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Timing of Ansa Cervicalis-to-recurrent Laryngeal Nerve Reinnervation: A Systematic Review

  • Matthew Fadhil
    Correspondence
    Address correspondence and reprint requests to Matthew Fadhil, Prince of Wales Otolaryngology Head and Neck Research Group, Prince of Wales Hospital, Sydney, New South Wales 2031, Australia.
    Affiliations
    Prince of Wales Otolaryngology Head and Neck Research Group, Prince of Wales Hospital, Sydney, New South Wales, Australia

    Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
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  • Thomas Havas
    Affiliations
    Prince of Wales Otolaryngology Head and Neck Research Group, Prince of Wales Hospital, Sydney, New South Wales, Australia

    Department of Otolaryngology, Prince of Wales Hospital, Sydney, New South Wales, Australia
    Search for articles by this author
  • Ian Jacobson
    Affiliations
    Prince of Wales Otolaryngology Head and Neck Research Group, Prince of Wales Hospital, Sydney, New South Wales, Australia

    Department of Otolaryngology, Prince of Wales Hospital, Sydney, New South Wales, Australia
    Search for articles by this author

      Abstract

      Background

      Ansa cervicalis-to-recurrent laryngeal nerve anastomosis (ARA) is an established technique for the treatment of recurrent laryngeal nerve (RLN) injury after head and neck surgery. However, the optimal timing of ARA remains unclear, and the evidence bases for ARA performed at each timepoint after RLN injury have not previously been clearly distinguished. We conducted a systematic review of the literature to evaluate the efficacy of ARA performed at different timepoints on postoperative voice outcomes.

      Methods

      A review of English-language journal articles published in the last 20 years was undertaken on three electronic databases: Ovid MEDLINE, PubMed and Embase. Studies with a focus on paediatric RLN injury, bilateral RLN injury, ansa cervicalis anatomy and non-ARA techniques alone were excluded.

      Results

      Twenty eight articles were included in the review. ARA was performed as a delayed surgery in 16/28 studies (57%), while immediate ARA was utilized in 14/28 studies (50%). On qualitative synthesis, delayed ARA was shown to be effective in improving patient-reported, subjective observer-reported and objective observer-reported voice outcomes. Likewise, a substantial body of evidence was identified demonstrating postoperative voice improvement with immediate ARA. On direct comparison of timepoints, some benefit was shown for early delayed ARA relative to late delayed operations, while no comparative data for immediate versus delayed repair were available in the literature.

      Conclusions

      ARA at both delayed and immediate timepoints is effective in the treatment of patients with RLN injury after head and neck surgery. The timing of ARA may have some influence on its efficacy, with early delayed repair potentially associated with superior outcomes to late delayed operations, and immediate ARA offering several practical advantages relative to delayed repair. Further comparative studies are required to better characterize the optimal timing of ARA after RLN injury.

      Key Words

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