Protection of Laryngeal Nerve Palsy using Amniotic Membrane Shield During Thyroid Surgery

Recurrent laryngeal nerve (RLN) palsy, subjective voice complaints, and iatrogenic hypoparathyroidism are the main risk factors of thyroid surgery (1; 2). The rate of unintentional transient RLN injury after total thyroidectomy has been reported in up to 30% of patients, and permanent paralysis ranges between 1-5.7% (3; 4). In patients undergoing concomitant central and/or lateral node dissection, the reported incidence is even greater (5). Patients with a RLN injury typically experience dysphonia for 10-12 weeks, with approximately 8-10% having a permanent vocal dysfunction. Even in the absence of overt nerve paralysis, voice alterations can be seen in 46-84 % of post-thyroidectomy patients (6; 7). Attempts to decrease the risk of nerve injury have been limited to accurate visualization and meticulous technique, performance of less extensive surgery and/or the use of nerve monitoring devices despite that their usage has never been shown to decrease RLN injury rates (8-10).