Sensitivity and Specificity of Intraoperative Recurrent Laryngeal Nerve Stimulation Test for Predicting Vocal Cord Palsy after Thyroid Surgery
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
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. Therefore, intraoperative awareness of the nerve’s status is of great importance. This study examined the sensitivity and specificity of a palpation technique to detect contraction of the posterior cricoarytenoid muscle (PCA) through the posterior hypopharyngeal wall while the RLN was being stimulated with a disposable nerve stimulator during thyroid surgery (the laryngeal palpation test) to predict postoperative RLN deficits.
A total of 2197 RLNs in 1376 patients were identified to be at risk of injury during thyroidectomy performed between July 2003 and August 2004. Postoperative RLN integrity was assessed using direct laryngoscopy or laryngofiberoscopy to visualize vocal fold mobility.
Altogether, 76 RLNs failed to elicit a PCA contraction in response to nerve stimulation, and 80 cases of temporary vocal cord palsy and 21 cases of permanent vocal cord palsy were recognized on postoperative evaluation. For postoperative vocal cord palsy, the sensitivity and specificity of the laryngeal palpation test were 69.3% and 99.7%, respectively, with a positive predictive value of 92.1% and negative predictive value of 98.5%. For permanent vocal cord palsy, the sensitivity and specificity were 85.7% and 97.3%, respectively, with a positive predictive value of 23.7% and negative predictive value of 99.8%.
The laryngeal palpation test is not a particularly useful method for predicting the level of RLN function after thyroidectomy. All patients must be examined postoperatively by direct laryngoscopy or laryngofiberoscopy to check vocal cord mobility. Even if there is no contraction of the PCA and we detect vocal cord palsy immediately after surgery, vocal cord palsy often recovers within 1 year when visual preservation of RLN is successful.
- Lo CY, Kwok KF, Yuen PW. A prospective evaluation of recurrent laryngeal nerve paralysis during thyroidectomy. Arch Surg 2000;135:204–207 CrossRef
- Steurer M, Passler C, Denk DM, et al. Advantages of recurrent laryngeal nerve identification in thyroidectomy and parathyroidectomy and the importance of preoperative and postoperative laryngoscopic examination in more than 1000 nerves at risk. Laryngoscope 2002;112:124–133 CrossRef
- Jatzko GR, Lisborg PH, Muller MG, et al. Recurrent nerve palsy after thyroid operations—principal nerve identification and a literature review. Surgery 1994;115:139–144
- Chiang FY, Wang LF, Huang YF, et al. Recurrent laryngeal nerve palsy after thyroidectomy with routine identification of the recurrent laryngeal nerve. Surgery 2005;137:342–347 CrossRef
- Randolph GW. Surgical anatomy of the recurrent laryngeal nerve. In Randolph GW, editor, Surgery of the Thyroid and Parathyroid Glands. Philadelphia, Saunders, 2003;300–342
- Beldi G, Kinsbergen T, Schlumpf R. Evaluation of intraoperative recurrent nerve monitoring in thyroid surgery. World J Surg 2004;28:589–591 CrossRef
- Thomusch O, Sekulla C, Walls G, et al. Intraoperative neuromonitoring of surgery for benign goiter. Am J Surg 2002;183:673–678 CrossRef
- Randolph GW, Kobler JB, Wilkins J. Recurrent laryngeal nerve identification and assessment during thyroid surgery: laryngeal palpation. World J Surg 2004;28:755–760 CrossRef
- Armstrong W, Hinton W. Multiple divisions of the recurrent laryngeal nerve: an anatomic study. Arch Surg 1951;62:532–539
- Rustad WH, Morrison LW. Revised anatomy of the recurrent laryngeal nerve: surgical importance based on the dissection of 100 cadavers. Laryngoscope 1952;62:237–249
- Katz AD. Extralaryngeal division of the recurrent laryngeal nerve: report on 400 patients and the 721 nerves measured. Am J Surg 1986;152:407–410 CrossRef
- Nemiroff PM, Katz AD. Extralaryngeal divisions of the recurrent laryngeal nerve; surgical and clinical significance. Am J Surg 1982;144:466–469 CrossRef
- Schweizer V, Dorfl J. The anatomy of the inferior laryngeal nerve. Clin Otolaryngol 1997;22:362–369 CrossRef
- Maranillo E, Leon X, Orus C, et al. Variability in nerve patterns of the adductor muscle group supplied by the recurrent laryngeal nerve. Laryngoscope 2005;115:358–362 CrossRef
- Worsey MJ, Carty SE, Watson CG. Success of unilateral neck exploration for sporadic primary hyperparathyroidism. Surgery 1993;114:1024–1029
- Sensitivity and Specificity of Intraoperative Recurrent Laryngeal Nerve Stimulation Test for Predicting Vocal Cord Palsy after Thyroid Surgery
World Journal of Surgery
Volume 30, Issue 7 , pp 1230-1233
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Industry Sectors
- Author Affiliations
- 1. Kuma Hospital, 8-2-35 Shimoyamate-dori, Chuo-ku, Kobe, 650-0011, Japan