If a recurrent laryngeal nerve injury is recognized intraoperatively, what is the preferred treatment?

When a recurrent laryngeal nerve injury is identified during surgery, the primary goal is to restore function to the nerve if possible. Repairing the nerve primarily is considered the preferred treatment option because it aims to restore the integrity of the nerve and potentially recover normal laryngeal function.

The recurrent laryngeal nerve is crucial for vocal cord function and airway protection; damage to this nerve can lead to vocal cord paralysis, which may cause significant complications such as voice changes and aspiration. When a nerve injury is recognized during the procedure, immediate intervention can provide the best chance for recovery. Surgical repair involves suturing the two ends of the nerve together in an effort to promote nerve healing and restoration of function.

While observation and monitoring may be appropriate in cases of minor or anticipated transient changes, waiting without intervention for a significant injury can lead to long-term complications. Tracheostomy is generally a method to manage airway complications resulting from such injuries rather than a direct treatment for the nerve injury itself. Long-term voice therapy is beneficial for functional rehabilitation after a nerve injury, but it is not a primary treatment option during surgery when an injury is identified. Hence, primary repair is preferred to directly address the injury and enhance the likelihood of recovery.