scholarly journals Voice rehabilitation of patients with unilateral laryngeal paresis after thyroid cancer surgery

2019 ◽  
Vol 64 (6) ◽  
pp. 356-362
Author(s):  
Evgeny L. Choynzonov ◽  
Lidiya N. Balatskaya ◽  
Sventlana Yu. Chizhevskaya ◽  
Olga V. Cheremisina ◽  
Elena A. Krasavina ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Interdisciplinary Approach ◽  
Recurrent Laryngeal Nerve Injury ◽  
Laryngeal Nerve ◽  
Social Adaptation ◽  
Voice Rehabilitation ◽  
Repeat Surgery ◽  
Nerve Paralysis ◽  
Increased Risk ◽  
The Voice

BACKGROUND: Recurrent laryngeal nerve injury is one of the most frequent complications of surgery for thyroid cancer. This injury may result in vocal cord paresis and respiratory failure. Repeat surgery for recurrent tumors involves increased risk of recurrent nerves paresis. AIM: to evaluate the efficacy of voice rehabilitation in patients with unilateral laryngeal paresis after surgery for thyroid cancer. MATERIAL AND METHODS: Between 2008 and 2017, a total of 54 patients with unilateral laryngeal nerve paralysis after surgery for thyroid cancer were treated at the Cancer Research Institute. All patients had histologically verified advanced stage (T3–4N0–2M0–1) of thyroid cancer. Papillary thyroid cancer was diagnosed in 87% cases. Endoscopic or laryngoscopic examination and acoustic voice analysis were the criteria for assessing voice rehabilitation efficacy. RESULTS: Positive outcomes of voice rehabilitation were obtained in 54 patients. The vocal fold mobility was completely restored in 36 (67%) patients. The voice function was recovered due to the compensation provided by the healthy half of the larynx in 11 (21%) patients. In 7 (12%) patients, the vocal sound improved, patients no longer complained of . speech fatigue, but hoarseness persisted. By the time of discharge, the patients were able to go back to work. The effectiveness of voice restoration in patients with unilateral laryngeal paresis was directly dependent on the early start of rehabilitation measures (5–7 days after surgery) subject to interdisciplinary approach. The voice rehabilitation course ranged from 3 to 6 weeks. CONCLUSIONS: Our technique of voice rehabilitation in patients with unilateral laryngeal paresis after surgery for thyroid cancer shortened the rehabilitation time, reduced disability in oncological patients practicing voice and speech professions and improved the quality of life and social adaptation of these patients.

scholarly journals A METHOD FOR RESTORING VOICE FUNCTION OF THE LARYNX AFTER OPERATIONS FOR THYROID CANCER

2020 ◽  
Vol 75 (3) ◽  
pp. 120-122
Author(s):  
N.V. Kovalenko ◽  
◽  
D.V. Fainshtein ◽  
V.V. Ponomaryev ◽  
A.Yu. Nenarokomov ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Respiratory Failure ◽  
Recurrent Laryngeal Nerve ◽  
Respiratory Function ◽  
Clinical Case ◽  
Vocal Folds ◽  
Laryngeal Nerve ◽  
Main Trunk ◽  
The Russian Federation ◽  
The Voice

The incidence of thyroid cancer in the period from 2008 to 2018 in the Russian Federation increased from 74,8 to 114,1 cases per 100,000 population. The risk of damage to the recurrent laryngeal nerve during primary operations ranges from 0,5 to 23 %, with repeated operations increases to 62 %. The Volgograd regional clinical oncological dispensary uses the technique of intraoperative restoration of the function of the recurrent laryngeal nerve by means of a micro-neural anastomosis with the main trunk of the vagus nerve. We have experience in performing 6 similar operations. The description of this technique is given on the example of a clinical case. The described technique allows you to completely restore the voice and mobility of the vocal folds of the larynx. Respiratory function is fully restored, which makes it possible to avoid the formation of a tracheostomy in case of bilateral nerve damage, and if even unilateral paresis led to decompensated respiratory failure.

scholarly journals Endoscopic thyroidectomy versus conventional open thyroidectomy for early differentiated thyroid cancer

2020 ◽  
Vol 10 (4) ◽  
Author(s):  
Hoang Hiep Phan ◽  
Keyword(s):  
Thyroid Cancer ◽  
Recurrent Laryngeal Nerve ◽  
Nerve Injury ◽  
Open Surgery ◽  
Differentiated Thyroid Cancer ◽  
Endoscopic Thyroidectomy ◽  
Recurrent Laryngeal Nerve Injury ◽  
Laryngeal Nerve ◽  
Laryngeal Nerve Injury ◽  
Open Lobectomy

