Recurrent laryngeal nerve injury in thyroid surgery: a review

Abstract

Recurrent laryngeal nerve palsy (RLNP) is an important and potentially catastrophic complication of thyroid surgery. Permanent RLNP occurs in 0.3-3% of cases, with transient palsies in 5-8%. A literature review and analysis of recent data regarding RLNP in thyroid surgery was performed, with particular focus on the identification of high-risk patients, the role of intraoperative identification and dissection of the nerve, and the role of intraoperative neuromonitoring (IONM) and optimal perioperative nerve assessment. In conjunction with the review, data from the Monash University/ Alfred Hospital Endocrine Surgery Unit between January 2007 and October 2011 were retrospectively analysed, including 3736 consecutive nerves at risk (NAR). The current literature and our data confirm that patients undergoing re-operative thyroid surgery and thyroid surgery for malignancies are at increased risk of RLNP. Intraoperative visualization and capsular dissection of the RLN remain the gold standard for intraoperative care during thyroid surgery for reducing RLNP risk. IONM should not be used as the sole mechanism for identifying and preserving the nerve, although it can be used to aid in the identification and dissection of the nerve, and may aid in nerve protection in high-risk cases including cancer surgery and re-operative surgery.

Treatment of Benign Thyroid Nodules: Comparison of Surgery with Radiofrequency Ablation

“…surgery has a high incidence of complications such as recurrent laryngeal nerve injury, hypoparathyroidism, and hypothyroidism 3,4,29,30 ; however, the complication rate reported for RFA was low in the study by Baek et al, 25 a 3.3% complication rate with thyroid RFA in their multicenter study. In our current study, the RFA complication rate was found to be lower than that of surgery.…”

Recurrent laryngeal nerve injury (RLNI) in thyroid surgery and its prevention

“…5 Review of literature revealed that the prevalence of RLN palsy varies from centre to centre depending upon the level of experience in thyroid surgery and the nature of surgery. Aytec and colleagues 15 reported 3.5% and 1.2% incidence of transient and permanent RLN injury, respectively and Hayward et al, 7 reported that permanent RLNP occurs in 0.3-3% of cases, with transient palsies in 5-8%, Chaing 14 has reported figures of 5.1% and 0.9% for transient and permanent RLN injury. Xu and colleagues 16 have reported 0.2% incidence of permanent RLN injury in their study in China.…”

“…6 An almost certain way to ensure the integrity of the RLN is to always identify the nerve during all surgical procedure on thyroid and parathyroid glands. 7 Anatomy of laryngeal nerve is shown in Figure 1. …”

Image-guided thermal ablation of benign thyroid nodules

“…Whereas thyroid surgery is widely available and safe in many centers, it still carries a 2-10 % risk of complications, such as neck scarring, hypothyroidism, postoperative hypoparathyroidism, recurrent laryngeal nerve injury, and the risks associated with general anesthesia. Surgery is also expensive, and may not be appropriate for a surgically high-risk individual [10,[25][26][27][28][29][30]. Over the last decade, thermal ablation techniques, such as laser ablation (LA), radiofrequency ablation (RFA), high-intensity-focus ultrasound (HIFU), and microwave ablation (MWA), have been proposed for the treatment of benign solid thyroid nodules, with encouraging results.…”