Surgical Methods and Experiences of Surgeons did not Significantly Affect the Recovery in Phonation Following Reconstruction of the Recurrent Laryngeal Nerve: Reply

Excerpt

Dr. Chandan Kumar Jha and Dr. Anjali Mishra, thank you for reading our recent article published in this journal [1] and providing very favorable comments on the present article and our previous articles on the reconstruction of the recurrent laryngeal nerve (RLN). You wrote that you did not routinely perform anastomosis of the transected RLN, especially when the nerve was resected segmentally. Although you did not perform a formal study, you had impression that patients’ subjective assessment of their voice did not differ among patients who had undergone anastomosis of the RLN and those who did not have this procedure. We reported that maximum phonation time (MPT) in patients who had resection of the RLN that was not repaired was significantly shorter than that of normal subjects and that patients who had reconstruction of the RLN achieved nearly normal value of MPT in our previous papers [2, 3] and the present paper also (Fig. 5) [1]. As you wrote, MPT does not directly mean quality of the voice or patient’s satisfaction on his or her voice. However, measurement of MPT is simple, easy, and practical and provides a quantitative value. Serial measurements of MPT following reconstruction of the RLN showed clear increase in MPT when patient’s voice began to recover [2]. Other researchers confirmed recovery in voice based on perceptual and acoustic evaluation [4, 5]. Measurements of MPTs depend on patients’ effort. Regarding mean airflow rate (MFR), we thought that this might be less dependent on patients’ effort and might provide more objective evaluation of laryngeal function during phonation. However, in the present series, it was less useful than MPT as described in our manuscript. …