Preservation of the Laryngeal Nerves during Total Thyroid Lobectomy

1977 ◽  
Vol 86 (6) ◽  
pp. 777-788 ◽  
Author(s):  
John M. Loré ◽  
Duck J. Kim ◽  
Samir Elias
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Total Thyroidectomy ◽  
Vocal Cord ◽  
Superior Laryngeal Nerve ◽  
Laryngeal Nerve ◽  
Parathyroid Glands ◽  
External Branch ◽  
Thyroid Lobectomy ◽  
Maximum Protection

A technique of exposure and preservation of the recurrent laryngeal nerve at the very onset of thyroidectomy and preservation of the external branch of the superior laryngeal nerve at the close of the procedure is described, which is believed to afford maximum protection to these nerves during total thyroid lobectomy and isthmusectomy as well as total thyroidectomy. At the same time, preservation of the parathyroid glands is achieved. In 120 exposures and preservations of the recurrent laryngeal nerve there have been no instances of a single permanent paralysis of this nerve. In 111 total thyroid lobectomies in which the external branch of the superior laryngeal nerve was placed in jeopardy, only one patient had a slight bowing of the vocal cord with excellent voice function during a limited follow-up period.

Thyroidectomy: Technique, Tips, and Troubleshooting

2018 ◽  
Author(s):  
Lindsay EY Kuo ◽  
Matthew A. Nehs
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Superior Laryngeal Nerve ◽  
Recurrent Laryngeal Nerve Injury ◽  
Laryngeal Nerve ◽  
Remote Access ◽  
Postoperative Hypocalcemia ◽  
Minimally Invasive Thyroidectomy ◽  
Perioperative Morbidity ◽  
Postoperative Hematoma ◽  
Thyroid Lobectomy

Historically, thyroidectomy was associated with a high mortality rate, now understood to likely be secondary to postoperative hypocalcemia. In the modern age, perioperative morbidity and mortality rates are extremely low, although some complications, such as recurrent laryngeal nerve injury, can have significant consequences. Understanding the safe approach to total thyroidectomy and thyroid lobectomy is key to minimizing operative morbidity. In particular, the capsular dissection technique facilitates identification and preservation of the recurrent laryngeal nerve and parathyroid glands. The postoperative care of the patient, including diagnosis and management of the more common complications such as hematoma or hypocalcemia, is crucial to optimize patient outcomes. Although novel thyroidectomy techniques have been developed to avoid or minimize the traditional neck incision, these approaches have not become widely used. This review contains 9 figures, 1 table, and 29 references.  Key Words: capsular dissection, external branch of the superior laryngeal nerve, intraoperative nerve monitoring, minimally invasive thyroidectomy, postoperative hematoma, postoperative hoarseness, postoperative hypocalcemia, recurrent laryngeal nerve, remote access thyroidectomy

Importance of Identifying the Course of the Recurrent Laryngeal Nerve in Total and Near-Total Thyroid Lobectomies

2005 ◽  
Vol 71 (3) ◽  
pp. 225-227
Author(s):  
Zeki Acun ◽  
Fikret Cinar ◽  
Alper Cihan ◽  
Suat Can Ulukent ◽  
Lokman Uzun ◽  
...  
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Total Thyroidectomy ◽  
Nerve Injury ◽  
Nerve Palsy ◽  
Recurrent Laryngeal Nerve Palsy ◽  
Recurrent Laryngeal Nerve Injury ◽  
Laryngeal Nerve ◽  
Thyroid Diseases ◽  
Thyroid Lobectomy ◽  
Laryngeal Nerve Injury

In our clinic, near-total thyroidectomy is the principal surgical procedure performed for benign thyroid diseases. We conducted a single-institution study on 176 consecutive patients who underwent near-total thyroidectomy due to various thyroid diseases. We compared the incidence of recurrent laryngeal nerve injury between total and near-total thyroid lobectomy sides in each patient. Our hypothesis was that the incidence of recurrent laryngeal nerve injury after total thyroid lobectomy would be similar to that of near-total thyroid lobectomy when the course of the recurrent laryngeal nerve was identified during surgery. The temporary recurrent laryngeal nerve palsy rates on the total and near-total thyroid lobectomy sides were 3.9 per cent (7 of 176 nerves) and 2.2 per cent (4 of 176 nerves), respectively. The difference was not statistically significant. Permanent recurrent laryngeal nerve palsy did not occur in any of our patients. In conclusion, the incidence of recurrent laryngeal nerve injury in total versus near-total thyroid lobectomy is not different when the course of the recurrent laryngeal nerve is identified during surgery.

scholarly journals The Effect of Intraoperative Neuromonitoring on Damage to the Laryngeal Nerves in Patients Undergoing Total Thyroidectomy.

