Recurrent Laryngeal Nerve Palsy in Well‐differentiated Thyroid Carcinoma: Clinicopathologic Features and Outcome Study

Abstract

Involvement of the recurrent laryngeal nerve (RLN) by well-differentiated thyroid carcinoma may not invariably lead to unilateral cord palsy, although the presence of RLN palsy is associated with locally advanced disease. The present study evaluates the clinicopathologic features and outcomes of patients surgically treated for well-differentiated thyroid carcinoma with documented nonfunctioning RLN at presentation. From 1970 to 2002, 20 of 709 patients undergoing surgical treatment for well-differentiated thyroid carcinoma were found to have ipsilateral unilateral cord palsy by routine preoperative laryngoscopy. There were 5 men and 15 women with a median age of 70 years. Nine patients (45%) did not have a clinically palpable thyroid mass, and hoarseness was the primary presenting symptom. All patients had histologically confirmed pT4 papillary thyroid carcinoma with a median size of 4 cm. Cervical nodal and pulmonary metastases were detected in 14 (70%) and 2 (10%) patients, respectively. The ipsilateral recurrent nerve was transected in all patients because of gross tumor involvement, and 19 patients underwent total or completion total thyroidectomy. Resection was incomplete in 15 patients, including 2 who underwent a debulking procedure and required reoperation for local control. Postoperative radioactive iodine ablation and external-beam irradiation were administered to 18 and 13 patients, respectively. Over a median follow-up of 4.5 years, 10 patients survived without evidence of recurrence, 5 died of disease recurrence, and 5 died of unrelated causes. The 5-year and 10-year cause-specific mortality was 17% and 42%, respectively. Patients developing distant metastasis at presentation or during follow-up had a significantly increased cause-specific mortality (p = 0.002). Preoperative RLN palsy can be the first symptom in patients with locally advanced papillary thyroid carcinoma. Despite the adoption of a relatively conservative surgical treatment, long-term survival can be achieved in selected patients.

Papillary Thyroid Carcinoma with Exclusive Involvement of a Functioning Recurrent Laryngeal Nerve May Be Treated with Shaving Technique

“…Considering the proximity of the RLN to the thyroid gland, this nerve is vulnerable to invasion by primary thyroid carcinomas with extrathyroidal invasion [4]. In cases of locally invasive PTC involving the RLN, controversy exists regarding the necessity for resection of the involved nerve or preservation using a surgical shaving technique.…”

General and regional anaesthesia for the thyroidectomy in rural/semi-urban Nigerian centres

“…It is noteworthy that 35% of the group one patients had steam inhalational therapy post operatively (12)(13)(14)(15). Bronchoscopic findings two weeks after admission were relatively normal except in three patients with some residual haematoma and one with hoarseness of voice (4,(28)(29)(30).…”

“…We quite appreciate that the number of patients were small and probably due to strict patient selection criteria but most of our findings were in agreement with the results of earlier workers. More so, when one considered this was done in rural/semiurban hospital settings (3,7,10,(25)(26)(27)(28)(29)(30). In conclussion, although, general endotracheal intubation anaesthesia remains the widely practiced form of anaesthesia, for thyroidectomy, regional anaesthesia is feasible, cheaper, conserves hospital beds and is associated with less complications …”

Is it advisable to perform preoperativelaryngoscopy in all patients due to undergo the thyroid and parathyroid surgery?Analysis of 5172 preoperative laryngoscopies

“…Встречаемость пареза гор-тани при выполнении рутинной предопера-ционной ларингоскопии при планировании операции на щитовидной или околощито-видных железах может варьировать от 0,25 до 6% [24,25]. Такой разброс объясняется различными группами пациентов, включен-ными в исследование (доля пациентов со злокачественными опухолями и включение или исключение пациентов с предшествую-щей операцией) [26,27].…”