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Transcutaneous Ultrasonography in Early Postoperative Diagnosis of Vocal Cord Palsy After Total Thyroidectomy

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Abstract

Purpose

This study evaluated the efficiency of transcutaneous laryngeal ultrasonography (TLUS) as an alternative to direct flexible laryngoscopy (DFL) in the early postoperative screening of vocal cord palsy (VCP) after total thyroidectomy, performed for benign and non-extensive malignant disease.

Methods

A prospective study was performed on patients who underwent total thyroidectomy between October 2013 and January 2015 at the Nantes University Hospital (France). Patients underwent DFL on postoperative day 1 performed by an otolaryngologist, followed by TLUS performed by a radiologist on postoperative day 1 or 2.

Results

One hundred and three (103) patients were included in this study, 17.5 % were male and 82.5 % were female, with a mean age of 51 ± 12 years. Nine patients (9.5 %) were diagnosed with postoperative VCP using DFL of these cases 2 were not completely resolved at 3 months postoperatively. Three cases of VCP (33 %) were diagnosed using TLUS. TLUS had a sensitivity of 33 % and a negative predictive value (NPV) of 95 % for the diagnosis of postoperative VCP. Vocal cords (VC) were unassessable in 27.2 % of patients. Unassessable VC were significantly associated with male gender (p = 0.0001), age (p = 0.0001), weight (p = 0.002), operating time (p = 0.032), postoperative drainage (p = 0.001), and thyroid weight (p = 0.001). Independent risk factors in the multivariate analysis were male gender (p = 0.0001) and age (p = 0.0001). In the group of women under 50-year old, TLUS had a sensitivity of 50 % and a NPV of 97.4 %.

Conclusion

TLUS sensitivity is insufficient in early postoperative screening of VCP after thyroid surgery. Ultrasonographic VCP diagnosis should be confirmed with DFL.

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Acknowledgments

The authors thank Dr Emmanuelle Langlois-Mourrain for her participation in performing the ultrasonographies. We also thank Pr Eric Frampas, Dr Cécile Caillard, and Dr Delphine Drui for critical insight and suggestions on this work, and Laurence Toqué and Ludwig Pasquier for their help.

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Authors and Affiliations

  1. Service de Clinique Chirurgicale Digestive et Endocrinienne, CHU Nantes, 1 place Alexis Ricordeau, 44093, Nantes Cedex 1, France

    Frédéric Borel, Andrew Spiers, Eric Mirallie & Claire Blanchard

  2. Service de Radiologie et Imagerie Médicale, CHU Nantes, Nantes, France

    Anne-Sophie Delemazure

  3. Service d’Oto-Rhino-Laryngologie, CHU Nantes, Nantes, France

    Florent Espitalier

Authors
  1. Frédéric Borel
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  2. Anne-Sophie Delemazure
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  3. Florent Espitalier
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  4. Andrew Spiers
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  6. Claire Blanchard
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Corresponding author

Correspondence to Claire Blanchard.

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The authors declare that they have no potential or real conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Human and animal rights and informed consent

Informed consent was obtained from all individual participants included in the study. This article does not contain any studies with animals performed by any of the authors.

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Borel, F., Delemazure, AS., Espitalier, F. et al. Transcutaneous Ultrasonography in Early Postoperative Diagnosis of Vocal Cord Palsy After Total Thyroidectomy. World J Surg 40, 665–671 (2016). https://doi.org/10.1007/s00268-015-3393-x

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  • DOI: https://doi.org/10.1007/s00268-015-3393-x

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