The Nerve to Thyrohyoid Muscle as a Novel Donor Nerve for Laryngeal Reinnervation.

OBJECTIVES: Recurrent laryngeal nerve (RLN) injury may be a consequence of surgical procedures of the skull base, neck, and chest, with adverse consequences to function and quality of life. Laryngeal reinnervation offers a potentially stable improvement in vocal fold position and tone. The classic donor nerve is the ansa cervicalis, but is not always available due to damage or sacrifice during previous neck surgeries. Our objective was to introduce the nerve to the thyrohyoid (TH) muscle as an alternate donor nerve for reinnervation, which has not previously been described. METHODS: Case series of two patients using the TH nerve for laryngeal reinnervation after RLN injury, with description of surgical harvest. RESULTS: Follow-up results are available for 10 months (one patient) and 3 years (one patient) demonstrating both subjective and objective improvement in function. GRBAS scores were reduced. Maximal phonation time was improved. Patient rating of voice was stable or improved postoperatively. One patient described significant preoperative dyspnea which was significantly improved postoperatively, from a score of 24 to 10 out of 40 on the dyspnea handicap index. VHI was improved in one patient, but scores elevated in the other, despite a change from "moderately severe impairment" to "normal voice" subjectively. Neither patient experienced significant complications from the procedure. CONCLUSION: Laryngeal reinnervation procedures provide good outcomes in pediatric patients. When ansa cervicalis is not available as a donor nerve, the nerve to TH provides a reasonable alternative.

[WAYS OF IMPROVEMENT OF LIFE QUALITY OF PATIENTS UNDERGOING THYROID SURGERY].

The authors analyzed quality of life before and after thyroid surgery in 350 patients. The article suggested the ways of improving of surgical treatment by developing some technical details. Indications to operation and choice of the operation volume were specified by morphological diagnostics refinement.

Effect of complicated thyroid surgical procedures on personal and professional life of patients.

UNLABELLED: Thyroid resection procedures are the most common endocrine surgery procedures in Poland; an estimated 25,000 procedures are performed annually. Long term patient outcomes are rarely analyzed. THE AIM OF THE STUDY: was to assess effect of complicated thyroid burgery procedures on personal and Professional life of patients. MATERIAL AND METHODS: Follow-up of patients with complications was conducted according to a predetermined protocol involving survey and biochemistry. RESULTS: Unilateral and bilateral vocal cord paralysis accounted for 69% and 8% of complications, respectively. The complications resolved unilaterally in 58% of patients with bilateral vocal cord paralysis. Persistent hypoparathyroidism accounted for 26% of cases of postoperative hypoparathyroidism. Following thyroid resection procedures all patients received supplementation of thyroid hormones and were monitored by an endocrinologist until their follow-up examination. Eighty eight percent patients with vocal cord paralysis were treated at an outpatient department of laryngology and/or speech therapy. Physical therapy resulted in improvement irrespective of final nature of the complications. Vocal cord paralysis or both complications concurrently result in marked prolongation of absence from work and resulted in disability pension in 15% of professionally active patients. Low level of adaptation to disease was found in 19% patients in the study group, while low score on Satisfaction with Life Scale (SWLS) was found in 17% patients in the study group, irrespective of the type of complication. CONCLUSIONS: Acceptance of complications after thyroid surgical procedures is difficult for patients and worsens their life satisfaction in the long term follow-up and adversely modifies their professional and personal life. In the long term perspective, persistent hypoparathyroidism is more burdensome for patients than recurrent laryngeal nerve injury. Chronic deficit of innervations does not require chronic substitution or specialist therapy that are necessary in the persistent hypoparathyroidism.