Study to assess proper timing of laryngoscopy in post-thyroid surgery patients to detect recurrent laryngeal nerve injury

Background: Thyroid surgeries are commonly done nowadays for benign and malignant conditions. Recurrent laryngeal nerve palsy (RLNP) is an important and potentially catastrophic complication of thyroid surgery. The purpose of the study was to determine the impact of rigid endoscopy (Hopkins rod-lens telescope) performed at different time intervals on the diagnosis of RLNP in post-thyroid surgery patients. Aims and Objectives: To assess Proper Timing of Laryngoscopy in Post-thyroid Surgery patients to Detect RLN Injury. Materials and Methods: Rigid endoscopy was performed postoperatively at day 0 (T0), at 2nd day post-op (T1), and day 14 (T2). For patients with RLNP, repeated examinations were performed at 2 months (T3), 6 months (T4), and 12 months (T5). Results: The study included 50 patients of thyroid swelling with different diagnoses. Overall, 35 patients appeared for postoperative laryngoscopic examination of the vocal folds at our center, providing 61 nerves at risk. RLNP rate was 8.1% at T0, 11.5% at T1, 9.8% at T2, 8.1% at T3, 4.9% at T4, and 3.3% at T5. T1 was significantly superior to all other time intervals in terms of diagnosis of RLNP but statistically not significant. Conclusion: Rigid endoscopy is essential for the detection of vocal cord paralysis after thyroidectomy. We report different time evaluation criteria of vocal cord morbidity with great and significant variability of results. Second day post-op inspection of the larynx (T1) is suggested.

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Recurrent laryngeal nerve and voice preservation: routine identification and appropriate assessment – two important steps in thyroid surgery

Annals of The Royal College of Surgeons of England ◽

10.1308/003588410x12771863936927 ◽

2011 ◽

Vol 93 (1) ◽

pp. 49-53 ◽

Cited By ~ 8

Author(s):

Ravindra Singh Mohil ◽

Pragnesh Desai ◽

Nitisha Narayan ◽

Maheswar Sahoo ◽

Dinesh Bhatnagar ◽

...

Keyword(s):

Recurrent Laryngeal Nerve ◽

Vocal Cord ◽

Thyroid Surgery ◽

Recurrent Laryngeal Nerve Palsy ◽

Laryngeal Nerve ◽

Voice Change ◽

Routine Identification ◽

Before And After ◽

Voice Preservation

INTRODUCTION The aims of this study were to assess and compare vocal cord functions before and after thyroid surgery after intra-operative identification of recurrent laryngeal nerve. PATIENTS AND METHODS Recurrent laryngeal nerve (RLN) is seen intra-operatively in all cases undergoing thyroid surgeries. Vocal cord functions including any voice change were evaluated by indirect laryngoscopy (I/L) and direct laryngoscopy (D/L) before and after surgery. RESULTS Prospective study on 100 patients over 18 months with a total of 146 nerves at risk (NAR). Majority were women (n = 86) with mean age of 37.48 years (range, 13–60 years). RLN was seen in all patients and 19 patients complained of some change in quality of their voice after surgery. Evaluation by I/L and D/L at 6 weeks showed recurrent laryngeal nerve palsy (RLNP) in nine (47.36%) and five (26%) of these 19 patients respectively. Analysed according to total NAR, the incidence of voice change and temporary RLN palsy (I/L and D/L) at 6 weeks was still less at 13.01%, 6.16% and 3.42%, respectively. Voice change improved in all cases at 3 months with no RLNP palsy by I/L or D/L. All these 19 patients had undergone difficult or extensive surgery for malignancy, large gland, extratyhroidal spread or fibrosis. CONCLUSIONS Despite identification and preservation of RLN, patients can develop postoperative voice change and RLNP although all voice change cannot be attributed to damaged RLN. Proper assessment of vocal cord functions by I/L and D/L laryngoscopy is required to rule out injuries to these nerves. Risk of damage is higher in patients undergoing more difficult surgery.

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Faculty Opinions recommendation of Postoperative laryngoscopy in thyroid surgery: proper timing to detect recurrent laryngeal nerve injury.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.4517960.4376061 ◽

2010 ◽

Author(s):

Gerhard Friedrich ◽

Georg Hammer

Keyword(s):

Recurrent Laryngeal Nerve ◽

Nerve Injury ◽

Thyroid Surgery ◽

Recurrent Laryngeal Nerve Injury ◽

Laryngeal Nerve ◽

Proper Timing ◽

Laryngeal Nerve Injury

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Predictive factors for recurrent laryngeal nerve palsy and hypoparathyroidism after thyroid surgery

Clinical Otolaryngology ◽

10.1111/j.1365-2273.2007.01383.x ◽

2007 ◽

Vol 32 (1) ◽

pp. 32-37 ◽

Cited By ~ 45

Author(s):

Y. Erbil ◽

U. Barbaros ◽

H. İşsever ◽

İ. Borucu ◽

A. Salmaslıoğlu ◽

...

