cord on that side is paralyzed. Symptoms include hoarseness, mis-swallowing, and short phonation. RLN reconstruction using one of the reconstruction techniques leads to the recovery of phonatory and swallowing function, although the normal motion of the vocal cord on the side of the anastomosis is not restored. We used direct anastomosis, free nerve grafting, ansa cervicalis-RLN anastomosis, and vagus-RLN anastomosis to reconstruct the RLN. Thyroid cancer often invades the RLN near the Berry\u2019s ligament. In such patients, surgeons might assume that reconstruction of the RLN may not be possible because the peripheral stump of the RLN cannot be observed. However, if we divide the inferior pharyngeal constrictor muscles along the lateral edge of the thyroid cartilage, the peripheral RLN can be identified, and nerve reconstruction can be performed. We refer to this procedure as \u201claryngeal approach\u201d.In summary, of the patients with thyroid cancer who required resection of the RLN, RLN reconstruction led to the recovery of phonatory function. We suggest that all thyroid surgeons familiarize themselves with these reconstruction techniques.<\/jats:p>","DOI":"10.3389\/fendo.2022.884866","type":"journal-article","created":{"date-parts":[[2022,6,9]],"date-time":"2022-06-09T00:32:15Z","timestamp":1654734735000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":23,"title":["Intraoperative Management of the Recurrent Laryngeal Nerve Transected or Invaded by Thyroid Cancer"],"prefix":"10.3389","volume":"13","author":[{"given":"Hiroo","family":"Masuoka","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akira","family":"Miyauchi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,6,9]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"85","DOI":"10.1097\/00000658-199707000-00012","article-title":"Preservation of Recurrent Laryngeal Nerve Invaded by Differentiated Thyroid Cancer","volume":"226","author":"Nishida","year":"1997","journal-title":"Ann Surg"},{"key":"B2","doi-asserted-by":"publisher","first-page":"S1","DOI":"10.1002\/lary.21119","article-title":"Electrophysiologic Recurrent Laryngeal Nerve Monitoring During Thyroid and Parathyroid Surgery: International Standards Guideline Statement","volume":"121","author":"Randolph","year":"2011","journal-title":"Laryngoscope"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1002\/lary.27360","article-title":"International Neuromonitoring Study Group Guidelines 2018: Part II: Optimal Recurrent Laryngeal Nerve Management for Invasive Thyroid Cancer-Incorporation of Surgical, Laryngeal, and Neural Electrophysiologic Data","volume":"128","author":"Wu","year":"2018","journal-title":"Laryngoscope"},{"key":"B4","article-title":"Treatment of Recurrent Laryngeal Nerve Paralysis by Several Types of Nerve Suture","volume":"94","author":"Miyauchi","year":"1993","journal-title":"J Jap Surg Soc"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1080\/110241598750005093","article-title":"The Role of Ansa-to-Recurrent-Laryngeal Nerve Anastomosis in Operations for Thyroid Cancer","volume":"164","author":"Miyauchi","year":"1998","journal-title":"Eur J Surg"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2013.06.052","article-title":"Outcome of Vocal Cord Function After Partial Layer Resection of the Recurrent Laryngeal Nerve in Patients With Invasive Papillary Thyroid Cancer","volume":"155","author":"Kihara","year":"2014","journal-title":"Surgery"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2009.09.018","article-title":"Improvement in Phonation After Reconstruction of the Recurrent Laryngeal Nerve in Patients With Thyroid Cancer Invading the Nerve","volume":"146","author":"Miyauchi","year":"2009","journal-title":"Surgery"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1080\/110241501316914939","article-title":"Opposite Ansa Cervicalis to Recurrent Laryngeal Nerve Anastomosis to Restore Phonation in Patients With Advanced Thyroid Cancer","volume":"167","author":"Miyauchi","year":"2001","journal-title":"Eur J Surg"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1007\/BF01653553","article-title":"Recurrent Laryngeal Nerve Anastomosis Following Thyroid Surgery","volume":"6","author":"Ezaki","year":"1982","journal-title":"World J Surg"},{"key":"B10","volume-title":"Surgical Techniques in Reconstruction of Injured RLN for Voice Rehabilitation","author":"Miyauchi","year":"2001"},{"key":"B11","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1016\/j.surg.2011.12.033","article-title":"Laryngeal Approach to the Recurrent Laryngeal Nerve Involved by Thyroid Cancer at the Ligament of Berry","volume":"152","author":"Miyauchi","year":"2012","journal-title":"Surgery"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1288\/00005537-198606000-00004","article-title":"Vocal Quality Following Laryngeal Reinnervation by Ansa Hypoglossi Transfer","volume":"96","author":"Crumley","year":"1986","journal-title":"Laryngoscope"}],"container-title":["Frontiers in Endocrinology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2022.884866\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,6,9]],"date-time":"2022-06-09T00:32:17Z","timestamp":1654734737000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2022.884866\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,6,9]]},"references-count":12,"alternative-id":["10.3389\/fendo.2022.884866"],"URL":"https:\/\/doi.org\/10.3389\/fendo.2022.884866","relation":{},"ISSN":["1664-2392"],"issn-type":[{"value":"1664-2392","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,6,9]]},"article-number":"884866"}}