Recurrent laryngeal nerve palsy during surgery for benign thyroid diseases: Risk factors and outcome analysis

Background: Thyroid surgery is one of the commonest surgeries performed by otolaryngologists. Currently, the main postoperative complications are hypocalcemia and recurrent laryngeal nerve (RLN) palsy. Extent of surgery, lack of identification of RLN/ parathyroid glands, malignancy, central compartment neck dissection, lateral neck dissection, previous surgery and size of goiter are the risk factors for complications. The objectives of this study were to determine the frequency of postoperative complications after thyroid surgery and to analyze the risk factors of complications. Methods: It was a prospective study of 45 patients undergoing thyroid surgery in eastern Nepal from March 2014 to September 2015. The postoperative complications and the risk factors associated with these complications were evaluated. Results: There were total of 45 cases of thyroid surgery, with the mean age of 39.04 years. The main postoperative complications were: hypocalcaemia (6 or 13.33% cases) and vocal cord palsy due to recurrent laryngeal nerve injury (5 or 11.11% cases). Temporary hypocalcaemia was observed in 3(6.67%) cases while permanent hypocalcaemia developed in other 3 (6.67%) cases. Similarly, the temporary and permanent recurrent laryngeal nerve palsy occurred in 3 (6.67%) cases and 2 (4.44%)cases respectively. The risk factors associated with hypocalcaemia were: malignancy, repeat operation, central compartment neck dissection and non-identification of parathyroid glands during surgery. Similarly, recurrent laryngeal nerve palsy was observed in cases of malignancy and central compartment neck dissection. Conclusion: The major postoperative complications of thyroid surgery were hypocalcaemia and recurrent laryngeal nerve palsy. Malignancy and central compartment neck dissection had effect on incidence of complications. Sound knowledge of anatomy and meticulous surgical technique are needed to reduce the incidence of complications.

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Risk factors for recurrent laryngeal nerve palsy after thyroidectomy

Open Medicine ◽

10.2478/s11536-011-0018-0 ◽

2011 ◽

Vol 6 (3) ◽

pp. 279-283 ◽

Cited By ~ 3

Author(s):

Petr Čelakovský ◽

Jan Vokurka ◽

Lukáš Školoudík ◽

Petr Kordač ◽

Eva Čermáková

Keyword(s):

Risk Factors ◽

Thyroid Cancer ◽

Thyroid Gland ◽

Recurrent Laryngeal Nerve ◽

Nerve Palsy ◽

Recurrent Laryngeal Nerve Palsy ◽

Laryngeal Nerve ◽

Multinodular Goitre ◽

Laryngeal Nerve Palsy ◽

Hashimoto's Disease

AbstractThis study investigates the incidence of temporary and permanent recurrent laryngeal nerve palsy (RLNP) and possible risk factors for patients with different types of thyroid gland diseases. 1224 consecutive patients who underwent thyroidectomy for treatment of various thyroid diseases between the years 2001–2005. The rates of RLNP were evaluated. The surgeon and type of thyroid gland disorder were recognised as possible risk factors for RLNP. The incidence of temporary/permanent RLNP for the whole group was 4.5/0.8%. The rates of temporary RLNP for groups, classified as multinodular goitre, Graves’ disease, thyroid cancer or Hashimoto’s disease were 4.3%, 4.3%, 5.2% and 5.7%, respectively. The rates of permanent RLNP for the same groups were 0.4%, 0.9%, 1.6% and 1.9%, respectively. The frequency of temporary RLNP for individual surgeons ranges from 2.8 to 7.0% and the rates of permanent RLNP is between 0–3.1%. There was no relationship between the surgeon’s experience (the number of procedures performed) and RLNP rates. Total thyroidectomy is a safe procedure associated with a low incidence of RLNP not only for benign multinodular goitre, but also for Graves’disease, thyroid cancer and Hashimoto’s disease. The rates of RLNP among individual surgeons are acceptable with small inter-individual differences.

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Benign thyroid adenoma causing recurrent laryngeal nerve palsy in a child

The Journal of Laryngology & Otology ◽

10.1017/s002221510011518x ◽

1991 ◽

Vol 105 (2) ◽

pp. 141-142 ◽

Cited By ~ 6

Author(s):

Sherif Habashi

Keyword(s):

Recurrent Laryngeal Nerve ◽

Nerve Palsy ◽

Recurrent Laryngeal Nerve Palsy ◽

Laryngeal Nerve ◽

Thyroid Adenoma ◽

Laryngeal Nerve Palsy ◽

Benign Thyroid

AbstractThe standard teaching is that only malignant thyroid masses produce recurrent laryngeal nerve palsy. An unusual exception to this rule is reported.

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The circumstances in which recurrent laryngeal nerve palsy occurs after surgery for benign thyroid disease: a retrospective study of 1026 patients

The Journal of Laryngology & Otology ◽

10.1017/s0022215121001493 ◽

2021 ◽

pp. 1-4

Author(s):

D Lenay-Pinon ◽

A Biet-Hornstein ◽

V Strunski ◽

C Page

Keyword(s):

Recurrent Laryngeal Nerve ◽

Thyroid Surgery ◽

Thyroid Disease ◽

Nerve Palsy ◽

Recurrent Laryngeal Nerve Palsy ◽

Laryngeal Nerve ◽

Benign Thyroid Disease ◽

Laryngeal Nerve Palsy ◽

Recurrent Laryngeal Nerves ◽

Benign Thyroid

Abstract Objective To evaluate the circumstances in which recurrent laryngeal nerve palsy occurs after thyroid surgery. Methods This study assessed 1026 patients who underwent surgery for benign thyroid disease over a seven-year period in a retrospective, single-centre study. Results With a total of 1835 recurrent laryngeal nerves at risk, there were 38 cases (2.07 per cent) of transient recurrent laryngeal nerve palsy and 8 (0.44 per cent) of permanent recurrent laryngeal nerve palsy. No explanation was found for 10 of the 46 cases of recurrent laryngeal nerve palsy. Among the 38 other cases, the probable causes included poor identification of the recurrent laryngeal nerve during surgery, involuntary resection of the nerve and several other factors. Conclusion Apart from accidental resection of the recurrent laryngeal nerve during thyroid surgery, the causes of post-operative recurrent laryngeal nerve palsy are often unclear and likely multifactorial. Poor identification of the recurrent laryngeal nerve during surgery is still the main cause of post-operative recurrent laryngeal nerve palsy, even when intra-operative neuromonitoring is used.

