Postoperative recurrent nerve palsy

Abstract

During the past seven years, a total of 1,713 patients underwent strumectomy for a variety of causes at the University of Düsseldorf. Unilateral palsies of the recurrent nerve developed in 147 patients. Both vocal cords were paralyzed in 22 patients. Of the 147 patients with unilateral palsies, 53 patients were available for follow-up examination after one year. In 28 of these patients, complete paresis of the vocal cord remained. Twenty-three patients showed complete recovery and normal function of the affected cord. In two patients, reduced but marked mobility of the previously completely paralyzed vocal cord was present. Of the 22 patients with bilateral recurrent nerve palsies, 10 were available for follow-up examination one year later. In three of these patients vocal cord movement was still absent, in three others one vocal cord showed normal function, and in only one patient did both vocal cords reveal normal physiologic mobility. Three other patients demonstrated a reduced but marked mobility of one vocal cord. The results are discussed in relation to the clinical and histologic data.

Continuous vagal IONM prevents recurrent laryngeal nerve paralysis by revealing initial EMG changes of impending neuropraxic injury: A prospective, multicenter study

“…Injury to the RLN can result from transection, compression, stretch, or thermal trauma to the main trunk or its branches . Nerve injuries may be divided into three categories: neuropraxia, axonotmesis, or neurotmesis, according to the Seddon classification .…”

“…Injury to the RLN can result from transection, compression, stretch, or thermal trauma to the main trunk or its branches. 37,38 Nerve injuries may be divided into three categories: neuropraxia, axonotmesis, or neurotmesis, according to the Seddon classification. 39 Of our five cases of nonreversible LOS, one case was a Type I segmental injury at the ligament of Berry/nerve entry site, and four cases were Type II global injuries.…”

International neural monitoring study group guideline 2018 part I: Staging bilateral thyroid surgery with monitoring loss of signal

“…Bilateral VCP rates may also be difficult to obtain, given the associated symptom variability, inconsistency in performing postoperative laryngeal exam, and variability in the need to secure the airway surgically. In existing English literature reporting on bilateral VCP, when bilateral VCP occurs after thyroidectomy, it is found to be permanent in 45% of patients . The risk of tracheotomy with bilateral VCP averages 30%, with an additional 21% requiring other varieties of acute airway surgery.…”

Need for an Individualized and Aggressive Management of Multinodular Goiters of Endemic Zones by Specially Trained Surgeons: Experience in Western Nepal

“…59,60 Complications rates are low in expert hands after total thyroidectomy as shown by many studies. [61][62][63][64][65] However, even after subtotal thyroidectomy, suppressive therapy was initially given in some patients, especially those with larger goiters in whom disease pathophysiology is not altered. Suppressive therapy was later discontinued because of risks related to subclinical hyperthyroidism in the elderly.…”