Keyword(s):

Recurrent Laryngeal Nerve ◽

Predictive Factors ◽

Thyroid Surgery ◽

Nerve Palsy ◽

Recurrent Laryngeal Nerve Palsy ◽

Laryngeal Nerve ◽

Laryngeal Nerve Palsy

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Recurrent laryngeal nerve palsy following heart-lung transplantation: three cases of vocal cord augmentation in the acute phase

The Journal of Laryngology & Otology ◽

10.1017/s0022215100110643 ◽

1989 ◽

Vol 103 (10) ◽

pp. 968-969 ◽

Cited By ~ 10

Author(s):

G. E. Murty ◽

M. C. F. Smith

Keyword(s):

Lung Transplantation ◽

Recurrent Laryngeal Nerve ◽

Vocal Cord ◽

Acute Phase ◽

Nerve Palsy ◽

Recurrent Laryngeal Nerve Palsy ◽

Bronchial Tree ◽

Laryngeal Nerve ◽

Vocal Cord Dysfunction ◽

Laryngeal Nerve Palsy

AbstractThree cases of left recurrent laryngeal nerve palsy following heart-lung transplantation are described. In each case, within twelve hours of extubation, the left vocal cord was injected with Teflon, and the paralyzed vocal cord thus displaced to the midline. Effective closure of the glottis was then possible, permitting an adequate cough, adequate clearing of the bronchial tree and minimising the risk of aspiration. Augmentation under general anaesthesia as soon as possible after discovery of vocal cord dysfunction is advocated. Suitable materials for injection are discussed. To our knowledge, this is the first reported series of vocal cord augmentation in the acute phase following heart-lung transplantation.

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Role of magnification and microscope in thyroid surgery safety and efficacy

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20212780 ◽

2021 ◽

Author(s):

Ravi K. S. ◽

Kiran M. Naik ◽

Swarna Priya M. ◽

Abhishek M. P.

Keyword(s):

Recurrent Laryngeal Nerve ◽

Parathyroid Gland ◽

Thyroid Surgery ◽

Recurrent Laryngeal Nerve Palsy ◽

Laryngeal Nerve ◽

Research Centre ◽

Institutional Review ◽

Benign Pathology ◽

Operative Complications ◽

Ethical Approval

Background: Thyroid surgery becomes challenging, due to closely related structures like recurrent laryngeal nerve and parathyroid gland. Microscope assisted surgery has better visualization for dissection, and decreases the risk of injury to the nerve, parathyroid gland, and its vascular pedicle. Hence it decreases the operative complications.Methods: This is a retrospective study of microscope-assisted thyroidectomy at Adichunchanagiri hospital and research centre, from May 2016 to April 2020. Ethical approval was obtained from institutional review committee. Types of surgery, post-operative hypocalcemia and recurrent laryngeal nerve function were analysed descriptively.Results: Out of total 30 microscope assisted thyroidectomy, 26 were female, 42 (87.5%) benign pathology, 6 (12.5%) malignant. Hemithyroidectomy was done in 25 (83.3%), total thyroidectomy 4 (13.3%), and completion thyroidectomy with neck dissection in 1 (3.3%). Among total thyroidectomies, transient hypocalcemia occurred in 2 (6.6%) and no temporary or permanent recurrent laryngeal nerve palsy.Conclusions: The use of microsurgical technique and loupes magnification in thyroid surgery are safety and effective procedures that require an appropriate training in microsurgery, but may significantly reduce post-operative complications.

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Assessment of morbidity and mortality of thyroid surgery

Anwer Khan Modern Medical College Journal ◽

10.3329/akmmcj.v6i2.31587 ◽

2017 ◽

Vol 6 (2) ◽

pp. 15-19

Author(s):

Md Mostafizur Rahman ◽

SM Golam Rabbani ◽

Md Abdur Rashid ◽

M Alamgir Chowdhury ◽

Fatema Nihar ◽

...

Keyword(s):

Recurrent Laryngeal Nerve ◽

Thyroid Surgery ◽

Nerve Palsy ◽

Recurrent Laryngeal Nerve Palsy ◽

Surgical Techniques ◽

Laryngeal Nerve ◽

Morbidity And Mortality ◽

Medical College ◽

Laryngeal Nerve Palsy ◽

Management Of Complications

Background: To find out the incidence and types of complications after thyroidectomy.To analyze the factors related to the complications of thyroid surgery.Material and method: The study was carried out at Shahid Suhrawardy medical college and Hospital, Dhaka from July 2007 to June 2008. Fifty patients were selected for the study who were treated by thyroidectomy. The mean patient's age at the time of surgery was 41.9±8.1 years ranged from 10 to 60 years. Data were collected in a prescribed data collection sheet. Then all data were compiled and analyzed.Result: 12% of the patients had transient hypoparathyroidism, 4% had haemorrhage, 2% had permanent hypoparathyroidism, 4% had temporary recurrent laryngeal nerve (RLN) palsy and 2% had permanent recurrent laryngeal nerve palsy. Other rare complications were superior laryngeal nerve palsy, hematoma, and wound infection.Conclusion: Improved surgical techniques and proper management of complications reduce the postoperative morbidity and mortality of thyroid surgery. In spite of all measures, keen observation in postoperative period is very important to find out the complications for early intervention.Anwer Khan Modern Medical College Journal Vol. 6, No. 2: July 2015, P 15-19

