Laryngeal approach to the recurrent laryngeal nerve involved by thyroid cancer at the ligament of Berry

Background. Thyroid cancer often involves the RLN at the ligament of Berry, which makes preservation of the nerve difficult. If the portion of RLN is resected, finding the peripheral RLN for reconstruction is difficult. Hem we describe a laryngeal approach performed before dissecting the RLN to overcome these problems. Methods. Between January 2007 and April 2011, 13 patients with papillary thyroid carcinoma had unilateral RLN involvement by the cancer at the ligament of Berry. Preoperatively, 8 had functioning vocal cords and 5 had unilateral paralysis. The laryngeal approach involves dividing the inferior pharyngeal constrictor muscle along the lateral edge of the thyroid cartilage and identifying the nerve under the muscle or behind the thyroid cartilage. This procedure was performed before resecting the tumor in 10 patients (Group 1) and after resection in the remaining 3 (Group 2). Results. In Group 1, the RLN could be preserved with sharp dissection in 3 with functioning vocal cords preoperatively. Postoperatively they restored vocal cord function. The remaining 7 needed resection of the portion of RLN. RLN reconstruction was easily, since the peripheral RLN had already been identified. All patients in Group 2 needed resection of the portion of RLN. The peripheral RLN was identified in 2 and ansa-RLN anastomosis was performed. However, this was not possible in 1 patient. Conclusion. In patients with thyroid cancer involving the RLN at the ligament of Berry, performing the laryngeal approach before dissecting the nerve facilitates preservation or reconstruction of the nerve. (Surgery 2012; 152:57-60).