Reinnervation of a transected nerve after thyroidectomy

Recurrent laryngeal nerve (RLN) injury remains one of the most significant morbidities of thyroidectomy. When the nerve is sacrificed either because of tumor invasion or iatrogenic injury, immediate reinnervation can restore phonatory function and prevent laryngeal muscle atrophy, even though physiological motion rarely returns. This review summarizes the current understanding of nerve degeneration and regeneration following transection of a motor nerve, the mechanisms of synkinesis, and the surgical techniques available for RLN reinnervation. Among these, the ansa cervicalis to RLN anastomosis has emerged as a practical and physiologically ideal method. Applications of nerve conduits and recent innovations in external branch of the superior laryngeal nerve reinnervation are also discussed.