Recurrent Laryngeal Nerve (RLN) Section

Considerations

• • 1976: Recurrent laryngeal nerve section for spastic dysphonia - Dedo 

    • Dedo and Izdebski pioneered the technique, largest series 

  • Consider preservation of the PCA branch

  • Consider the alternative SLADR procedure - 1999: Selective laryngeal adductor denervation-reinnervation: a new surgical treatment for adductor spasmodic dysphonia

    • RLN section is an older procedure than SLADR

    • SLADR is a less studies procedure 

    • RLN section has a larger number of cases reported with longer patient follow-up

    • While the SLADR was developed with potential theoretical advantages, the RLN section is much easier to perform technically and has equivalent reported outcomes and complications

Preparation

Procedure

Sample operative report

Findings:

Left RLN identified and confirmed using NIM monitor

Performed section (3.5 cm segment) of L RLN

Procedure in detail:

The patient was transported into the operating room and placed on the operating table in the supine position. Time out completed. GETA applied; Medtronic NIM ETT placed for RLN monitoring. Shoulder roll placed.

The neck was examined. The 3 cm midline horizontal incision was marked between the cricoid cartilage and sternal notch in a natural skin crease. The skin was cleansed and 1% Lidocaine with 1:100,000 Epinephrine was infiltrated locally. Sterile preparation and drape completed.

Skin incised with 15 blade. Platysma incised with Bovie. Anterior jugular veins were ligated, as needed. Subplatysmal flaps raised and retracted. Midline raphe divided with Bovie and strap muscles retracted laterally. Left thyroid lobe identified and dissected to expose carotid artery, prevertbral fascia, and tracheo-esophageal groove.

Left RLN identified, confirmed with NIM stimulation and 0.5 mAmp, and dissected from its inferior course to its superior insertion at the cricothyroid joint. Once isolated, 3.5 cm segment of RLN ligated with 3-0 Silk and divided. Irrigation, valsalva performed. Hemostasis achieved with bipolar cautery.

Strap musculature reapproximated in the midline with running 4-0 Polysorb. Platysma and deep dermis reapproximated with buried interrupted 4-0 Polysorb. Epidermis reapproximated with interrupted subcuticular 5-0 Biosyn. Skin cleansed. Mastisol, Steri-strips, Telfa, Tegadem applied.

Patient extubated and transferred to PACU in stable condition.

Post op

• • Complications

  • 1982: Respiratory distress after recurrent laryngeal nerve sectioning for adductor spastic dysphonia

Pearls & Pitfalls

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