2021 ◽  
Author(s):  
Piotr Bryk ◽  
Stanisław Głuszek
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Total Thyroidectomy ◽  
Nodular Goiter ◽  
Intraoperative Neuromonitoring ◽  
Laryngeal Nerve ◽  
Control Group ◽  
Study Group ◽  
Laryngeal Nerves ◽  
Recurrent Laryngeal Nerves

Abstract Background: Assessment of intraoperative neuromonitoring in the prevention of damage to the recurrent laryngeal nerve during total thyroidectomy.Material and methods: A group of 367 patients qualified for the study, including 312 women (85.01%) and 55 (14.99%) men, aged 18-79, having undergone total thyroidectomy due to a neutral nodular goiter. The patients were operated on by one surgeon. The study group consisted of 205 patients, including 173 (84.39%) women and 32 (15.61%) men, aged 19-79, who were operated on with the use of intraoperative neuromonitoring. The control group consisted of 162 patients, including 139 (85.80%) women and 23 (14.20%) men, aged 18-77 years, who had undergone surgery only with macroscopic visualization of the recurrent laryngeal nerve without the application of intraoperative neuromonitoring. Then, in the period from 2 to 10 years after the surgery, follow-up examinations were performed, which included 153 patients from the control group (74.6% [153/205]) and 122 patients from the study group (75.3% [122 / 162] Results: The frequency of vocal fold palsy did not differ significantly statistically in the study group and the control group (study group: 4.9% [10/205], control group: 4.9% [8/162]; p = 0.979). In the follow-up study, the incidence of laryngeal fold palsy did not show statistically significant differences between the study and control groups. Most of the damage to the recurrent laryngeal nerves was persistent.Conclusions: Neuromonitoring did not reduce the number of recurrent laryngeal nerve injuries in relation to the nerve visualization alone in noncapsular total thyroidectomy for benign nodular goiter, performed by the same experienced surgeon.

Loupe Magnification Reduces Postoperative Hypocalcemia after Total Thyroidectomy

2010 ◽  
Vol 76 (12) ◽  
pp. 1345-1350 ◽  
Author(s):  
Giacomo Pata ◽  
Claudio Casella ◽  
Francesco Mittempergher ◽  
Laura Cirillo ◽  
Bruno Salerni
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Total Thyroidectomy ◽  
Injury Rate ◽  
Laryngeal Nerve ◽  
Parathyroid Glands ◽  
Postoperative Hypocalcemia ◽  
Surgical Teams ◽  
Pathology Reports ◽  
The Impact ◽  
Loupe Magnification

We aimed to evaluate the impact of loupe magnification (LM) on incidental parathyroid gland removal (from pathology reports), hypocalcemia, and recurrent laryngeal nerve (RLN) injury after total thyroidectomy and answer the question of whether this tool should be always recommended for patient's safety. Between January 2005 and December 2008, 126 patients underwent total thyroidectomy with routine use of 2.5 X galilean loupes; their charts were compared with data on 118 patients operated on between January 1997 and December 2000 without LM (two different equally skilled surgical teams operating in the two periods). LM decreased the rate of inadvertent parathyroid glands removal (3.8 vs 7.8% of total parathyroid glands; P = 0.01), as well as of biochemical (20.6 vs 33.9%; P = 0.028) and clinical (12.7 vs 33%; P = 0.0003) hypocalcemia after thyroidectomy. All cases (16 of 16) of symptomatic hypocalcaemia in the LM group proved to be associated with parathyroidectomy vs 76.9 per cent (30 of 39) without LM ( P = 0.046). A trend toward decreased RLN injury rate, although statistically insignificant, was reported, being unilateral transient, unilateral permanent, and bilateral transient palsy rates 6.8, 2.5, and 1.7 per cent, respectively, without LM vs 4.8, 2.4, and 0.8 per cent, respectively, with LM ( P = 0.69; P = 1, and P = 0.61, respectively). Our results do support the routine use of LM during total thyroidectomy.

Vocal fold palsy after use of the laryngeal mask airway

1996 ◽  
Vol 110 (4) ◽  
pp. 383-384 ◽  
Author(s):  
Hamid Daya ◽  
William J. Fawcett ◽  
Neil Weir
Keyword(s):  
Laryngeal Mask Airway ◽  
Recurrent Laryngeal Nerve ◽  
Vocal Fold ◽  
Superior Laryngeal Nerve ◽  
Laryngeal Nerve ◽  
Laryngeal Mask ◽  
External Branch ◽  
Vocal Fold Palsy

AbstractWe report two cases of left vocal fold palsy following use of the laryngeal mask airway. In both cases anaesthesia was uneventful with a duration of about 60 minutes. It is proposed that high intra-cuff pressures induced during anaesthesia resulted in distension of the hypopharynx and subsequent neuropraxia of the motor branches of the recurrent laryngeal nerve and the external branch of the superior laryngeal nerve.

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