Skip to main content

Advertisement

SpringerLink
Log in

Risk factors predisposing for recurrent laryngeal nerve palsy following thyroid malignancy surgery: experience from a tertiary oncology centre

  • Head and Neck
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Background

Postoperative recurrent laryngeal nerve (RLN) palsy is one of the major morbidities encountered after thyroid surgery. The risk further increases when surgery is performed for thyroid malignancies.

Methodology

A retrospective study of patients who underwent hemi, total or completion thyroidectomy at our institute between June 2017 to May 2019 were analyzed. We assessed factors that predisposed to the development of RLN palsy.

Results

The study comprised of 228 patients. A total of 400 nerves were at risk. The RLN palsy rate was 6.8% (n = 27). On univariate and multivariate analysis, the risk of RLN palsy was seen most with pT4a tumor (OR = 8.5), gross extra-thyroidal extension (ETE) (OR = 3.5) and tracheo-esophageal groove (TEG) (OR = 2.8) involvement, followed by aggressive histopathology, and central compartment node positivity.

Conclusion

pT4a tumors, gross ETE, and TEG involvement were the leading causes predisposing for the development of RLN palsy in our series.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Efremidou EI et al (2009) The efficacy and safety of total thyroidectomy in the management of benign thyroid disease: a review of 932 cases. Can J Surg 52(1):39

    PubMed  PubMed Central  Google Scholar 

  2. Steurer M et al (2002) 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 112(1):124–133

    Article  Google Scholar 

  3. Crumley RL (1994) Unilateral recurrent laryngeal nerve paralysis. J Voice 8(1):79–83

    Article  CAS  Google Scholar 

  4. Altorjay Á et al (2009) Place and value of the recurrent laryngeal nerve (RLN) palpatory method in preventing RLN palsy during thyroid surgery. Head Neck 31(4):538–547

    Article  Google Scholar 

  5. Erbil Y et al (2007) Predictive factors for recurrent laryngeal nerve palsy and hypoparathyroidism after thyroid surgery. Clin Otolaryngol 32(1):32–37

    Article  CAS  Google Scholar 

  6. Jatzko GR et al (1994) Recurrent nerve palsy after thyroid operations—principal nerve identification and a literature review. Surgery 115(2):139–144

    CAS  PubMed  Google Scholar 

  7. Sevim TJ (2007) Risk factors for permanent laryngeal nerve paralysis in patients with thyroid carcinoma. Clin Otolaryngol 32(5):378–383

    Article  CAS  Google Scholar 

  8. Atallah I et al (2009) Role of intraoperative neuromonitoring of the recurrent laryngeal nerve in high-risk thyroid surgery. J Otolaryngol Head Neck Surg 38(6):613–618

    PubMed  Google Scholar 

  9. Barczyński M et al (2009) Randomized clinical trial of visualization versus neuromonitoring of recurrent laryngeal nerves during thyroidectomy. Br J Surg 96(3):240–246

    Article  Google Scholar 

  10. Pisanu A et al (2014) Systematic review with meta-analysis of studies comparing intraoperative neuromonitoring of recurrent laryngeal nerves versus visualization alone during thyroidectomy. J Surg Res 188(1):152–161

    Article  Google Scholar 

  11. Pantvaidya G et al (2018) Does the recurrent laryngeal nerve recover function after initial dysfunction in patients undergoing thyroidectomy? Laryngoscope Investig Otolaryngol 3(3):249–252

    Article  Google Scholar 

  12. Tuttle RM, Haugen B, Perrier ND (2017) Updated American Joint Committee on Cancer/tumor-node-metastasis staging system for differentiated and anaplastic thyroid cancer: what changed and why?. Mary Ann Liebert, New York

    Google Scholar 

  13. Čelakovský P et al (2011) Risk factors for recurrent laryngeal nerve palsy after thyroidectomy. Cent Eur J Med 6(3):279–283

