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Postoperative laryngoscopy in thyroid surgery: proper timing to detect recurrent laryngeal nerve injury

Langenbeck's Archives of Surgery volume 395, pages 327–331 (2010)Cite this article

Abstract

Background

There is currently a lack of consensus to support the proper timing for postoperative laryngoscopy that is reliable to diagnose recurrent laryngeal nerve palsy (RLNP) after thyroid surgery. The purpose of this study was to investigate the impact of different time intervals of fiber-optic nasolaryngoscopy (FNL) on the diagnosis of RLNP.

Method

FNL was performed postoperatively at day 0 (T1), at second day post-op (T2), and +2 weeks (T3). For patients with RLNP, repeated examinations were performed at +2 (T4), +6 (T5), and +12 months (T6).

Results

Four hundred thirty-four patients appear for postoperative FNL, providing 825 nerves at risk. Permanent RLNP occurred in 0.7%, temporary RLNP in 6.7%. RLNP rate was 6.4% at T1, 6.7% at T2, 4.8% at T3, 2.5% at T4, 0.8% at T5, and 0.7% at T6. Full recovery of vocal cord function was confirmed after rehabilitation in 87.5% of cases at T5 and 89% in T6. T2 was significantly superior to T3 in terms of diagnosis of RLNP (P < 0.05). Of patients at T2, 10.7% did not see any reason to FNL because of their normal voice register.

Conclusion

FNL is essential for the detection of vocal cord paralysis after thyroidectomy. We report different time evaluation criteria of vocal cord motility with great and significant variability of results. Second day post-op inspection of the larynx (T2) is suggested. Symptomatic voice assessment is insufficient.

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References

  1. Brok HA, Copper MP, Stroeve RJ, Ongerboer de Visser BW, Venker-van Haagen AJ, Schouwenburg PF (1999) Evidence for recurrent laryngeal nerve contribution in motor innervation of the human cricopharyngeal muscle. Laryngoscope 109(5):705–708

    Article  CAS  PubMed  Google Scholar 

  2. Lahey FH, Hoover WB (1938) Injuries to the recurrent laryngeal nerve in thyroid operations: their management and avoidance. Ann Surg 108(4):545–562

    CAS  PubMed  Article  Google Scholar 

  3. Hermann M, Alk G, Roka R, Glaser K, Freissmuth M (2002) Laryngeal recurrent nerve injury in surgery for benign thyroid diseases: effect of nerve dissection and impact of individual surgeon in more than 27,000 nerves at risk. Ann Surg 235(2):261–268

    Article  PubMed  Google Scholar 

  4. Thomusch O, Machens A, Sekulla C (2000) Multivariate analysis of risk factors for postoperative complications in benign goiter surgery: prospective multicenter study in Germany. World J Surg 24(11):1335–1341

    Article  CAS  PubMed  Google Scholar 

  5. Barczyński M, Konturek A, Cichoń S (2009) Randomized clinical trial of visualization versus neuromonitoring of recurrent laryngeal nerves during thyroidectomy. Br J Surg 96(3):240–246

    Article  PubMed  Google Scholar 

  6. Bergenfelz A, Jansson S, Kristoffersson A, Mårtensson H, Reihnér E, Wallin G, Lausen I (2008) Complications to thyroid surgery: results as reported in a database from a multicenter audit comprising 3,660 patients. Langenbeck's Arch Surg 393(5):667–673

    Article  CAS  Google Scholar 

  7. Randolph GW (ed) (2003) Surgical anatomy of the recurrent laryngeal nerve. In: Surgery of the thyroid and parathyroid glands. Elsevier Science, Philadelphia

  8. Randolph GW, Kamani D (2006) The importance of preoperative laryngoscopy in patients undergoing thyroidectomy: voice, vocal cord function, and the preoperative detection of invasive thyroid malignancy. Surgery 139(3):357–362

    Article  PubMed  Google Scholar 

  9. Echternach M, Maurer CA, Mencke T, Schilling M, Verse T, Richter B (2009) Laryngeal complications after thyroidectomy: is it always the surgeon? Arch Surg 144(2):149–153

    Article  PubMed  Google Scholar 

  10. Jeannon JP, Orabi AA, Bruch GA, Abdalsalam HA, Simo R (2009) Diagnosis of recurrent laryngeal nerve palsy after thyroidectomy: a systematic review. Int J Clin Pract 63(4):624–629

