Assessment of recurrent laryngeal nerve function during thyroid surgery

Smith, J.; Douglas, J.; Smith, B.; Ayshford, T.; Dougherty, C.
February 2014
Bulletin of The Royal College of Surgeons of England;Feb2014, Vol. 96 Issue 2, p130
INTRODUCTION There is disparity in the reported incidence of temporary and permanent recurrent laryngeal nerve (RLN) palsy following thyroidectomy. Much of the disparity is due to the method of assessing vocal cord function. We sought to identify the incidence and natural history of temporary and permanent vocal cord palsy following thyroid surgery. The authors wanted to establish whether intraoperative nerve monitoring and stimulation aids in prognosis when managing vocal cord palsy. METHODS Prospective data on consecutive thyroid operations were collected. Intraoperative nerve monitoring and stimulation, using an endotracheal tube mounted device, was performed in all cases. Endoscopic examination of the larynx was performed on the first postoperative day and at three weeks. RESULTS Data on 102 patients and 123 nerves were collated. Temporary and permanent RLN palsy rates were 6.1% and 1.7%. Most RLN palsies were identified on the first postoperative day with all recognised at the three-week review. No preoperative clinical risk factors were identified. Although dysphonia at the three-week follow-up visit was the only significant predictor of vocal cord palsy, only two-thirds of patients with cord palsies were dysphonic. Intraoperative nerve monitoring and stimulation did not predict outcome in terms of vocal cord function. CONCLUSIONS Temporary nerve palsy rates were consistent with other series where direct laryngoscopy is used to assess laryngeal function. Direct laryngoscopy is the only reliable measure of cord function, with intraoperative monitoring being neither a reliable predictor of cord function nor a predictor of eventual laryngeal function. The fact that all temporary palsies recovered within four months has implications for staged procedures.


Related Articles

  • Bilateral vocal cord paralysis associated with laryngeal myxedema. Kovács, Viktória; Teymoortash, Afshin; Werner, Jochen Alfred; Lichtenberger, György // European Archives of Oto-Rhino-Laryngology;Apr2010, Vol. 267 Issue 4, p565 

    For managing dyspnea caused by bilateral vocal cord paralysis as a complication of thyroidectomy in the acute postoperative period, reversible vocal cord lateralisation is performed at the authors’ departments. However, in the later postoperative period of thyroidectomy when there is no...

  • Microscopic bilateral posterior cordotomy in severe obstructive sleep apnea syndrome with bilateral vocal cord paralysis. Sarıman, Nesrin; Koca, Öncel; Boyacı, Zerrin; Levent, Ender; Soylu, Akın; Alparslan, Sümeyye; Saygı, Attila // Sleep & Breathing;Feb2012, Vol. 16 Issue 1, p17 

    Background: Vocal cord paralysis is a rare cause of obstructive sleep apnea syndrome (OSAS). Recurrent laryngeal nerve injury after thyroid gland surgery is one of the leading causes of acquired vocal cord paralysis. Report: A 46-year-old woman with OSAS due to bilateral abductor vocal cord...

  • Sensitivity and Specificity of Intraoperative Recurrent Laryngeal Nerve Stimulation Test for Predicting Vocal Cord Palsy after Thyroid Surgery. Tomoda, Chisato; Hirokawa, Yoshihiro; Uruno, Takashi; Takamura, Yuuki; Ito, Yasuhiro; Miya, Akihiro; Kobayashi, Kaoru; Matsuzuka, Fumio; Kuma, Kanji; Miyauchi, Akira // World Journal of Surgery;Jul2006, Vol. 30 Issue 7, p1230 

    Introduction: Recurrent laryngeal nerve (RLN) palsy after thyroidectomy, although infrequently encountered, can decrease quality of life. In addition to the hoarseness that occurs with unilateral RLN palsy, bilateral RLN palsy leads to dyspnea and often to life-threatening glottal obstruction....

  • Management von Nachblutungen nach Schilddrüsenoperationen. Lorenz, K.; Sekulla, C.; Kern, J.; Dralle, H. // Der Chirurg;Jan2015, Vol. 86 Issue 1, p17 

    The incidence of postoperative hemorrhage following thyroid surgery stands at 1%-2 %. This low incidence contrasts with the significant potential complications of postoperative hemorrhage. Influencing factors and measures mentioned in the literature and own studies are discussed. Although an...

  • Complications and Adverse Effects Associated with Intraoperative Nerve Monitoring During Thyroid Surgery Under General Anesthesia. Chen, Peng; Liang, Feng; Li, Long-yun; Zhao, Guo-qing // Cell Biochemistry & Biophysics;Mar2015, Vol. 71 Issue 2, p1029 

    This study covers a large cohort of patients (3,029 cases) who underwent thyroid surgery under intraoperative nerve monitoring (IONM). Most common problems and complications associated with the surgery were identified and analyzed. On the basis of this analysis, we provide some practical advices...

  • LARYNGOSCOPIC CLINIC. Gore-Tex extrusion following type I thyroplasty. Krane, Natalie A.; Hu, Amanda; Satalof, Robert T. // ENT: Ear, Nose & Throat Journal;Apr/May2016, Vol. 95 Issue 4/5, p138 

    The article discusses the case of a 67-year-old woman who has been diagnosed with type I Gore-Tex thyroplasty. Topics covered include the extrusion of Gore-Tex to treat the right vocal fold paralysis, glottic insufficiency and dysphonia. Also mentioned are the various kinds of implants that can...

  • Evaluation of Intraoperative Recurrent Nerve Monitoring in Thyroid Surgery World J. Surg. Vol. 28, No. 5, May 2004. Beldi, Guido; Kinsbergen, Thomas; Schlumpf, Rolf // World Journal of Surgery;Jun2004, Vol. 28 Issue 6, p589 

    Surgical exposure of the recurrent laryngeal nerve decreases the incidence of nerve injuries during thyroid surgery. Intraoperative neuromonitoring was introduced to facilitate identification and protection of the recurrent laryngeal nerve. Between February 1996 and June 2002 a total of 288...

  • Thyroid surgery complications similar for older, younger patients.  // Endocrine Today;Nov2009, Vol. 7 Issue 13, p31 

    This article discusses a study which compared complications of thyroid surgery in older and younger patients.

  • Thyroid surgery complications similar for older, younger patients.  // Hem/Onc Today;12/10/2009, Vol. 10 Issue 23, p74 

    The article discusses research on the similarity of thyroid surgery complications in older and younger patients, published in a 2009 issue of the journal "Archives of Otolaryngology--Head and Neck Surgery."


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics