Recurrent Laryngeal Nerve Injury After Aortic Surgery Shows Favourable Recovery, suggests study

A new study published in The Journal of Thoracic and Cardiovascular Surgery showed that injuries to the recurrent laryngeal nerve after aortic surgery were not as frequent as previously stated.

Progress in surgical methods and care before and after thoracic aortic surgery has led to better results. Nonetheless, damage to the recurrent laryngeal nerve (RLN) is often not identified even though it is important clinically. The occurrence of this injury varies, from about 1% in surgeries on the ascending aorta to more than 25% in complex procedures involving the aortic arch and descending aorta.

The left RLN is especially at risk because of its position under the aortic arch. Damage to this nerve can lead to issues like vocal cord paralysis, hoarseness, swallowing difficulties, aspiration, and lung problems. Although some recovery can happen naturally, there is limited information on regaining vocal function. This research delved into the frequency of RLN injuries, the recovery of voice function, and overall outcomes after thoracic aortic surgery.

A retrospective study conducted at a single center involved reviewing the medical records of adult individuals who underwent aortic arch or thoracoabdominal aortic surgery from 2001 to 2024. Postoperative vocal cord paralysis was used to diagnose recurrent laryngeal nerve injury. Aortic arch procedures encompassed partial and total arch replacement, whereas thoracoabdominal surgery focused on the upper part of the descending aorta. The main goal was the complete restoration of voice function. Other outcomes of interest were the restoration of normal vocal cord movement, any remaining voice changes, the necessity for speech therapy, and any interventions on the vocal cords.

Out of 2,983 individuals who had aortic surgery, 70 patients (2.3%) were found to have recurrent laryngeal nerve injury following the operation. The median follow-up period was 17 months with an interquartile range of 7 to 25 months. The occurrence of recurrent laryngeal nerve injury was 1.7% for arch surgery and 5.3% for thoracoabdominal procedures.

During the last follow-up, half of the patients (50%) regained their voice completely, while 30% experienced mild dysphonia, 13% had moderate dysphonia, and 7% suffered from severe dysphonia. Voice therapy was provided to 70% of the patients, and 14% needed additional interventions for their vocal cords.

Overall, the frequency of repeated damage to the recurrent laryngeal nerve following aortic surgery was less than what was previously stated. Most patients had positive functional results, with many recovering full or nearly full voice function through conservative or interventional treatments. It is crucial to have organized follow-up care and a team approach to ensure the best possible results following recurrent laryngeal nerve injury.

Source:

Pregaldini, F., Potratz, P., Seifert, E., Nucera, M., Mosbahi, S., Bartkevics, M., Schmidli, J., Siepe, M., Yildiz, M., & Schoenhoff, F. S. (2026). Functional outcome after recurrent laryngeal nerve injury following thoracic aortic surgery. The Journal of Thoracic and Cardiovascular Surgery. https://doi.org/10.1016/j.jtcvs.2026.09.030