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Short- and Long-Term Results of Total vs Subtotal Thyroid- ectomies in the Surgical Treatment of Graves' Disease

Swiss Surgery ◽

10.1024/1023-9332.7.1.20 ◽

2001 ◽

Vol 7 (1) ◽

pp. 20-24 ◽

Cited By ~ 14

Author(s):

Robert ◽

Mariéthoz ◽

Pache ◽

Bertin ◽

Caulfield ◽

...

Keyword(s):

Recurrent Laryngeal Nerve ◽

Nerve Palsy ◽

Recurrent Laryngeal Nerve Palsy ◽

Laryngeal Nerve ◽

Long Term Results ◽

Graves Disease ◽

Laryngeal Nerve Palsy ◽

Short And Long Term

Objective: Approximately one out of five patients with Graves' disease (GD) undergoes a thyroidectomy after a mean period of 18 months of medical treatment. This retrospective and non-randomized study from a teaching hospital compares short- and long-term results of total (TT) and subtotal thyroidectomies (ST) for this disease. Methods: From 1987 to 1997, 94 patients were operated for GD. Thirty-three patients underwent a TT (mostly since 1993) and 61 a ST (keeping 4 to 8 grams of thyroid tissue - mean 6 g). All patients had received propylthiouracil and/or neo-mercazole and were in a euthyroid state at the time of surgery; they also took potassium iodide (lugol) for ten days before surgery. Results: There were no deaths. Transient hypocalcemia (< 3 months) occurred in 32 patients (15 TT and 17 ST) and persistent hypocalcemia in 8 having had TT. Two patients developed transient recurrent laryngeal nerve palsy after ST (< 3 months). After a median follow-up period of seven years (1-15) with five patients lost to follow-up, 41 patients having had a ST are in a hypothyroid state (73%), thirteen are euthyroid (23%), and two suffered recurrent hyperthyroidism, requiring completion of thyroidectomy. All 33 patients having had TT - with follow-ups averaging two years (0.5-8) - are receiving thyroxin substitution. Conclusions: There were no instances of persistent recurrent laryngeal nerve palsy in either group, but persistent hypoparathyroidism occurred more frequently after TT. Long after ST, hypothyroidism developed in nearly three of four cases, whereas euthyroidy was maintained in only one-fourth; recurrent hyperthyroidy was rare.

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Recurrent Laryngeal Nerve Palsy after Esophagectomy and Efficacy of Multidisciplinary Perioperative Management on Prevention of Postoperative Pneumonia

Nihon Kikan Shokudoka Gakkai Kaiho ◽

10.2468/jbes.68.189 ◽

2017 ◽

Vol 68 (2) ◽

pp. 189-191 ◽

Cited By ~ 1

Author(s):

A. Okamura ◽

M. Watanabe ◽

Y. Imamura ◽

S. Kamiya ◽

M. Hayami ◽

...

Keyword(s):

Recurrent Laryngeal Nerve ◽

Nerve Palsy ◽

Perioperative Management ◽

Recurrent Laryngeal Nerve Palsy ◽

Laryngeal Nerve ◽

Postoperative Pneumonia ◽

Laryngeal Nerve Palsy

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Brachial plexus neuritis and recurrent laryngeal nerve palsy

Journal of Neurology ◽

10.1007/bf00314184 ◽

1988 ◽

Vol 235 (5) ◽

pp. 323-323 ◽

Cited By ~ 10

Author(s):

E. A. C. M. Sanders ◽

V. M. H. Van den Neste ◽

T. U. Hoogenraad

Keyword(s):

Brachial Plexus ◽

Recurrent Laryngeal Nerve ◽

Nerve Palsy ◽

Recurrent Laryngeal Nerve Palsy ◽

Laryngeal Nerve ◽

Laryngeal Nerve Palsy ◽

Brachial Plexus Neuritis

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Recurrent laryngeal nerve palsy secondary to benign thyroid disease

The Journal of Laryngology & Otology ◽

10.1017/s0022215100128385 ◽

1994 ◽

Vol 108 (10) ◽

pp. 878-880 ◽

Cited By ~ 12

Author(s):

J. E. Fenton ◽

C. I. Timon ◽

D. P. McShane

Keyword(s):

Recurrent Laryngeal Nerve ◽

Thyroid Disease ◽

Nerve Palsy ◽

Recurrent Laryngeal Nerve Palsy ◽

Laryngeal Nerve ◽

Recurrent Laryngeal Nerve Paralysis ◽

Recurrent Nerve ◽

Benign Thyroid Disease ◽

Nerve Paralysis ◽

Benign Thyroid

Abstract: A recurrent nerve palsy occurring in the presence of a goitre is considered to be caused by thyroid malignancy until proven otherwise.Three cases are described in which benign thyroid disease resulted in recurrent laryngeal nerve paralysis. Recent haemorrhage was implicated histologically as the possible aetiology in all three cases. The importance of identifying and preserving the recurrent laryngeal nerve in the surgical management is highlighted.

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