Recurrent Laryngeal Nerve Palsy in Thyroid Gland Surgery Related to Operations and Nerves at Risk

Mårtensson, Hans; Terins, Janis

doi:10.1001/archsurg.1985.01390280065014

Cited by 137 publications

(78 citation statements)

References 9 publications

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“…Therefore, it is impossible to evaluate central node metastasis on imaging studies. Furthermore, re-operation for recurrence to the central node may induce severe complications such as recurrent laryngeal nerve injury and persistent hypoparathyroidism [76][77][78]. Routine central node dissection is therefore recommended during surgery for papillary carcinoma [79].…”

Section: Lymph Node Dissectionmentioning

confidence: 99%

Prognostic Factors and Therapeutic Strategies for Differentiated Carcinomas of the Thyroid

2009

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Abstract. Differentiated thyroid carcinoma originates from thyroid follicular cells and is the most prominent malignancy of the endocrine organs. There are two histological types of differentiated carcinoma, namely, papillary and follicular carcinoma. According to reports from Western countries, papillary carcinoma comprises 85.3% of thyroid malignancies in whites, and 72.3% in blacks [1,2]. In Japan, a previous study showed that the prevalence of papillary carcinoma was 78.4% based on material registered between 1977 and 1986 [3], but according to recent findings reported in 2004 by Japanese Society of Thyroid Surgeons (JSTS), papillary carcinoma accounted for as much as 93% of all thyroid carcinomas. Papillary carcinoma frequently metastasizes to the regional lymph node and shows multicentricity in the thyroid gland. It usually shows a typical ultrasonographic appearance and can be rather easily diagnosed by fine needle aspiration biopsy (FNAB) [4][5][6]. Follicular carcinoma accounts for 10.9-20.5% of the patients in the United States [1,2]. In Japan, the prevalence of follicular carcinoma was reported to be 17.2% [3], but it decreased to 5% in a report by JSTS in 2004. This carcinoma is only occasionally diagnosed preoperatively, because it is hard to discriminate follicular carcinoma from benign adenoma on imaging studies and cytologic findings. In contrast to papillary carcinoma, follicular carcinoma more often metastasizes to distant organs than regional lymph nodes. In Japan, the prevalence of papillary carcinoma increased and that of follicular carcinoma decreased between reports from 1977 to 1986 and that in 2004, which may be because follicular variant of papillary carcinoma was classified into follicular carcinoma in the previous results. Generally, these carcinomas show an indolent character, but when the lesion dedifferentiates and becomes undifferentiated carcinoma, it displays very rapid growth with an adverse prognosis and is regarded even as the most aggressive malignancy among human solid carcinomas [7,8]. Furthermore, cases showing certain characteristics are likely to be constantly progressive and even become life-threatening. Such cases should be regarded as "high-risk" requiring careful and extensive surgical treatment and postoperative follow-up. Indeed, it is most important for physicians to correctly distinguish high-risk cases from those with an indolent character, although how to evaluate the biological characteristics of thyroid carcinoma and how to identify high-risk cases remains highly controversial. In this review, the methods of distinguishing high-risk cases and the appropriate therapeutic strategies for papillary and follicular carcinomas predominantly based on our experience are emphasized and our proposals for therapies including surgical treatment are demonstrated.

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Section: Lymph Node Dissectionmentioning

confidence: 99%

Prognostic Factors and Therapeutic Strategies for Differentiated Carcinomas of the Thyroid

2009

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“…Postoperative recurrent nerve palsy has the potential for recovery,with a recovery rate ranging from 50% to 88%. 14,16,18 In our study, RLN palsy was seen in15 out of 112 cases in immediate postoperative period. But during 3 weeks period, 10 out of 15 cases fully recovered and five cases didnt show any recovery.…”

Section: Discussionmentioning

confidence: 48%

Recurrent Laryngeal Nerve Palsy After Thyroid Surgery and Literature Review

Dutta¹,

Sinha²,

Baskota³

2012

Nepalese J ENT Head Neck Surg

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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 ...

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“…Endocrine surgeons in Japan tend to routinely dissect the central compartment during surgery for papillary carcinoma [67][68][69]. Re-operation for recurrence to the central node may include severe complications such as recurrent laryngeal nerve injury and persistent hypoparathyroidism [70][71][72]. There are no guidelines recommending lateral node dissection unless clinically apparent node metastasis has been detected in the compartment.…”

Section: Discussionmentioning

confidence: 99%

Well-Differentiated Thyroid Carcinoma Invading the Larynx and Trachea

Laus¹

2013

CMR

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Larynx and trachea invasion by thyroid cancer is an uncommon but difficult problem. There is no consensus on indication for the extent of surgery, particularly when there is a requirement for airway reconstruction. In general, the surgeon must decide between a complete ablation of the tumor at the cost of large-mutilation and a less radical dissection that leaves residual tumor to be treated with radiation therapy and additional radio-iodine.

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Recurrent Laryngeal Nerve Palsy in Thyroid Gland Surgery Related to Operations and Nerves at Risk

Cited by 137 publications

References 9 publications

Prognostic Factors and Therapeutic Strategies for Differentiated Carcinomas of the Thyroid

Prognostic Factors and Therapeutic Strategies for Differentiated Carcinomas of the Thyroid

Recurrent Laryngeal Nerve Palsy After Thyroid Surgery and Literature Review

Well-Differentiated Thyroid Carcinoma Invading the Larynx and Trachea

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