The evolution and progress of mechanism and prevention of recurrent laryngeal nerve injury
Vocal fold paralysis is among the most severe complications in neck and chest surgery, being most commonly associated with thyroid and parathyroid procedures; nevertheless, it may also be an effect of cardiac or thoracic surgery. It should be remembered that the scale of the problem is much greater than it might be thought. The phenomenon most assuredly results from lack of true data to be provided by all the centers involved in surgical procedures performed in this region. The improvement of surgical techniques and the strife to limit injuries have become the symbol of progress in surgery, and quality of life after thyroid and parathyroid procedures—a sign of striving for the least number of complications. Side by side with development of new technologies there have emerged possibilities of monitoring the electrophysiological function of the nerves that help in identification of these life-important structures and allow for prognosticating their postoperative function. It should be emphasized that understanding anatomy, laws that govern neural conductivity and the ability to use new technologies have become the determinants of quality in thyroid and parathyroid surgery. The paper discusses the most important problems pertaining to injuries of the recurrent laryngeal nerves (RLNs), the mechanisms of injury infliction, intraoperative identification and prevention, as well as prognosticating the postoperative voice quality.