    Google Scholar 

  14. Zakaria HM et al (2011) Recurrent laryngeal nerve injury in thyroid surgery. Oman Med J 26(1):34

    Article  Google Scholar 

  15. Passler C et al (2002) Thyroid surgery in the geriatric patient. Arch Surg 137(11):1243–1248

    Article  Google Scholar 

  16. Jiang Y et al (2014) Prevention and treatment of recurrent laryngeal nerve injury in thyroid surgery. Int J Clin Exp Med 7(1):101

    PubMed  PubMed Central  Google Scholar 

  17. Chiang F-Y et al (2005) Recurrent laryngeal nerve palsy after thyroidectomy with routine identification of the recurrent laryngeal nerve. Surgery 137(3):342–347

    Article  Google Scholar 

  18. Ooi LL, Soo KC (1992) Tracheo-oesophageal groove clearance in well-differentiated thyroid carcinoma. Ann Acta Med Singapore 21(5):699–700

    CAS  Google Scholar 

  19. Roh J-L, Kim J-M, Park CI (2008) Lateral cervical lymph node metastases from papillary thyroid carcinoma: pattern of nodal metastases and optimal strategy for neck dissection. Ann Surg Oncol 15(4):1177–1182

    Article  Google Scholar 

  20. Shaha AR (1998) Management of the neck in thyroid cancer. Otolaryngol Clin N Am 31(5):823–831

    Article  CAS  Google Scholar 

  21. Silver CE et al (2011) Aggressive variants of papillary thyroid carcinoma. Head Neck 33(7):1052–1059

    Article  Google Scholar 

  22. Asioli S et al (2014) Cytomorphologic and molecular features of hobnail variant of papillary thyroid carcinoma: case series and literature review. Diagn Cytopathol 42(1):78–84

    Article  Google Scholar 

  23. Chow S-M et al (2003) Diffuse sclerosing variant of papillary thyroid carcinoma—clinical features and outcome. Eur J Surg Oncol 29(5):446–449

    Article  Google Scholar 

  24. Mazzaferri EL, Doherty GM, Steward DL (2009) The pros and cons of prophylactic central compartment lymph node dissection for papillary thyroid carcinoma. Thyroid 19(7):683–689

    Article  Google Scholar 

  25. Pereira JA et al (2005) Nodal yield, morbidity, and recurrence after central neck dissection for papillary thyroid carcinoma. Surgery 138(6):1095–1101

    Article  Google Scholar 

  26. Pantvaidya G et al (2017) Morbidity of central compartment clearance: comparison of lesser versus complete clearance in patients with thyroid cancer. J Cancer Res Ther 13(1):102

    Article  CAS  Google Scholar 

  27. Zheng S et al (2013) Effect of intraoperative neuromonitoring on recurrent laryngeal nerve palsy rates after thyroid surgery—a meta-analysis. J Formos Med Assoc 112(8):463–472

    Article  Google Scholar 

  28. Duclos A et al (2011) Influence of intraoperative neuromonitoring on surgeons’ technique during thyroidectomy. World J Surg 35(4):773–778

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Head and Neck Surgical Oncology, Homi Bhabha National Institute, Tata Memorial Hospital, Parel, Mumbai, 400012, India

    Supreet Singh Nayyar, Shivakumar Thiagarajan, Akshat Malik, Adhara Chakraborthy & Devendra Chaukar

  2. Division of Neurosurgery, Department of Surgical Oncology, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, India

    Parthiban Velayutham

Authors
  1. Supreet Singh Nayyar
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shivakumar Thiagarajan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Akshat Malik
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Adhara Chakraborthy
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Parthiban Velayutham
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Devendra Chaukar
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Shivakumar Thiagarajan.

Ethics declarations

Conflict of interest

No potential conflicts of interest to disclose for any author.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Nayyar, S.S., Thiagarajan, S., Malik, A. et al. Risk factors predisposing for recurrent laryngeal nerve palsy following thyroid malignancy surgery: experience from a tertiary oncology centre. Eur Arch Otorhinolaryngol 277, 1199–1204 (2020). https://doi.org/10.1007/s00405-020-05788-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00405-020-05788-0

Keywords

Search

Navigation