Recurrent Laryngeal Nerve Palsy After Thyroid Surgery and Literature Review

Abstract

Thyroid surgery is one of the common surgeries performed in head and neck region. Recurrent laryngeal nerve paralysis is one of the most frequent and serious complications after thyroid operation. Permanent nerve palsy may occur in 0% to 2.1%, with an average of approximately 0.5% to 1%. Temporary palsy varies from 2.9% to over 10% 1 . The right-sided nerve is at higher risk due to its wide anatomical variation as compared to the left one. This complication rate can be minimized by accurate anatomical knowledge and meticulous surgical technique. The aim of this study is to assess the recurrent laryngeal nerve status during intraoperative period and early postoperative period. M A T E R I A L S A N D M E T H O D S :This was a prospective observational study done from 1st of November 2006 to 31st of October 2010 in Ganesh Man Singh Memorial Acadamy of ENT & HN Studies, Institute of Medicine, Tribhuvan University Teaching Hospital, Maharajgung, Kathmandu,Nepal. Patients undergoing thyroid surgeries for both malignant and non malignant conditions were included in the study. Patients who had preoperative recurrent laryngeal palsy were excluded from the study as well as the patients undergoing isthmusectomy and enucleation of cyst were also excluded because recurrent laryngeal were not identified and handled in these cases. All the surgeries were performed by senior surgeon. The recurrent laryngeal nerve was identified in tracheoesophageal groove and preserved. The status of nerve during intraoperative period , type of thyroid surgery were noted. The vocal cord mobility was assessed during six days of hospital stay and on 3rd week of surgery. Postoperative vocal cord palsy was defined as the presence of an immobile vocal cord or the decreased movement of the vocal cord during phonation. R E S U L T S :A total no of 112 cases of thyroid surgery were performed over a period of four years. Six cases were excluded from the study. Among excluded cases, one patient underwent enucleation of cyst, two patients had isthmusectomy where recurrent laryngeal nerve was not handled. Three patient of thyroid malignancy in whom recurrent laryngeal nerve palsy was present preoperatively were also excluded from the study. O b j e c t i v e :To observe the recurrent laryngeal nerve (RLN) status after thyroid surgery done for various types of thyroid pathology. M a t e r i a l a n d M e t h o d s :It was a prospective observational study done from 1st of November 2006 to 31st of October 2010 in Ganesh Man Singh Memorial Acadamy of ENT & HN Studies, Institute of Medicine, Tribhuvan University Teaching Hospital, Maharajgung, Kathmandu. Patients undergoing different types of thyroid surgeries for both malignant and non malignant thyroid pathology were included in the study. The status of recurrent laryngeal nerve during surgery and early postoperative period were observed. R e s u l t s :There were total 112 cases of thyroid surgery done over a period of four year. Recurrent laryngeal nerve ( RLN) palsy was observed in 15 cases in immediate ...

Factors Predisposing to Post Thyroidectomy Vocal Cord Paralysis at Ospital ng Maynila Medical Center

“…13 In contrast, the study of Dutta et al reported that more than half underwent lobectomy while the rest were distributed among total thyroidectomy, subtotal and completion thyroidectomy, with about 13% RLNI. 14 The majority were patients who underwent total thyroidectomy; 3x higher than patients who underwent subtotal thyroidectomy and 1.5x higher than those who underwent lobectomy. 14 Our current study attempted to determine the association between type of surgery and the presence of RLNI.…”

“…14 The majority were patients who underwent total thyroidectomy; 3x higher than patients who underwent subtotal thyroidectomy and 1.5x higher than those who underwent lobectomy. 14 Our current study attempted to determine the association between type of surgery and the presence of RLNI. However, there was no significant association found between these two variables.…”