Paresis of the larynx after operations on the thyroid gland in an oncological clinic and methodological aspects of its relief

Abstract

Introduction. Paresis and paralysis of the larynx are a fairly common complication after thyroid surgery and are found in all clinics (oncology and endocrinology). The frequency of this complication according to the literature ranges from 4 to 35%. The risk of damage to the recurrent nerve increases especially during repeated operations on the thyroid gland. According to the literature, postoperative transient and persistent paresis of the larynx is distinguished.Aim. To evaluate objective data on the larynx state in the postoperative period, estimate the time required for reversal of laryngeal paresis, and develop a laryngeal function recovery complex for the postoperative period.Materials and methods. We analyzed data on 628 patients treated at the clinic in the department of head and neck tumors in 2020–2021. The study included 47 patients (7.2%) who met the selected criteria. Among them were 40 women and 7 men. The average age is 51 years (43–60 years). The duration of the disease averaged 62 months (24–102). In 38 patients, papillary cancer was detected, in 1 – medullary, in 8 – follicular tumors of a benign nature.Results of the study. Early detection of laryngeal paresis occurred in 42 patients. In 52% (24 patients), postoperative hypocalcemia was detected, which was stopped on the background of drug administration. In 3 patients, fold mobility remained on days 1–2 after surgery, and paresis appeared on days 4–5. Speech therapy work includes a phased set of activities: 1) rational psychotherapy; 2) work on the normalization of physiological and phonation respiration; 3) phonopedic exercises; 4) in the presence of dysphagia, work is carried out to restore the function of swallowing.Conclusions. The development of postoperative paresis of the larynx is possible even if the integrity of the recurrent nerves is preserved; the use of the technique of microsurgical neurolysis can significantly reduce the frequency of paresis of the larynx; with transient paresis, most often mobility is restored after 1-3 months; the use of an integrated approach to the rehabilitation of this category of patients allows to achieve improved functional results; with bilateral persistent paralysis of the larynx, as an alternative to tracheostomy, the chordotomy technique using a CO2 laser can be used.