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Is There Any Reliable Predictor of Functional Recovery Following Post-thyroidectomy Vocal Fold Paralysis?

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Abstract

Background

Predicting definitive outcomes of post-thyroidectomy vocal fold paralysis (VFP) is challenging. We aimed to identify reliable predictors based on intraoperative neuromonitoring (IONM) and flexible fiberoptic laryngostroboscopy (FFL) findings.

Methods

Among 1172 thyroid operations performed from April to December 2021, all patients who exhibited vocal fold paralysis (VFP) at post-operative laryngoscopy were included. IONM data, including type of loss of signal (LOS), were collected. Patients underwent FFL, with arytenoid motility assessment, at 15, 45 and 120 days post-operatively. Patients were divided into two groups: those who recovered vocal fold motility (VFM) by the 120th post-operative day (recovery group) and those who did not (non-recovery group).

Results

Fifty-nine VFP cases (5.0% of total patients) met the inclusion criteria. Eight patients were lost at follow-up and were excluded. Overall, 9 patients were included in the non-recovery group (0.8% of total patients) and 42 in the recovery group. Among various predictive factors, only arytenoid fixation (AF) at the 15th post-operative day and Type I LOS were significant predictors for no VFM recovery (p = 0.007, RR = 9.739, CI:1.3–72.3 and p = 0.001, RR = 9.25, CI:2.2–39.3 for AF and Type I injury, respectively). The combination of type of LOS and arytenoid motility at the 15th post-op day yielded satisfactory predictive values for the progression of transient VFP to permanent.

Conclusions

Arytenoid motility at the 15th post-op day and type II LOS are associated with recovery of VFM. Type of LOS and FFL could be included in the follow-up protocols of patients with VFP to reliably predict clinical outcomes.

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Acknowledgements

The authors would like to extend their deep appreciation to the personnel of the Division of Endocrine and Metabolic Surgery and of the Department of Otolaryngology for assisting in the conduction of this study

Funding

All the authors declare that they have received no funding for this study.

Author information

Author notes

  1. Luca Revelli and Pierpaolo Gallucci contributed equally to this work and share co-authorship.

Authors and Affiliations

  1. Centro di Ricerca in Chirurgia delle Ghiandole Endocrine e dell’Obesità, Università Cattolica del Sacro Cuore, Rome, Italy

    Luca Revelli, Pierpaolo Gallucci, Nikolaos Voloudakis, Sofia Di Lorenzo, Lucia D’Alatri, Francesco Pennestri, Carmela De Crea & Marco Raffaelli

  2. UOC Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy

    Luca Revelli, Pierpaolo Gallucci, Nikolaos Voloudakis, Sofia Di Lorenzo, Francesco Pennestri, Carmela De Crea & Marco Raffaelli

  3. UOC Otorinolaringoiatria, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy

    Maria Raffaella Marchese, Claudio Montuori & Lucia D’Alatri

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  1. Luca Revelli
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Correspondence to Nikolaos Voloudakis.

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Conflict of interest

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Ethical approval

The authors declare to have read, understood and comply with the ethical requirements guidelines of SJEG. This study was approved by the Ethics Committee of Fondazione Policlinico Universitario Agostino Gemelli IRCCS (Protocol number: 23274/21).

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Informed consent was obtained from all individual participants included in the study.

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This study was accepted for oral presentation at the International Surgical Week 2022–2022 Meeting of the International Association of Endocrine Surgeons (I.A.E.S.), Vienna (Austria) 15–18th August 2022.

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Revelli, L., Gallucci, P., Marchese, M.R. et al. Is There Any Reliable Predictor of Functional Recovery Following Post-thyroidectomy Vocal Fold Paralysis?. World J Surg 47, 429–436 (2023). https://doi.org/10.1007/s00268-022-06765-w

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