The Utility of Evaluating True Vocal Fold Motion Before Thyroid Surgery

Farrag, Tarik Y.; Samlan, Robin A.; Lin, Frank R.; Tufano, Ralph P.

doi:10.1097/01.mlg.0000191472.02720.1f

Cited by 127 publications

(93 citation statements)

References 14 publications

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“…100 Of 340 pre-thyroidectomy patients, VF motion abnormalities were found in 6.5%. 101 A finding of VF paralysis on preoperative examination strongly suggests the presence of invasive thyroid malignancy. In 1 study, the rate of preoperative VF paralysis in a series of patients with invasive thyroid malignancy was over 70% versus 0.3% in the control group of patients with noninvasive thyroid disease.…”

Section: Action Statement Profilementioning

confidence: 99%

“…One-third of 340 such patients evaluated preoperatively had no voice complaints. 101 Two studies reported limited sensitivity of vocal symptoms in the prediction of vocal fold paralysis ranging from 33% to 68%. 101,102 In one study, one third of 98 patients with postoperative vocal fold paralysis were ultimately judged to be asymptomatic in terms of vocal symptoms.…”

Section: Action Statement Profilementioning

confidence: 99%

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Clinical Practice Guideline: Improving Voice Outcomes after Thyroid Surgery

Chandrasekhar

Randolph

Seidman³

et al. 2013

Otolaryngol.--head neck surg.

352

100

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Objective. Thyroidectomy may be performed for clinical indications that include malignancy, benign nodules or cysts, suspicious findings on fine needle aspiration biopsy, dysphagia from cervical esophageal compression, or dyspnea from airway compression. About 1 in 10 patients experience temporary laryngeal nerve injury after surgery, with longer lasting voice problems in up to 1 in 25. Reduced quality of life after thyroid surgery is multifactorial and may include the need for lifelong medication, thyroid suppression, radioactive scanning/treatment, temporary and permanent hypoparathyroidism, temporary or permanent dysphonia postoperatively, and dysphagia. This clinical practice guideline provides evidence-based recommendations for management of the patient's voice when undergoing thyroid surgery during the preoperative, intraoperative, and postoperative period.Purpose. The purpose of this guideline is to optimize voice outcomes for adult patients aged 18 years or older after thyroid surgery. The target audience is any clinician involved in managing such patients, which includes but may not be limited to otolaryngologists, general surgeons, endocrinologists, internists, speech-language pathologists, family physicians and other primary care providers, anesthesiologists, nurses, and others who manage patients with thyroid/voice issues. The guideline applies to any setting in which clinicians may interact with patients before, during, or after thyroid surgery. Children under age 18 years are specifically excluded from the target population; however, the panel understands that many of the findings may be applicable to this population. Also excluded are patients undergoing concurrent laryngectomy. Although this guideline is limited to thyroidectomy, some of the recommendations may extrapolate to parathyroidectomy as well.Results. The guideline development group made a strong recommendation that the surgeon should identify the recurrent laryngeal nerve(s) during thyroid surgery. The group made recommendations that the clinician or surgeon should (1) document assessment of the patient's voice once a decision has been made to proceed with thyroid surgery; (2) examine vocal fold mobility, or refer the patient to a clinician who can examine vocal fold mobility, if the patient's voice is impaired and a decision has been made to proceed with thyroid surgery; (3) examine vocal fold mobility, or refer the patient to a clinician who can examine vocal fold mobility, once a decision has been made to proceed with thyroid surgery if the patient's voice is normal and the patient has (a) thyroid cancer with suspected extrathyroidal extension, or (b) prior neck surgery that increases the risk of laryngeal nerve injury (carotid endarterectomy, anterior approach to the cervical spine, cervical esophagectomy, and prior thyroid or parathyroid surgery), or (c) both; (4) educate the patient about the potential impact of thyroid surgery on voice once a decision has been made to proceed with thyroid surgery; (5) inform the anesthesi...

