Is It Meaningful to Preserve a Palsied Recurrent Laryngeal Nerve?

Yu, Shun; Lammers, B. J.; Boehner, Hinrich; Pohl, Peter; Goretzki, P. E.

doi:10.1089/thy.2007.0124

Cited by 29 publications

(20 citation statements)

References 11 publications

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“…Patients with RLN palsy in benign thyroid disease can experience recovery of the palsy and this has been previously documented [16]. In two of our patients, the RLN palsy fully recovered following surgery.…”

Section: Discussionsupporting

confidence: 76%

Recurrent laryngeal nerve palsy in benign thyroid disease: can surgery make a difference?

Moorthy

Balfour

Jeannon

et al. 2011

Eur Arch Otorhinolaryngol

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The association between a pre-operative recurrent laryngeal nerve (RLN) palsy and thyroid disease is usually suggestive of locally advanced malignant thyroid disease by invasion of the nerve. However, the risk of benign thyroid disease causing paralysis to the nerve is extremely rare and has been scarcely reported. The aims of this paper are to analyse the experience of patients presenting with RLN palsy and benign multinodular goitre (MNG), evaluate the mechanisms of pathogenesis and determine if thyroid surgery may be of benefit for these patients. A retrospective review was conducted of five patients presenting to the Otorhinolaryngology Head and Neck Surgery Department at Guy's and St Thomas' NHS Foundation Trust Hospital between 2000 and 2009. All patients were evaluated with fibre-optic laryngoscopy, ultrasound-guided fine needle aspiration cytology and computerised tomography. All patients underwent total or completion thyroidectomy and a handheld nerve stimulator (Xomed-Medtronics Vari-Stim III(®)) was used at the end of the procedure to check the integrity of the RLN. Post-operatively all patients were followed up for at least 12 months with fibre-optic laryngoscopy. Five females with an age range between 32 and 81 years presented with RLN palsy and benign MNG. All patients underwent total or completion thyroidectomies with preservation of the affected nerves. Two patients recovered the function of the nerves. All patients were confirmed to have benign multinodular goitres on histological analysis. RLN palsy in the presence of benign disease is rare. Patients should be carefully evaluated to confirm the palsy and exclude malignant disease prior to surgery. Surgery should be undertaken to remove the MNG, confirm the diagnosis and preserve the affected nerve. There is a significant chance that some of these patients will recover the function of the nerve.

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Section: Discussionsupporting

confidence: 76%

Recurrent laryngeal nerve palsy in benign thyroid disease: can surgery make a difference?

Moorthy

Balfour

Jeannon

et al. 2011

Eur Arch Otorhinolaryngol

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“…For this reason, the IONM can be used to detect the correct position of the RLN (before visual confirmation early at the beginning of the procedure), stimulating via the probe the overlying tissue of the tracheo-esophageal groove as described by our technique. Recent consensus guidelines have recommended more extended surgery for differentiated thyroid cancers (DTC) and benign thyroid disease, i.e., total thyroidectomies [19][20][21][22][23]. Bilimoria demonstrated that total thyroidectomy results in lower recurrence rates and improved survival for differentiated thyroid cancer compared with less extensive procedures [20].…”

Section: Discussionmentioning

confidence: 99%

“…In thyroid cancer patient, preoperative laryngeal paresis usually results in sacrificing or reconstructing the RLN during thyroidectomy [23]. Some authors recently justified the preservation of the RLN using IONM despite local invasion of the nerve by extrathyroidal extension or regional lymph node metastases [23].…”

Section: Discussionmentioning

confidence: 99%

“…Some authors recently justified the preservation of the RLN using IONM despite local invasion of the nerve by extrathyroidal extension or regional lymph node metastases [23]. Chi and associates [23] demonstrated that even in a palsied RLN, a positive electrophysiological response may still be provided by monitoring. This means that laryngeal muscles may retain residual innervations [23].…”

Section: Discussionmentioning

confidence: 99%

“…Chi and associates [23] demonstrated that even in a palsied RLN, a positive electrophysiological response may still be provided by monitoring. This means that laryngeal muscles may retain residual innervations [23]. Therefore the approach of Chi and associates is to save even the palsied nerve whenever possible (if a positive electrophysiological response is still present) to prevent the complete atrophy of a paralyzed vocal cord.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Intraoperative neuromonitoring for thyroid malignancy surgery: technical notes and results from a retrospective series

et al. 2010

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This study evaluates the role of intraoperative neuromonitoring (IONM) for thyroidectomy performed in cancer patients with emphasis on postoperative recurrent laryngeal nerve paralysis (RLNP). The study is a retrospective series comprising 76 thyroidectomy alone (control group) versus 76 thyroidectomy with IONM. In the control group the laryngeal nerves have been identified by visualization solely. In the IONM group both vagal nerve and RLN have been localized and monitored during thyroid resection. The main surgical outcome was RLN morbidity. All patients undergo pre- and postoperative laryngeal examination. Overall RLN morbidity was 3.9% in the IONM group and 9.2% in the control group (P < 0.05). There have been two cases of permanent RLNP (2.6%) in the control group and one in the IONM group (1.3%), one case of bilateral RLN injury in the control group. The incidences of temporary RLNP in the IONM group have been 2.6 versus 6.5% in the control group. IONM is an effective procedure in thyroid cancer patients.

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Innervation of the human posterior cricoarytenoid muscle by the external branch of the superior laryngeal nerve

et al. 2017

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Is It Meaningful to Preserve a Palsied Recurrent Laryngeal Nerve?

Cited by 29 publications

References 11 publications

Recurrent laryngeal nerve palsy in benign thyroid disease: can surgery make a difference?

Recurrent laryngeal nerve palsy in benign thyroid disease: can surgery make a difference?

Intraoperative neuromonitoring for thyroid malignancy surgery: technical notes and results from a retrospective series

Innervation of the human posterior cricoarytenoid muscle by the external branch of the superior laryngeal nerve

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