Introduction: Endoscopic thyroidectomy has been applied prudently for malignant thyroid tumors. The aim of our study was to compare the outcomes of endoscopic lobectomy and conventional open lobectomy for early differentiated thyroid cancer. Materials and Methods: From October 2018 to October 2019, 485 patients with early differentiated thyroid cancer underwent thyroid lobectomy in National hospital of Endocrinology enrolled. Of them, 235 patients underwent endoscopic lobectomy (EL) and 250 patients underwent conventional open lobectomy (OL). Results: The mean age of the patients was lower in the EL group (22,3 ± 3,6 years) than in the OL group (31,0 ± 5,8 years, P = 0,013). The ratio female/male was higher in the EL group than in the OL group (12/1 vs 7/1, P = 0,002). The operation time in the EL group was longer than in the OL group (58,4 ± 12,9 vs 42,3 ± 9 minutes, P = 0,014). However, there was no significant differences between EL group and OL group in tumor size (1,2 ± 0,2 vs 1,1 ± 0,6, P = 0,123), blood loss (12,5 ± 0,9 vs 13,6 ± 1,6ml, P = 0,457), postoperative hospital day (4,35 ± 1,4 vs 4,1 ± 1,1 days, P = 0,061), transient hypoparathyroidism (0,85% vs 0,8%, P = 0,431) or transient recurrent laryngeal nerve injury (1,27% vs 1,2%, P = 0,311). The drainage volume in the EL group was higher than in the OL group (75,5 ± 11,4 vs 54,1 ± 10,1ml, P = 0,046). Postoperative bleeding was similar in two groups (0,42% vs 0,4%, P = 0,457). There was no postoperative complications such as permanent recurrent laryngeal nerve injury, tracheal perforation, conversion to open surgery, chyle leak, surgical site infection. Patients in the EL group experienced with less pain than those in the OL group at 1 and 2 days after operation according to a visual analog scale (VAS) (P = 0,047). Wound site numbness is significantly less pronounced in the OL group (p = 0,032). Cosmetically, patients in the EL group were more satisfied than in OL group according to the questionnaire we used (P = 0,021). Conclusions: Endoscopic thyroidectomy for patients with early differentiated thyroid cancer is a safe and effective procedure with excellent cosmetic outcome. Postoperative hospital length stays and complications were similar to conventional open surgery.

scholarly journals Clinical Complications Post Thyroidectomy

2020 ◽  
Vol 3 (1) ◽  
pp. 159-162
Author(s):  
Syed Abdul Hakeem
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Nerve Injury ◽  
Superior Laryngeal Nerve ◽  
Recurrent Laryngeal Nerve Injury ◽  
Laryngeal Nerve ◽  
General Surgeon ◽  
Recurrent Laryngeal Nerve Paralysis ◽  
Metabolic Disturbances ◽  
Nerve Paralysis ◽  
Laryngeal Nerve Injury

Background: One of the most commonly conducted operations by a general surgeon are thyroid surgeries. Many complications of thyroid operation are linked to metabolic disturbances or a recurrent laryngeal nerve injury. Superior laryngeal nerve injury, inflammation, weakness  of airways and bleeding are other risks. Subjects and Methods: This randomized retrospective sample consists of 50 successive patients who undergo various thyroidectomy procedures and who meet the inclusion criteria after having been introduced to OPD. Results: Post-operative complications following thyroidectomy was seen in 30% of the patients with Hypocalcemia being one of the most prevalent complications postoperatively observed in 18% of the patients followed by wound infection seen in 6% of the cases studied. The frequency of hematoma at the surgical site was 2%. Recurrent Laryngeal Nerve paralysis seen in 2% of the cases and Seroma formation was reported in one individual constituting 2% of the cases. Conclusion: Effective patient surgical control is important and assists in the early detection and treatment of such complications.Careful post-operative patient monitoring ensures quick intervention and helps the patient to achieve better results.

Postoperative Complications of Thyroid and Parathyroid Disease

2017 ◽  
Author(s):  
Joseph R Imbus ◽  
David F Schneider
Keyword(s):  
Critical Care ◽  
Recurrent Laryngeal Nerve ◽  
Nerve Injury ◽  
Recurrent Laryngeal Nerve Injury ◽  
Laryngeal Nerve ◽  
Background Information ◽  
Endocrine Surgery ◽  
Recurrent Laryngeal Nerve Paralysis ◽  
Nerve Paralysis ◽  
Laryngeal Nerve Injury

Although thyroid and parathyroid surgery is considered very safe, with rare morbidity and mortality, serious complications can occur. These include bilateral recurrent laryngeal nerve injury, life-threatening hematoma, and severe hypoparathyroidism. Although infrequent, these complications require timely identification and intensive care. Critical care physicians should understand the clinical presentations and management of affected patients. This review provides a critical care–focused review of endocrine surgery complications, including relevant background information, definitions, risk factors, identification, and management. Special clinical situations and treatment considerations are included. Figures show the vocal fold anatomy in recurrent laryngeal nerve paralysis, the regulation of calcium homeostasis, and electrocardiogram changes seen in the setting of severe hypocalcemia. This review contains 3 figures, and 58 references. Key words: hypocalcemia, hypoparathyroidism, neck hematoma, parathyroid, recurrent laryngeal nerve injury, thyroid

scholarly journals Learning Curve for Using Intraoperative Neural Monitoring Technology of Thyroid Cancer

