For the treatment of laryngeal nerve injury complicated by thyroid surgery, the traditional view is to observe for 3-6 months before considering whether to take therapeutic measures, but more and more clinical studies have shown that surgical treatment of laryngeal nerve injury complicated by thyroid surgery should be performed early to improve the recovery rate of laryngeal nerve function. 1, the characteristics of the laryngeal nerve injury Many studies have shown that the laryngeal nerve injury complicated by thyroid surgery, the site is mostly in the lower part of the larynx near the laryngeal nerve entry, mostly due to suture ligation or scar adhesions, few cases were cut. In the vicinity of the laryngeal nerve, the inferior thyroid artery often divides into several branches or forms a small vascular network around the laryngeal nerve, and when the so-called extracapsular resection is performed, the inferior thyroid artery is prone to fracture, regression and bleeding, and blindly ligating or suturing to stop bleeding when the anatomy of the laryngeal nerve is not available, which can easily cause misligation of the laryngeal nerve. 2, early detection of laryngeal nerve injury The literature reports that the incidence of laryngeal nerve injury complicated by thyroid surgery, especially unilateral laryngeal nerve injury, varies greatly. The reasons for this are mainly that the patient’s paralyzed vocal cords are fixed in the paramedian or midline position, less speech during the postoperative hospitalization, mute voice is not obvious, and failure to perform laryngoscopy in a timely manner; some patients have mute voice performance, but they are discharged from the hospital and lose visits. Therefore, the vocal condition of patients should be carefully observed after thyroid surgery, and laryngoscopy should be performed in time for early detection of laryngeal recurrent nerve injury if there is a change in voice. 3, timing of treatment of laryngeal nerve injury Injury to the laryngeal nerve during thyroid surgery can cause paralysis of the laryngeal nerve, with a small chance of temporary paralysis and mostly permanent paralysis. Bilateral laryngeal nerve palsy often requires tracheotomy and subsequent vocal fold abduction or CO2 laser unilateral phialotomy to improve respiratory distress; unilateral laryngeal nerve palsy caused by the affected side of the vocal fold paramedian fixation, it is necessary to rely on the compensatory induction of the healthy vocal fold to improve the quality of vocalization, but even if the healthy vocal fold can be compensated induction to close the vocal folds, due to the loss of innervation of the affected vocal fold, its vocal fatigue and vocal deafness In 1992, Elies first reported the surgical exploration and decompression of 10 cases of laryngeal recurrent nerve injury within 7 d after thyroid surgery, and the nerve function was restored in 8 cases. Subsequent studies at home and abroad have shown that early exploration of the recurrent laryngeal nerve, through a variety of means such as nerve decompression, can restore and improve the function of the recurrent laryngeal nerve. 4.Surgical exploration after laryngeal nerve injury For laryngeal nerve injury caused by thyroid surgery, there is no specific examination means to determine whether the laryngeal nerve is ligated by sutures or has been cut, and laryngeal nerve exploration is the only means to clarify the nature of the injury. The nerve is usually explored under general anesthesia, and the original incision is followed to enter the surgical area, avoiding the thyroid area where the scar nodes are dense, and the nerve is searched for in the tracheoesophageal groove or the laryngeal entry of the recurrent laryngeal nerve, which is generally altered (shallow) due to suture ligation or scar adhesions. The nerve ligated with sutures often shows edema of the nerve at the proximal end of the larynx, and the local dilatation is neuroma-like, and after careful peeling under the microscope, the nodes in the dilated nerve will be found. If the nerve at the proximal larynx is disconnected, the distal nerve should be dissected from the larynx downward to find the distal nerve. 5. Main methods to restore the function of the recurrent laryngeal nerve 5.1 Decompression of the recurrent laryngeal nerve For cases where the recurrent laryngeal nerve is adhered by scar or ligated by sutures or stitches within 3 months after surgery, the nerve function can be completely restored after scar release and removal of the thread knots. In cases where the injury is more than 4 months old, there is less hope for recovery of nerve function, although the suture knot is removed. 5.2 End-to-end anastomosis of the recurrent laryngeal nerve Suitable for early cases where the unilateral recurrent laryngeal nerve has been severed. If the two severed ends are close to each other, tension-free alignment anastomosis is feasible. Since the recurrent laryngeal nerve is a mixed nerve, the innervation of its adductor and abductor muscles cannot be precisely restored, the tone and inward motion of the affected vocal folds can often be restored, and the quality of vocalization can be improved. 5.3 Cervical collateral laryngeal retrolaryngic nerve anastomosis is indicated in cases of early unilateral laryngeal retrolaryngic nerve injury where end-to-end nerve anastomosis cannot be performed. The cervical nerve collaterals originating from the subglottic nerve and cervical plexus are anastomosed with the proximal trunk or internal revenue of the recurrent laryngeal nerve to restore the inward motion of the vocal folds and improve the quality of voice. If the proximal laryngeal end of the recurrent laryngeal nerve cannot be found and it is difficult to perform nerve anastomosis, a small piece of nerve muscle can be taken from the cervical collaterals into the anterior cervical strap muscle and implanted into the cricoarytenoid muscle, which is expected to improve the vocal fold tone and inotropic function, but the efficacy is not exact.