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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Article info
Publication history
Published online: June 04, 2022
Accepted:
April 13,
2022
Publication stage
In Press Corrected ProofFootnotes
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Identification
Copyright
© 2022 The Voice Foundation. Published by Elsevier Inc. All rights reserved.
