From the Research
Management of recurrent laryngeal nerve (RLN) injury after corpectomy requires prompt recognition and a multidisciplinary approach, with a focus on conservative treatment and speech therapy as the primary management strategy, as supported by the most recent and highest quality study 1. The initial management includes immediate otolaryngology consultation for laryngoscopy to assess vocal cord function and injury severity.
- Conservative treatment is appropriate for most cases, focusing on voice therapy and speech rehabilitation to improve vocal function and compensatory techniques.
- Corticosteroids (methylprednisolone 1mg/kg/day for 5-7 days with taper) may be prescribed to reduce inflammation and edema around the nerve, although the efficacy of intraoperative corticosteroids in preventing or treating postoperative RLNP is still debated 2.
- For severe cases with significant voice impairment or aspiration risk, surgical interventions such as vocal cord medialization (injection laryngoplasty or thyroplasty) may be necessary, with temporary medialization achievable with injectable materials like hyaluronic acid or collagen, and permanent procedures considered if no recovery occurs within 6-12 months 3, 4. Close monitoring with serial laryngoscopic examinations every 4-6 weeks for the first 6 months is essential to track recovery, as most patients with transient postoperative RLN injury recover normal vocal cord mobility within 6 months 3. Patients should be counseled about potential complications including voice changes, aspiration risk, and breathing difficulties, and the management approach varies based on injury severity, as RLN injuries can range from neurapraxia (temporary dysfunction with good recovery potential) to complete transection (permanent damage requiring more aggressive intervention) 5, 1.