Extended parathyroidectomy with reconstruction of the recurrent laryngeal nerve for an atypical tumor of the parathyroid gland: clinical observation

In this case report the authors inform about primary hyperparathyroidism (PHPT) caused by an atypical tumor of the parathyroid gland. The diagnosis of PHPT was established only six years after the patient developed disease-specific complaints. According to scintigraphy with 99mTc-technetril and multislice computed tomography, a giant adenoma of the parathyroid gland on the right was identified. Considering the increased risk of the patient having a malignant neoplasm of the parathyroid gland, extended surgical treatment of PHPT was performed in the enblock volume. The operation was accompanied by resection of the right recurrent nerve. The reconstruction was performed with the formation of an epineural anastomosis with the medial portion of the fibers of the right vagus nerve, covering the suture line with a vascular coupling from a free graft of the branch of the saphenous jugular vein. Treatment allowed to achieve remission of the disease, but was complicated by the development of right-sided laryngeal paralysis. Vocal function was restored due to the achievement of the medial position of the right vocal fold and motor compensation of the left half of the larynx.