Thyroid papillary carcinoma with invasion to bilateral recurrent laryngeal nerves

Abstract

Summary Four cases of thyroid papillary carcinoma with invasion to bilateral recurrent laryngeal nerves are presented. Preservation of the nerves under the microscope could not succeed in all four cases. Composite resection of the nerves and immediate reinnervation were performed in two cases including one case who showed bilateral vocal cord paralysis preoperatively. In these two cases, laterofixation of unilateral vocal cords was immediately performed in addition to thyroid operation. Although the cancer did not recur in these two cases, postoperative phonation was poor. Preservation of bilateral nerves with invaded lymph nodes was selected in the other two cases who did not show vocal cord paralysis preoperatively. Although radioiodine isotope therapy was added postoperatively in these two cases, unilateral vocal cord paralysis was observed in one case 3 years later. Complete cure was attempted by aggressive composite resection and immediate reinnervation of recurrent laryngeal nerves in the case with invasion of papillary carcinoma to unilateral nerves, although the decision of composite resection for the case with bilateral invasion was difficult. Which is the priority, complete cure for the carcinoma or preservation of the phonation? Preservation of recurrent laryngeal nerves with residual carcinoma was recommended in recent reports and guidelines of the British Thyroid Association.