2019 ◽  
Vol 2019 ◽  
pp. 1-6
Author(s):  
Ning Zhao ◽  
Zhigang Bai ◽  
Changsheng Teng ◽  
Zhongtao Zhang
Keyword(s):  
Thyroid Cancer ◽  
Learning Curve ◽  
Recurrent Laryngeal Nerve ◽  
Nerve Injury ◽  
Recurrent Laryngeal Nerve Injury ◽  
Laryngeal Nerve ◽  
Cancer Surgery ◽  
Monitoring Technology ◽  
Laryngeal Nerve Injury ◽  
Neural Monitoring

We investigated the learning curve for using intraoperative neural monitoring technology in thyroid cancer, with a view to reducing recurrent laryngeal nerve injury complications. Radical or combined radical surgery for thyroid cancer was performed in 82 patients with thyroid cancer and 147 recurrent laryngeal nerves were dissected. Intraoperative neural monitoring technology was applied and the “four-step method” used to monitor recurrent laryngeal nerve function. When the intraoperative signal was attenuated by more than 50%, recurrent laryngeal nerve injury was diagnosed, and the point and causes of injury were determined. The time required to identify the recurrent laryngeal nerve was 0.5–2 min and the injury rate was 2.7%; injuries were diagnosed intraoperatively. Injury most commonly occurred at or close to the point of entry of the nerve into the larynx and was caused by stretching, tumor adhesion, heat, and clamping. The groups are divided in chronological order; a learning curve for using intraoperative neural monitoring technology in thyroid cancer surgery was generated based on the time to identify the recurrent laryngeal nerve and the number of cases with nerve injury. The time to identify the recurrent laryngeal nerve and the number of injury cases decreased markedly with increasing patient numbers. There is a clear learning curve in applying intraoperative neural monitoring technology to thyroid cancer surgery; appropriate use of such technology aids in the protection of the recurrent laryngeal nerve.

scholarly journals Thyroid Cancer In Children: A Multicenter International Study Highlighting Clinical Features And Surgical Outcomes Of Primary And Secondary Tumors

2021 ◽  
Author(s):  
Cristina Martucci ◽  
Alessandro Crocoli ◽  
Maria Debora De Pasquale ◽  
Claudio Spinelli ◽  
Silvia Strambi ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Clinical Features ◽  
Surgical Outcomes ◽  
Surgical Oncology ◽  
Recurrent Laryngeal Nerve Injury ◽  
Disease Relapse ◽  
Genetic Syndromes ◽  
Surgical Morbidity ◽  
Secondary Tumors ◽  
Increased Risk

Background: Thyroid gland malignancy is rare in pediatrics (0.7% of tumors); only 1.8% are observed in patients < 20 yrs with a higher prevalence recorded in females and adolescents. Risk factors include genetic syndromes - MEN disorders, autoimmune disease and ionizing radiation exposure. Radiotherapy is also linked with increased risk of secondary thyroid cancers. The present study describes the clinical features and surgical outcomes of primary and secondary thyroid tumors. Methods: Institutional data was collected on pediatric patients with thyroid cancer during 2000 - 2020 from 8 International Surgical Oncology centers. Statistical analysis was performed using GraphPad Prism. Results: Of 255 cases of thyroid cancer, only 13 (5.1%) were secondary tumors. Primary thyroid malignancies were more likely to be multifocal in origin (odds ratio [OR] 1.993, 95% confidence interval [CI] 0.7466-5.132, p 0.2323), had bilateral glandular location (OR 2.847, 95% CI 0.6835-12.68, p 0.2648) and proved metastatic at 1st diagnosis (OR 1.259, 95% CI 0.3267-5.696 p>0.999). Secondary tumors showed a higher incidence of disease relapse (OR 1.556, 95% CI 0.4579-5.57, p 0.4525) and surgical morbidity (OR 2.042, 95% CI 0.7917-5.221, p 0.1614) including hypoparathyroidism and recurrent laryngeal nerve injury. Overall survival (OS) was 99% at 1 year and 97% after 10 years. No EFS differences were evident with primary vs. secondary tumors (Chi square 0.7307, p 0.39026). Conclusions: This multicenter study demonstrates excellent survival for pediatric thyroid malignancy. Secondary tumors exhibit greater disease relapse (15.8% vs 10.5%) and a higher incidence of surgical related complications (36.8% vs 22.2%).

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