    Article  PubMed  Google Scholar 

  11. Farrag TY, Samlan RA, Lin FR, Tufano RP (2006) The utility of evaluating true vocal fold motion before thyroid surgery. Laryngoscope 116(2):235–238

    Article  PubMed  Google Scholar 

  12. Schlosser K, Zeuner M, Wagner M, Slater EP, Domínguez Fernández E, Rothmund M, Maschuw K (2007) Laryngoscopy in thyroid surgery: essential standard or unnecessary routine? Surgery 142(6):858–864

    Article  PubMed  Google Scholar 

  13. Miller S (2004) Voice therapy for vocal fold paralysis. Otolaryngol Clin North Am 37(1):105–119

    Article  PubMed  Google Scholar 

  14. Laccourreye O, Papon JF, Kania R, Crevier-Buchman L, Brasnu D, Hans S (2003) Intracordal injection of autologous fat in patients with unilateral laryngeal nerve paralysis: long-term results from the patient's perspective. Laryngoscope 113(3):541–545

    Article  PubMed  Google Scholar 

  15. Seddon H (1965) Nerve injuries. Med Bull (Ann Arbor) 31:4–10

    CAS  Google Scholar 

  16. Wagner HE, Seiler C (1994) Recurrent laryngeal nerve palsy after thyroid gland surgery. Br J Surg 81(2):226–228

    Article  CAS  PubMed  Google Scholar 

  17. Karlan MS, Catz B, Dunkelman D, Uyeda RY, Gleischman S (1984) A safe technique for thyroidectomy with complete nerve dissection and parathyroid preservation. Head Neck Surg 6(6):1014–1019

    Article  CAS  PubMed  Google Scholar 

  18. Chiang FY, Lu IC, Kuo WR (2008) The mechanism of recurrent laryngeal nerve injury during thyroid surgery—the application of intraoperative neuromonitoring. Surgery 143(6):743–749

    Article  PubMed  Google Scholar 

  19. Snyder SK, Lairmore TC, Hendricks JC, Roberts JW (2008) Elucidating mechanisms of recurrent laryngeal nerve injury during thyroidectomy and parathyroidectomy. J Am Coll Surg 206(1):123–130

    Article  PubMed  Google Scholar 

  20. Watkinson JC, British Thyroid Association (2004) The British Thyroid Association guidelines for the management of thyroid cancer in adults. Nucl Med Commun 25(9):897–900

    Article  PubMed  Google Scholar 

  21. Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, Mazzaferri EL, McIver B, Sherman SI, Tuttle RM, American Thyroid Association Guidelines Taskforce (2006) Management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 16(2):109–142

    Article  PubMed  Google Scholar 

  22. Kelchner LN, Stemple JC, Gerdeman E, Le Borgne W, Adam S (1999) Etiology, pathophysiology, treatment choices, and voice results for unilateral adductor vocal fold paralysis: a 3-year retrospective. J Voice 13(4):592–601

    Article  CAS  PubMed  Google Scholar 

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Competing interest

The authors declare that they have no competing interest.

Authors' contributions

GD, PC, and RD have made substantial contributions to acquisition of data; FR and LB contributed to study conception and design; GD contributed to analysis and interpretation of data; LB and RD contributed to drafting of manuscript; and RD contributed to critical revision and supervision.

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Affiliations

  1. Endocrine Surgery Research Center, Department of Surgical Sciences, University of Insubria (Varese-Como), Via Guicciardini 21100, Varese, Italy

    Gianlorenzo Dionigi, Luigi Boni, Francesca Rovera, Stefano Rausei, Paolo Castelnuovo & Renzo Dionigi

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  1. Gianlorenzo Dionigi
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  2. Luigi Boni
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  3. Francesca Rovera
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  4. Stefano Rausei
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  5. Paolo Castelnuovo
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  6. Renzo Dionigi
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Correspondence to Gianlorenzo Dionigi.

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Dionigi, G., Boni, L., Rovera, F. et al. Postoperative laryngoscopy in thyroid surgery: proper timing to detect recurrent laryngeal nerve injury. Langenbecks Arch Surg 395, 327–331 (2010). https://doi.org/10.1007/s00423-009-0581-x

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  • DOI: https://doi.org/10.1007/s00423-009-0581-x

Keywords

  • Thyroidectomy
  • Morbidity
  • Recurrent laryngeal nerve
  • Laryngoscopy