Bilateral Vocal Palsy After Total Thyroidectomy: Expert Opinion on Two Malpractice Claims

Abstract

Two patients complained of hoarseness, respiratory distress and swallowing disorders early after total bilateral thyroidectomy for multinodular goiter and cancer, respectively. Faulty surgical techniques had caused injury to bilateral recurrent laryngeal nerves (RLNs) during thyroidectomy and the associated central lymph node dissection. The operation notes showed no statement regarding the identification, dissection, exposure and/or functional integrity of the RLN on either side of the thyroid and no mention of the first resected lobe. This report reviews the personal experience of the authors in thyroid surgery for use in 2 medical malpractice claims and for future reference.

The Consistency of Intraoperative Neural Monitoring in Thyroid Surgery

“…One of the concerns relating to guidelines in the field of IONM is related to their medicolegal implications (13)(14)(15)(16)(17)(18)(19). Some reports suggest that the courts are applying new clinical practice guidelines in their decision-making processes, it is worthwhile to anecdotally recall a case in which a patient sustained RLN palsy after thyroid surgery, and the plaintiffs' expert supported the view that IONM was considered the standard of care (13)(14)(15)(16)(17)(18)(19).…”