Narrative review of proving the causal link of recurrent laryngeal nerve injury and thyroidectomy: a medico legal appraisal

Abstract

The recurrent laryngeal nerve (RLN) injuries are frequent complications related to thyroid surgery determining patient complaints and malpractice litigations. In the present work, the authors provide a brief review on the peculiarities of RLN injuries associated with thyroidectomy to highlight the various aspects of medicolegal assessment of causal link between surgery and nerve damage. The characteristics of thyroid disease, the anatomical peculiarities of surgery site and the nerve identification and preservation are factors that mostly influence the liability admission or rejection. In this context, the clinical records are fundamental, representing the most important probative tool. The possibility of having a set of information collected by clinical records, which allows for analysis and comparison to be made regarding the adherence to standards for thyroid surgery, is essential to set any medico-legal deliberation. However, the medicolegal evaluation can be very difficult. The practitioners involved in the medicolegal analysis of patient complaints related to this thyroidectomy complication need an in-depth knowledge of surgical technique, damage prevention activities and related clinical picture. To this must be added an adequate competence in the evaluation of the causal link (relation between the event and the injury and between that injury and the temporary/permanent impairment) based on the rigorous application of the medicolegal method.

The Application Value of the Central Lymph Node Metastasis Risk Assessment Model in Papillary Thyroid Microcarcinoma of Stage cN0: A Study of 828 Patients

“…Numbness of hands and feet, difficulty in articulation, and even inability to breathe are still the major problems perplexing surgeons. These issues need to be addressed, especially in an era when changes in quality of life are incorporated into surgical outcomes (20,21). pCND is more prone to RLN injury because the path of the RLN is included in the surgical field of CLND.…”

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

“…Avoiding iatrogenic RLN injury is essential for voice and swallowing outcomes after thyroid surgery. Impaired RLN function and vocal fold movement are problematic complications that may lead to medicolegal litigation after thyroid surgery in the quality-of-life era (8,9,42,43).…”

New Developments in Anterior Laryngeal Recording Technique During Neuromonitored Thyroid and Parathyroid Surgery

“…Recurrent laryngeal nerve (RLN) paralysis remains a common thyroid surgery complication that can cause dysphonia, aspiration, and, in some cases, interference with breathing. Therefore, RLN paralysis is a common cause of litigation after thyroid surgery in the current era in which quality of life change is included in assessment of surgical outcome (2,3). One major change in the past two decades is the growing acceptance of intraoperative neural monitoring (IONM) as a tool for minimizing surgical risk by assisting surgeons in the early localization and identification of the RLN and as a tool for assisting clinical decision-making by enabling real-time monitoring of evoked electrophysiologic laryngeal electromyography (EMG) responses during thyroid surgery.…”

“…. Electrode (needle) insertion may be complicated by scar tissue caused by revision surgery or, in older adults, by calcified TC(3). Intralaryngeal penetration of (needle) electrode may cause laryngeal hematoma, laceration, infection, or rupture of an endotracheal cuffPercutaneous(1).…”

“…Transcutaneous (1). and (2) same as Transcartilage/Percutaneous method(3). Biphasic EMG signals of acceptable quality recorded (adhesive skin electrode)(1) The recorded EMG amplitude of skin electrode is relatively lower* (2) The electrode sensitivity could be affected by patient characteristics (short or obese neck), tumor size, and degree of subplatysmal flap elevation.…”