Recovery of Voice After Reconstruction of the Recurrent Laryngeal Nerve and Adjuvant Nimodipine

World J Surg. 2018 Mar;42(3):632-638. doi: 10.1007/s00268-017-4235-9.

Abstract

Background: Transection injury to the recurrent laryngeal nerve (RLN) has been associated with permanent vocal fold palsy, and treatment has been limited to voice therapy or local treatment of vocal folds. Microsurgical repair has been reported to induce a better function. The calcium channel antagonist nimodipine improves functional recovery after experimental nerve injury and also after cranial nerve injury in patients. This study aims to present voice outcome in patients who underwent repair of the RLN and received nimodipine during regeneration.

Methods: From 2002-2016, 19 patients were admitted to our center with complete unilateral injury to the RLN and underwent microsurgical repair of the RLN. After nerve repair, patients received nimodipine for 2-3 months. Laryngoscopy was performed repeatedly up to 14 months postoperatively. The Voice Handicap Index (VHI) was administered, and patients' maximum phonation time (MPT) was recorded during the follow-up.

Results: All patients recovered well after surgery, and nimodipine was well tolerated with no dropouts. None of the patients suffered from atrophy of the vocal fold, and some patients even showed a small ab/adduction of the vocal fold on the repaired side with laryngoscopy. During long-term follow-up (>3 years), VHI and MPT normalized, indicating a nearly complete recovery from unilateral RLN injury.

Conclusions: In this cohort study, we report the results of the first 19 consecutive cases at our center subjected to reconstruction of the RLN and adjuvant nimodipine treatment. The outcome of the current strategy is encouraging and should be considered after iatrogenic RLN transection injuries.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Calcium Channel Blockers / therapeutic use*
  • Cohort Studies
  • Combined Modality Therapy
  • Female
  • Humans
  • Laryngoscopy
  • Male
  • Microsurgery
  • Middle Aged
  • Nerve Regeneration
  • Neurosurgical Procedures
  • Nimodipine / therapeutic use*
  • Phonation
  • Reconstructive Surgical Procedures
  • Recovery of Function
  • Recurrent Laryngeal Nerve Injuries / complications
  • Recurrent Laryngeal Nerve Injuries / surgery*
  • Thyroidectomy / adverse effects
  • Vocal Cord Paralysis / etiology
  • Vocal Cord Paralysis / physiopathology*
  • Voice / physiology*

Substances

  • Calcium Channel Blockers
  • Nimodipine