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Section: Action Statement Profilementioning

confidence: 99%

Section: Action Statement Profilementioning

confidence: 99%

Clinical Practice Guideline: Improving Voice Outcomes after Thyroid Surgery

Chandrasekhar

Randolph

Seidman³

et al. 2013

Otolaryngol.--head neck surg.

352

100

View full text Add to dashboard Cite

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“…64 Other studies reported one-third of all patients will have some degree of preoperative vocal cord hypomobility on examination. 66,67 In instances of preoperative cord deficit being caused by benign goitre, it is reported that 89% will recover full function after surgery. 68 Pre-intubation laryngoscopy and subsequent assessment has revealed that vocal fold injury can occur in approximately 30% of endotracheal intubations and 4% of post-operative RLNP are attributable to intubation injury.…”

Section: Perioperative Evaluation Of Rln Functionmentioning

confidence: 99%

Recurrent laryngeal nerve injury in thyroid surgery: a review

Hayward

Grodski

Yeung

et al. 2012

ANZ Journal of Surgery

205

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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“…Second, if recurrent laryngeal nerve palsy is identified before surgery, the surgeon can be prepared in case that an accidental injury of the contralateral healthy side occurs, and early detection of need for tracheostomy will prevent the patients from suffocation [2][3][4][5] . At last, since recurrent laryngeal nerve palsy is frequent complication occurring in thyroid surgery, absence of postoperative recurrent laryngeal nerve palsy can be one of the criteria for proper surgical quality [6,7] . Laryngeal fiberscope, now electroendoscope is in popular use in Japan, is the most common and reliable instrument for directly checking vocal fold (VF) mobility, but is a little invasive and uncomfortable for patients [2,8] .…”

Section: Introductionmentioning

confidence: 99%

Indication and validity of ultrasonographic evaluation for assessment of vocal fold mobility before and after thyroid surgery

Ebina

Sugitani

Orita

et al. 2015

IJDI

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Background: Evaluating recurrent laryngeal nerve function before and after thyroid surgery is important. Although laryngeal electroendoscope is the most reliable tool for evaluating vocal fold (VF) mobility, ultrasonography (US) may offer a non-invasive alternative. The aim of this study is to evaluate the validity and limitation of US evaluation for the assessment of VF mobility.Methods: This was a study for diagnostic testing of US in a single center. One hundred and one patients who underwent thyroid surgery between February 2011 and August 2011 were enrolled to this study. Observation of the VF mobility using a B-mode US scanner was performed before and after thyroid surgery, through the thyrohyoid membrane, thyroid notch, and cricothyroid membrane. The results of US were compared with those of electroendoscopic examination which was performed on the same day but after the US.Results: First we excluded one case that could not be observed by electroendoscopic examination before surgery. After excluding the cases which the VF mobility was invisible by US, we analyzed 89 out of the 100 patients before thyroid surgery and 89 out of the 101 patients after surgery. The sensitivity and specificity of US were 87.5%, 100% for before and 94.4%, 100% for after surgery, respectively. It was significantly more difficult to assess the VF mobility by US among patients who were men (odds ratio [OR] 24.7, 95% confidence interval [CI] 4.9-124.2), 65 years old or more (OR 3.5, 95% CI 1.0-11.9), and have past history of thyroid surgery (OR 7.9, 95% CI 2.1-29.2). Being obese was also a significant factor (OR 10.5, 95% CI 1.7-64.8) among younger patients (less than 65 years).Conclusion: US evaluation can be used for the assessment of recurrent laryngeal nerve function before and after thyroid surgery. This is a safe and non-invasive diagnostic tool which may be performed as a first-line method.

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The Utility of Evaluating True Vocal Fold Motion Before Thyroid Surgery

Cited by 127 publications

References 14 publications

Clinical Practice Guideline: Improving Voice Outcomes after Thyroid Surgery

Clinical Practice Guideline: Improving Voice Outcomes after Thyroid Surgery

Recurrent laryngeal nerve injury in thyroid surgery: a review

Indication and validity of ultrasonographic evaluation for assessment of vocal fold mobility before and after thyroid surgery

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