Recurrent Laryngeal Nerve Injury in Thyroid Surgery

Zakaria, Hazem; Awad, Naif A Al; Kreedes, Ali S Al; Al-Mulhim, Abdul Mohsin A; Al-Sharway, Mohammed A; Hadi, Maha Abdul; Sayyah, Ahmed A Al

doi:10.5001/omj.2011.09

Cited by 122 publications

(126 citation statements)

References 29 publications

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“…Therefore, methods that can reduce the incidence of this complication are of great interest. 13 Careful identification and meticulous thyroid dissection is essential to prevent RLN injury. Some surgeons are of the opinion that it is not possible to identify the recurrent laryngeal nerve in every case.…”

Section: Results and Observationsmentioning

confidence: 99%

Recurrent laryngeal nerve injury (RLNI) in thyroid surgery and its prevention

et al. 2015

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Section: Results and Observationsmentioning

confidence: 99%

Recurrent laryngeal nerve injury (RLNI) in thyroid surgery and its prevention

et al. 2015

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“…permanent RLNP is 2-30% for re-operative procedures. 4,[12][13][14][15][16] In re-operative surgery, anatomical planes are distorted due to scarring from the primary procedure, resulting in difficult RLN identification and increased nerve traction.…”

Section: Risk Factors For Rlnp In Thyroid Surgerymentioning

confidence: 99%

Recurrent laryngeal nerve injury in thyroid surgery: a review

Hayward

Grodski

Yeung

et al. 2012

ANZ Journal of Surgery

204

129

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Recurrent laryngeal nerve palsy (RLNP) is an important and potentially catastrophic complication of thyroid surgery. Permanent RLNP occurs in 0.3-3% of cases, with transient palsies in 5-8%. A literature review and analysis of recent data regarding RLNP in thyroid surgery was performed, with particular focus on the identification of high-risk patients, the role of intraoperative identification and dissection of the nerve, and the role of intraoperative neuromonitoring (IONM) and optimal perioperative nerve assessment. In conjunction with the review, data from the Monash University/ Alfred Hospital Endocrine Surgery Unit between January 2007 and October 2011 were retrospectively analysed, including 3736 consecutive nerves at risk (NAR). The current literature and our data confirm that patients undergoing re-operative thyroid surgery and thyroid surgery for malignancies are at increased risk of RLNP. Intraoperative visualization and capsular dissection of the RLN remain the gold standard for intraoperative care during thyroid surgery for reducing RLNP risk. IONM should not be used as the sole mechanism for identifying and preserving the nerve, although it can be used to aid in the identification and dissection of the nerve, and may aid in nerve protection in high-risk cases including cancer surgery and re-operative surgery.

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“…As a result, the patient can develop inspiratory stridor, dyspnoea, tachypnoea, and nasal flaring [4,5]. Sole dysphonia without dyspnoea could also be a possible observation [10]. In institutions where direct laryngoscopy is not performed as a standard procedure to visualize vocal cords after surgery, the diagnosis of bilateral paralysis can be missed if there is an inability to visualize vocal cords due to a missing patient cooperation, for instance.…”

Section: Discussionmentioning

confidence: 99%

Bi Lateral Vocal Cord Paralysis Post Thyroidectomy Causing Total Airway Obstruction: Case Report

Mundada¹

2011

TOATJ

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Thyroid surgery in recent years is generally considered quite safe. Better preoperative preparation and proper surgical techniques of thyroidectomy have minimized complications to less than 2-3%. Bilateral recurrent nerve palsy is the rarest of all complications, with a reported incidence varying between 0.4% to 14 %, but can be potentially fatal if missed [1,2].We report a case in which the patient experienced life threatening stridor and severe dyspnoea requiring re-intubation few minutes after extubation.Keywords: Vocal cord palsy, total thyroidectomy, airway obstruction. CASE REPORTA 29 year old female patient, weighing 48kg, presented with a thyroid swelling of about 3x3 cm in size, that has existed for six months. No retrosternal extension or pressure symptoms were observed. Following her previous diagnosis of thyroid hyperfunction she has been treated with Carbimazole and Propanolol for six months. Presently she was asymptomatic and her thyroid function tests were normal. Preoperative indirect laryngoscopy showed normal cord movements. X-ray of the neck did not show any deviation or tracheal compression. The preoperative histopathology report was suggestive of malignancy.On the day of surgery her pulse rate was 78 beats per minute, rhythmic and her blood pressure was 130/86 mmHg. After securing an intravenous (i.v) line, 1 mg of Midazolam and 100 mcg of Fentanyl were administered intravenously. Anesthesia was induced with 100 mg of Propofol and intubation was facilitated by administereing 75 mg suxamethonium. Anesthesia was maintained with N 2 O, O 2 (60 : 40) and 2% sevoflurane. Vecuronium was used as muscle relaxant and the intraoperative anesthetic course was uneventful.The surgery was performed without complications and lasted for about 3 hours. Before closure, a negative suction drain was inserted into the wound and pressure dressing was applied after surgery.At the end of surgery, neuromuscular blockade was reversed with 2.5 mg Neostigmine in combination with 0.2 mg Glycopyrolate. Once a Train of four (TOF-) ratio of 0.9 was measured, and the patient while intubated showed a normal tidal volume and respiratory rate. After extubation, the patient was obeying commands but was unable to speak

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Recurrent Laryngeal Nerve Injury in Thyroid Surgery

Abstract: The present study showed that thyroid carcinoma, re-operation for recurrent goiter, non-identification of RLN and total thyroidectomy were associated with a significantly increased risk of operative recurrent laryngeal nerve injury.

Cited by 122 publications

References 29 publications

Recurrent laryngeal nerve injury (RLNI) in thyroid surgery and its prevention

Recurrent laryngeal nerve injury (RLNI) in thyroid surgery and its prevention

Recurrent laryngeal nerve injury in thyroid surgery: a review

Bi Lateral Vocal Cord Paralysis Post Thyroidectomy Causing Total Airway Obstruction: Case Report

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