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Value of intra-operative neuromonitoring of the recurrent laryngeal nerve in total thyroidectomy for benign goitre

The Journal of Laryngology & Otology ◽

10.1017/s0022215115001152 ◽

2015 ◽

Vol 129 (6) ◽

pp. 553-557 ◽

Cited By ~ 7

Author(s):

C Page ◽

P Cuvelier ◽

A Biet ◽

V Strunski

Keyword(s):

Recurrent Laryngeal Nerve ◽

Total Thyroidectomy ◽

Nerve Palsy ◽

Recurrent Laryngeal Nerve Palsy ◽

Laryngeal Nerve ◽

Control Group ◽

Laryngeal Nerve Palsy ◽

Significant Difference ◽

Patient Groups ◽

The Impact

AbstractObjective:This study aimed to evaluate the impact of intra-operative neuromonitoring of the recurrent laryngeal nerve during total thyroidectomy for benign goitre.Methods:A single-centre retrospective study using historical controls was conducted for a 10-year period, comprising a series of 767 patients treated by total thyroidectomy for benign goitre. Of these, 306 had intra-operative neuromonitoring of the recurrent laryngeal nerve and 461 did not. Post-operative laryngeal mobility was assessed in all patients by direct laryngoscopy before hospital discharge and at post-operative follow-up visits.Results:In all, 6 out of 461 patients (1.30 per cent) in the control group and 6 out of 306 patients (1.96 per cent) in the intra-operative neuromonitoring group developed permanent recurrent laryngeal nerve palsy. No statistically significant difference was observed between the two patient groups.Conclusion:Intra-operative neuromonitoring does not appear to affect the post-operative recurrent laryngeal nerve palsy rate or to reliably predict post-operative recurrent laryngeal nerve palsy. However, it can accurately predict good nerve function after thyroidectomy.

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Comparison of Recurrent Laryngeal Nerve Identification Time in the Lower Central Triangle During Thyroid Surgery Using Neurophysiological Mapping and Monitoring

Medicina ◽

10.3390/medicina57080748 ◽

2021 ◽

Vol 57 (8) ◽

pp. 748

Author(s):

Eunhye Lee ◽

Keunchul Lee ◽

Hyeongwon Yu ◽

Sujin Kim ◽

Youngjun Chai ◽

...

Keyword(s):

Recurrent Laryngeal Nerve ◽

Vocal Cord ◽

Thyroid Surgery ◽

Vocal Cord Palsy ◽

Laryngeal Nerve ◽

Follicular Neoplasm ◽

National University ◽

Seoul National University ◽

Definition Of ◽

Intraoperative Nerve Monitoring

Background and Objectives: Preserving the recurrent laryngeal nerve (RLN) is important in thyroid surgery. However, no standardized surgical method for locating the RLN has been established. We defined a new anatomical definition termed “lower central triangle” (LCT) for consistent identification of RLN and used intraoperative nerve monitoring (IONM) to aid in identification and dissection of RLN. Materials and Methods: Patients undergone thyroidectomy were reviewed retrospectively in Seoul National University Bundang Hospital from January to September 2017. Patients with papillary thyroid carcinoma, follicular neoplasm, and Graves’ Disease were included while right side non-RLN in arteriosus lusoria, cancer invasion, pre-existing vocal cord palsy, or under the age of 18 were excluded. RLNs were tested with IONM within LCT consisting of the lower pole as the apex and the common carotid artery as the opposite side. The samples were divided into two groups, IONM and non-IONM. Results: Forty lobes in total were included, 22 in IONM group and 18 in non-IONM group. Groups were not significantly different in age, cancer proportion, and accompanying thyroiditis while sex and nodule size differed. RLN detection time was 10.43 sec shorter (p < 0.001), and confirmation time was 10.67 sec shorter (p = 0.09) in IONM group than in non-IONM group. Both right and left RLNs were located predominately in the middle of LCT. No transient or permanent vocal cord palsy occurred. Conclusions: While IONM is an appropriate aid for thyroidectomy, our approach using LCT to locate the RLN is a novel definition of anatomy that provides prompt identification of the RLN in thyroid surgery.

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