Recurrent laryngeal nerve injury after thyroid and parathyroid surgery

Joliat, Gaëtan‐Romain; Guarnero, Valentine; Demartines, Nicolas; Schweizer, Valérie; Matter, Maurice

doi:10.1097/md.0000000000006674

Cited by 129 publications

(131 citation statements)

References 22 publications

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“…According to our results, the incidence of new VFP was 53 in 920 (5.8%) operations and 55 in 1296 (4.2%) nerves at risk. Compared to the results of previous studies in which routine laryngoscopy was used [4,5], our complication rate was lower (5.8% against 7.6-13.9%). On the other hand, we observed much higher rate of permanent VFP than was demonstrated in these previous studies (3.2-3.4% against 0.9-1.4%).…”

Section: Discussioncontrasting

confidence: 85%

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

et al. 2019

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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.

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Section: Discussioncontrasting

confidence: 85%

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

et al. 2019

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“…These causes were found in previous studies with different range of incidence. [3,[29][30][31][32][33][34] Idiopathic cause of vocal fold paralysis was found in 19 cases (17.9%). This finding is in conjugation with literature; Al-Khtoum N et al found that the incidence of idiopathic vocal fold paralysis was 18.9%.…”

Section: Discussionmentioning

confidence: 99%

Etiological Factors and Management of Vocal Fold Paralysis: Single Institution Study

Alassiry¹,

Hassan²

2018

IJO

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Vocal fold paralysis is a sign of underlying diseases. However, etiologies of this problem are varied and changing from center to center and need more clarification. The aim of the study is to determine the etiological factors and management options of vocal fold paralysis among patients attended to the voice clinic center at King Abdul-Aziz Medical City. The medical records of 106 patients diagnosed with vocal fold paralysis were studied retrospectively. The following variables were recorded; age, gender, occupation, smoking, surgical history, radiation history, cause and type of vocal fold paralysis, associated risks, and management. Out of the 106 cases, 58 were males and 48 females with a ratio of 1.2:1. The age of the patients ranged from 6-92 years. Surgical trauma (iatrogenic) was the leading cause of vocal fold paralysis (45.3%) followed by idiopathic (17.9%), external neck trauma (13.2), Non-laryngeal malignancy (6.6%), post upper respiratory tract infection and viral infection (5.7%), TB and TB lymphadenitis (3.8%), intubation (2.8%), neurogenic (1.8%) and thyroid mass (1.8%). Total thyroidectomy was the most common surgical etiology of vocal fold paralysis (38.8%). The most common etiology of vocal fold paralysis is surgery and most cases were total thyroidectomy. Otolaryngologists should be familiar with the etiology, incidence, evaluation, and management options of vocal fold paralysis to optimize patient care and avoid further complication. We recommend that all patients undergoing total thyroidectomy and surgeries related to the course of recurrent laryngeal nerves should have detailed voice assessment pre-and postoperatively.

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“…The right recurrent laryngeal nerve [1] The right and left nerves are not symmetrical. The right RLN is shorter and makes a quick entry and exit at the apex of the right chest.…”

Section: Functionmentioning

confidence: 99%

“…The RLN remains in the tracheooesophageal groove heading up and out of the thoracic inlet. In the neck, the RLN cannot help but annoy thyroid surgeons before reaching its final destination [1]. The thoracic surgeon encounters the ascending left RLN when performing Mediastinoscopy.…”

Section: Surgical Exposure Of the Right Rlnmentioning

confidence: 99%

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Anatomy of the Thoracic Recurrent Laryngeal Nerves from a Surgeon’s Perspective

Amer¹

2017

Anat Physiol

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There is a need for a fresh understanding of the course of the recurrent laryngeal nerves (RLN) in the chest. Thoracic surgeons avoid dissection around the nerves altogether to avoid its injury. This is impacting on how comprehensive nodal dissection can be in lung cancer surgery. It's imperative to understand the anatomy of the course of the nerves in extreme details before having the confidence to preserve the motor branch. In the chest the course of the right RLN is short and the thoracic surgeon is unlikely to cut it inadvertently. The left RLN is more complex and requires in-depth understanding. Absolute mastery of the RLN anatomy is the best way to preserve it, and we strongly believe that 'the best way to avoid injuring the RLN is to expose it and note the course of its motor branch'. By improving exposure of the RLN and armed with the knowledge of detailed anatomy it was possible to point out a safe way to harvest nodes in stations 3p, 2-4R, 5-6L, 4L and 2L. RLN palsy should be an historical event for the thoracic surgeon.

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Recurrent laryngeal nerve injury after thyroid and parathyroid surgery

Cited by 129 publications

References 22 publications

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

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

Etiological Factors and Management of Vocal Fold Paralysis: Single Institution Study

Anatomy of the Thoracic Recurrent Laryngeal Nerves from a Surgeon’s Perspective

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