Laryngeal examination in thyroid and parathyroid surgery: An American Head and Neck Society consensus statement

Abstract

This American Head and Neck Society (AHNS) consensus statement discusses the techniques of laryngeal examination for patients undergoing thyroidectomy and parathyroidectomy. It is intended to help guide all clinicians who diagnose or manage adult patients with thyroid disease for whom surgery is indicated, contemplated, or has been performed. This consensus statement concludes that flexible transnasal laryngoscopy is the optimal laryngeal examination technique, with other techniques including laryngeal ultrasound and stroboscopy being useful in selected scenarios. © 2016 Wiley Periodicals, Inc. Head Neck 38: 811–819, 2016

Opportunities and challenges of intermittent and continuous intraoperative neural monitoring in thyroid surgery

“…Among 285 patients who had VF palsy from the very beginning, 36 patients (13%) had a completely normal voice, whereas 41 patients (14.3%) with some degree of hoarseness revealed abnormal IONM signals with preserved nerve conductivity ( Figure 2A). This is why preoperative laryngoscopy is an integral element of IONM, even in the presence of a normal voice (7). Clinical practice has been a different story, though.…”

The Recurrent Laryngeal Nerve and Thyroid Surgery; Who to Scope, When to Visualize, Who to Stimulate

“…For benign diseases, 89% of cord dysfunction will recover post-operatively (4). Some causes of pre-operative hoarseness include hyperaemia (gastro oesophageal reflux), Reinkes oedema, chronic laryngitis and endotracheal intubation (vocal cord injuries occur in 30% of intubations) (4,16). Post operative hoarseness occurs in 30-87% of surgeries while post-operative dysphagia will occur in 50% of cases (4,16).…”

“…Some causes of pre-operative hoarseness include hyperaemia (gastro oesophageal reflux), Reinkes oedema, chronic laryngitis and endotracheal intubation (vocal cord injuries occur in 30% of intubations) (4,16). Post operative hoarseness occurs in 30-87% of surgeries while post-operative dysphagia will occur in 50% of cases (4,16). Causes include recurrent laryngeal nerve injury, external superior laryngeal nerve injury, cricoid muscle dysfunction, soft tissue swelling and intubation injuries (4% of recurrent laryngeal nerve injury is due to intubation) (16).…”

“…Post operative hoarseness occurs in 30-87% of surgeries while post-operative dysphagia will occur in 50% of cases (4,16). Causes include recurrent laryngeal nerve injury, external superior laryngeal nerve injury, cricoid muscle dysfunction, soft tissue swelling and intubation injuries (4% of recurrent laryngeal nerve injury is due to intubation) (16). Vocal cord palsy may be present without voice change and vice versa.…”

“…Vocal cord palsy may be present without voice change and vice versa. Sensitivity of voice changes in predicting cord paralysis greatly varies (33-68%) (4,16). Preop cord assessment is necessary as it directs intraoperative decision making (16).…”