Incidence, Risk Factors, and Natural Outcome of Vocal Fold Paresis in 920 Thyroid Operations with Routine Pre‐ and Postoperative Laryngoscopic Evaluation

Abstract

Background The aim of this study was to determine the incidence, risk factors, and spontaneous recovery rate of vocal fold paresis (VFP) with routine laryngoscopy before and after thyroid surgery. Methods All consecutive patients undergoing primary or redo thyroid surgery between years 2011-2016 were prospectively registered in an electronic database, and scheduled for pre-and postoperative laryngoscopic vocal fold inspection by otolaryngologists independently of the surgical team. Results A total of 920 thyroid operations with 1296 nerves at risk were performed in 866 patients. Pre-and postoperative laryngoscopy was done in 95% and 98%, respectively. Preoperative VFP was detected in 24 (2.8%) patients. New postoperative VFP was found in 53 of 920 operations (5.8%) and in 55 of 1296 nerves at risk (4.2%). After 12 months, 14 had recovered full vocal fold function and eight had near-complete recovery. VFP was permanent after 29 operations (3.2%); two patients were lost to follow-up with uncertain outcome. Of the 1296 nerves at risk, injury was permanent in 30 (2.3%). In multivariate analysis, patients operated for recurrent goiter had nearly nine times higher risk of new VFP (23% rate), whereas patients with malignant histology had three times higher risk of postoperative VFP (up to 22% rate). Conclusion VFP continues to be a serious complication of thyroid surgery, especially in operations for redo goiter and thyroid malignancy. The incidence of VFP may be underestimated unless laryngoscopic examinations are performed routinely.

Lateral approach contributes to shortened surgical time in video-assisted neck surgery (VANS) for thyroid nodule

“…Furthermore, we reviewed complications of our patients in VANS. Postoperative RLNP is the most common complication in thyroid surgery; the reported incidence ranges between 1.4% and 6.3% [ [21] , [22] , [23] , [24] ]. In our series, RLNP was noted in 4 patients (5.7%) including permanent palsy in 1 case (1.4%); the incidence ratio was considered to be no different from reports of conventional surgery, which is considered about 3% to 6% [ 19 ].…”

Recurrent Laryngeal Nerve Paralysis Following Thyroidectomy: Analysis of Factors Affecting Nerve Recovery

“…18 Our overall rate of paralysis was 11.1%. Many studies chose 1 year to follow the progress of vocal fold recovery, which might explain their paralysis rate since recovery is unpredictable and might take longer than 6 months to recover 5,[19][20][21][22] ; it can even take up to 2 years to recover. 21 Of note, it is worth mentioning that our definition of recovery is a bit stricter than other studies.…”

Analysis of Risk Factors for Phonation Disorders after Thyroid Surgery

“…Similarly, in a study by Caulley et al [ 23 ], thyroid cancer turned out to be the most important risk factor for phonation disorders. A study by Heikknen et al involving 920 operations showed that thyroid cancer increased the risk of complications three-fold, and that among all the factors, it was the most significant [ 24 ]. An analysis of risk factors for complications conducted by Gunn et al in 2020 based on a group of 11,000 patients showed that thyroid cancer was a statistically significant factor in vocal cord paralysis (OR = 2.1; p < 0.001) [ 25 ].…”

“…This could explain our results, which showed that age was significant for the occurrence of transient but not permanent paralysis. Permanent paralysis is most often the result of irreversible mechanical damage during thyroid surgery [ 24 ].…”