Total thyroidectomy (TT) is a surgical procedure which involves complete removal of the thyroid gland, usually done in massive goitre compressing the trachea and esophagus, hyperthyroidism and carcinoma of thyroid gland. Laryngeal nerve damage is one of the most feared complications after TT which can lead to permanent changes in voice. Recent research suggests the occurrence of voice changes without any visible laryngeal nerve damage. Present study attempts to compare the pre and post-operative voice characteristics in individuals with total thyroidectomy without any laryngeal nerve damage. A total of 27 subjects (21 females and 6 males) who underwent total thyroidectomy participated in the study. Their recorded phonation of vowel/a/was subjected to two types of analyses viz. Perceptual analysis (using CAPE-V rating scale) and Acoustic analysis (using Multi Dimensional Voice Profile). Results of perceptual analysis indicated slight decrease in overall severity, roughness and breathiness and a slight increase in strainness, in only males. Acoustic analysis findings supported perceptual results with minimal changes in most of the parameters. The results suggest that after total thyroidectomy, in the absence of visible laryngeal nerve damage, functional changes in voice are minimal and temporary in nature. This study provides an insight to Otolaryngologists and Speech Language Pathologists about the voice characteristics in individuals with thyroidectomy, enabling them to formulate appropriate therapy protocol for this population. It further attempts to sensitize surgeons and physicians on the need for referral of this population to Speech Language Pathologist in the event of dysphonia.Keywords Total thyroidectomy Á Perceptual analysis Á Acoustical analysis Á Laryngeal nerve damage Total thyroidectomy (TT) is one of the surgical options for individuals with thyroid problems. This procedure involves complete removal of the thyroid gland and is usually done in cases of massive goitre compressing the trachea and esophagus, in cases of hyperthyroidism or carcinoma of thyroid gland. The intricate and delicate anatomic structures for voice production lie in close proximity to thyroid gland and are vulnerable during operations on the thyroid.Complications subsequent to TT may range from minor (post operative seroma) to major ones (injury to laryngeal nerve). Injury to laryngeal nerve can be either due to injury to external branch of superior laryngeal nerve (SLN) or recurrent laryngeal nerve (RLN). Reported risk of SLN injury varies from 0.3 to 13% [1]. The estimated frequency of RLN injury fluctuates between 5 and 10%, of which 5% are temporary and between 0.8 and 1.7% are permanent [2].Voice changes due to SLN and RLN injury may also be associated with laryngotracheal fixation with impairment of vertical movement or by temporary malfunction of the strap muscles after surgery. Typical voice symptoms after surgery are vocal fatigue during phonation and with high pitch and singing voice [3]. People with injury to...

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Background Thyroidectomy is a frequently performed surgery for benign and malignant conditions. Nevertheless, one of the most critical complications of thyroidectomy is recurrent laryngeal nerve (RLN) injury leading to vocal cord paralysis. A thorough knowledge of the anatomical variations of RLN and ligation of the related vessels close to their distal branches is critical to avoid injury. Case presentation Here, we report the first case of bilateral trifurcation of recurrent laryngeal nerve (RLN) in a 40-year old woman with multinodular goitre. Total thyroidectomy was performed and RLN was preserved bilaterally. Followed by a precise dissection, fine branches were traced penetrating the larynx. We did not observe any further post-operative complications and patient was discharged with desired outcomes. Conclusions Anatomical variations of the RLN include—bifurcations, trifurcations, relation of RLN with inferior thyroid artery (ITA) and presence of non-recurrent laryngeal nerve. Only RLN dividing at a distance greater than 5 mm (branching point distance) before its entry into the larynx beneath the cricothyroid are said to bifurcate or trifurcate. Approximately 25% of nerves show branching [71%—unilateral and 18%—bilateral bifurcation]. Incidence of unilateral trifurcations have been noted be 0.9% and the rates of bilateral trifurcation and the divisions of the branches is yet to be ascertained. This is the first report of a bilateral trifurcation of RLN, detected in patient with multinodular goitre and hence warrants a precise analysis of variations of the RLN in patients undergoing thyroidectomy, which is critical to prevent RLN injury.