Long-term voice quality outcomes after total thyroidectomy: a prospective multicenter study

Borel, Frédéric; Christou, Niki; Marret, Olivier; Mathonnet, Muriel; Caillard, C.; Bannani, Sahar; Drui, Delphine; Espitalier, F.; Blanchard, Claire; Mirallié, Éric

doi:10.1016/j.surg.2017.09.023

Cited by 27 publications

(33 citation statements)

References 30 publications

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“…This underlines the need for formalized practical training and the identification of the "danger zone" to choose the most appropriate technique. These serious adverse events were regressive, in contrast with surgery, which is complicated by definitive recurrent laryngeal nerve palsy in 1 to 6% of cases [49], voice changes in 5 to 25% of cases [50] and hypoparathyroidism in 1 to 12% of cases [51,52]. Although the efficacy was similar in reducing symptoms, a comparative study (surgery vs. RFA) [53] showed that the frequency of complications was higher with surgery for the treatment of nodular goiters (6% vs. 1%).…”

Section: Discussionmentioning

confidence: 99%

Safety and efficacy of thermal ablation (radiofrequency and laser): should we treat all types of thyroid nodules?

Hamou¹,

Ghanassia

Espiard³

et al. 2019

International Journal of Hyperthermia

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Section: Discussionmentioning

confidence: 99%

Safety and efficacy of thermal ablation (radiofrequency and laser): should we treat all types of thyroid nodules?

Hamou¹,

Ghanassia

Espiard³

et al. 2019

International Journal of Hyperthermia

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“…Although neuromuscular compensation is well-recognized as a major cause of voice impairment after thyroid surgery [ 29 , 30 ], the current study yielded several insights: (1) if RLN injury is moderate, nerve recovery may occur immediately after surgery, and compensation may result in almost undetectable subjective and objective voice changes; (2) a severe RLN injury may impair the swallowing function. In addition to choking caused by VFM impairment, changes in neuromuscular function associated with swallowing after RLN injury requires further study.…”

Section: Discussionmentioning

confidence: 89%

How the Severity and Mechanism of Recurrent Laryngeal Nerve Dysfunction during Monitored Thyroidectomy Impact on Postoperative Voice

Huang

Chiang

et al. 2021

Cancers

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Intraoperative neuromonitoring can qualify and quantify RLN function during thyroid surgery. This study investigated how the severity and mechanism of RLN dysfunction during monitored thyroid surgery affected postoperative voice. This retrospective study analyzed 1021 patients that received standardized monitored thyroidectomy. Patients had post-dissection RLN(R2) signal <50%, 50–90% and >90% decrease from pre-dissection RLN(R1) signal were classified into Group A-no/mild, B-moderate, and C-severe RLN dysfunction, respectively. Demographic characteristics, RLN injury mechanisms(mechanical/thermal) and voice analysis parameters were recorded. More patients in the group with higher severity of RLN dysfunction had malignant pathology results (A/B/C = 35%/48%/55%, p = 0.017), received neck dissection (A/B/C = 17%/31%/55%, p < 0.001), had thermal injury (p = 0.006), and had asymmetric vocal fold motion in long-term postoperative periods (A/B/C = 0%/8%/62%, p < 0.001). In postoperative periods, Group C patients had significantly worse voice outcomes in several voice parameters in comparison to Group A/B. Thermal injury was associated with larger voice impairments compared to mechanical injury. This report is the first to discuss the severity and mechanism of RLN dysfunction and postoperative voice in patients who received monitored thyroidectomy. To optimize voice and swallowing outcomes after thyroidectomy, avoiding thermal injury is mandatory, and mechanical injury must be identified early to avoid a more severe dysfunction.

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“…Thyroid surgery is one of the most commonly performed endocrine surgical procedures, the risk of complications is high due to the anatomical structure and physiological function of the RLN. Symptoms after thyroid surgery may include dysphagia, dysphonia, aspiration, choking, and even dyspnea (10)(11)(12)(13). The management of symptomatic patients varied case by case, from voice therapy, vocal fold injection, thyroplasty to tracheotomy.…”

Section: Discussionmentioning

confidence: 99%

“…Intraoperative injury to the RLN can cause vocal cord paralysis. Symptoms may include hoarseness, choking, dysphagia and dysphonia in unilateral vocal cord paralysis, in addition, difficulty breathing may occur in cases of bilateral vocal cord paralysis (10)(11)(12)(13). To reduce this major cause of morbidity after thyroid surgery, visual identification of RLN is the standard practice, and IONM facilitates this procedure (10,(14)(15)(16).…”

Section: Intraoperative Neuromonitoring and Rln Thermal Injury Caused By Ebdsmentioning

confidence: 99%

Improving Voice Outcomes After Thyroid Surgery – Review of Safety Parameters for Using Energy-Based Devices Near the Recurrent Laryngeal Nerve

Wang

Huang

et al. 2021

Front. Endocrinol.

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Technological advances in thyroid surgery have rapidly increased in recent decades. Specifically, recently developed energy-based devices (EBDs) enable simultaneous dissection and sealing tissue. EBDs have many advantages in thyroid surgery, such as reduced blood loss, lower rate of post-operative hypocalcemia, and shorter operation time. However, the rate of recurrent laryngeal nerve (RLN) injury during EBD use has shown statistically inconsistent. EBDs generate high temperature that can cause iatrogenic thermal injury to the RLN by direct or indirect thermal spread. This article reviews relevant medical literatures of conventional electrocauteries and different mechanisms of current EBDs, and compares two safety parameters: safe distance and cooling time. In general, conventional electrocautery generates higher temperature and wider thermal spread range, but when applying EBDs near the RLN adequate activation distance and cooling time are still required to avoid inadvertent thermal injury. To improve voice outcomes in the quality-of-life era, surgeons should observe safety parameters and follow the standard procedures when using EBDs near the RLN in thyroid surgery

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Long-term voice quality outcomes after total thyroidectomy: a prospective multicenter study

Cited by 27 publications

References 30 publications

Safety and efficacy of thermal ablation (radiofrequency and laser): should we treat all types of thyroid nodules?

Safety and efficacy of thermal ablation (radiofrequency and laser): should we treat all types of thyroid nodules?

How the Severity and Mechanism of Recurrent Laryngeal Nerve Dysfunction during Monitored Thyroidectomy Impact on Postoperative Voice

Improving Voice Outcomes After Thyroid Surgery – Review of Safety Parameters for Using Energy-Based Devices Near the Recurrent Laryngeal Nerve

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