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

Sarma, Mridul Kumar; Kakati, Kaberi; Sharma, Kalpana; Goswami, S. C.

doi:10.18203/2320-6012.ijrms20150242

Cited by 6 publications

(16 citation statements)

References 16 publications

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“…Majority of patients in our study were Euthyroid when they presented, and it was comparable to study by Sarma MK et al 18 In study done by Patel MM et al 19 hyperthyroid state was more predominant (Table 16).…”

Section: Thyroid Function Statussupporting

confidence: 89%

“…When compared with studies done by V Yagnik et al, 20 Zakaria HM et al, 10 Formanez AJ, 11 Joliat GR et al, 21 the rate of RLN palsy in our study was less. Only in one study done by Sarma MK et al 18 the rate of RLN injury was slightly lesser when compared with our study. In study done by Zakaria HM et al 10 it was 0.29% which was slightly less than our study (Table 17).…”

Section: Rln Palsycontrasting

confidence: 77%

“…In all studies mentioned except one, the rate of Temporary RLN injury was higher than our study. Only in study by Sarma MK et al 18 transient RLN injury was less than our study. In studies done by Formanez A. J.…”

Section: Rln Palsycontrasting

confidence: 68%

“…NTT procedure was performed for 14 patients (28.8%), 28 RLNs were at risk. 18 RLNs were identified and one of them was injured, 10 RLNs were not identified and none of them was injured the p value was 0.107 which was not significant. STT were performed for 19 patients (18.8%), 38 RLNs were at risk.…”

Section: Figure 3 Laterality Of Rln Palsymentioning

confidence: 81%

“…In a study done by Sarma MK et al 18 and Zakaria HM et al 10 the most common indication for surgery was colloid goiter followed by MNG. In a study done by Zakaria HM et al 10 most common indication for surgery was MNG which was similar to the present study.…”

Section: Diagnosismentioning

confidence: 99%

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Descriptive Analytical Study of Recurrent Laryngeal Nerve Palsy in Thyroidectomy- Identified versus Non-Identified Recurrent Laryngeal Nerve

Shameem¹,

Goli²

2019

jebmh

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BACKGROUND Unilateral or Bilateral Recurrent Laryngeal Nerve (RLN) injuries represent one of the most feared complications after thyroid and parathyroid surgeries. We wanted to estimate the incidence rate of RLN injury in patients undergoing thyroidectomy and compare it when RLN was identified and when not identified during thyroidectomy. METHODS 65 patients admitted for thyroid disorders who underwent thyroidectomy were included. Preoperatively and post operatively, indirect laryngoscopy was done in all patients and patients with immobile vocal cords were excluded from the study. Patients were followed during the 1 st post-op week for any symptoms of RLN injury. Indirect laryngoscopy was done in all the patients on post op day 5 and follow up was done up to 6 months. The patients with vocal cord palsy were subjected to voice therapy. Upon follow up for 6 months, if the patient recovered, it was taken as transient RLN injury and in patients in whom immobility was persistent for more than 6 months it was considered as permanent RLN injury. RESULTS The age of patients ranged from 19 to 75 years, with a mean age of 45.94±12.05 years. Most of the patients who underwent thyroidectomy in our institute were between 30 to 50 years of age. Among the 101 cases, 84 (83.1%) were female and 17 (16.9%) were male with a female to male ratio of 4.9:1. Majority (60.3%) of cases was euthyroid, followed by hypothyroid 23 (22.7). Hyperthyroid state was observed in 17 (16.8%) cases. Benign thyroid disease accounted for 94.1% (n=95) of the patients operated while cancer of the thyroid was noted in 5.9% (n=6). Majority of patients (57.4%) underwent Total Thyroidectomy (TT) followed by Sub-Total Thyroidectomy (STT) (18.8%). Hemi-thyroidectomy was done in 10 patients (9.9%) where only 1 out of 2 nerves was at risk. Total Nerves at risk of injury (TNR) were 192. The rate of recurrent laryngeal nerve injury in the present study was 3.125 for every 100 thyroidectomies done in our institute. During the study period, 5.9% of the patients who underwent thyroidectomy developed RLN palsy wherein 3.125% of the total 192 nerves at risk were injured. CONCLUSIONS Routine post-operative follow-up of patients with indirect laryngoscopy appears to help in early identification of RLN palsy. It appears that identification of RLN during thyroidectomy is likely to reduce the rates of recurrent laryngeal nerve injury especially while doing total thyroidectomy.

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Section: Thyroid Function Statussupporting

confidence: 89%

Section: Rln Palsycontrasting

confidence: 77%

Section: Rln Palsycontrasting

confidence: 68%

Section: Figure 3 Laterality Of Rln Palsymentioning

confidence: 81%

Section: Diagnosismentioning

confidence: 99%

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Descriptive Analytical Study of Recurrent Laryngeal Nerve Palsy in Thyroidectomy- Identified versus Non-Identified Recurrent Laryngeal Nerve

Shameem¹,

Goli²

2019

jebmh

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Incidence of Vocal Cord Palsy in Patients Undergoing Thyroid Surgery for Benign Causes and the Impact of Age, Gender, Type of Thyroid Surgery, and an Indication of Surgery on It

Kareem,

Abdulkareem

2022

JSMC

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Background Thyroidectomy is common neck surgery, and recurrent laryngeal nerve (RLN) palsy is one of its devastating complications. Objectives To know the incidence of RLN palsy in patients who underwent thyroid surgeries for benign diseases in Sulaimani city and the effect of age, gender, and indication and types of surgery on its incidence. Patients and Methods The prospective observational study included 112 patients admitted to the Otolaryngology/Head and Neck Surgery Department of Sulaimani Teaching Hospital and private hospitals in Sulaimani from May to October 2020. All cases of thyroidectomy for benign conditions were included. Patients with voice problems before surgery, thyroid malignancies, follow up for less than one month, and a history of aerodigestive tract surgery was excluded. Age, gender, and preoperative symptoms were recorded. Indications, type and technique of surgery, pre-and postoperative vocal cord status, and complications were evaluated. Mallampati scores were recorded. Results The mean ± SD (standard deviation) of patients’ ages was 43.5 ± 13.03 years, ranging from 21 to 75 years. The female to male ratio was 4.9:1, and 78 patients (69.6%) had abnormal thyroid function tests. All collected parameters from age, gender, indication and technique or type of surgery had no significant effect on postoperative vocal cord status. Conclusion The association of age, gender, type and technique of the surgery, indication for surgery, and the diagnosis of thyroid problem with the development of RLN palsy were statistically not significant.

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Rekürren Laringeal Sinirin Hidrodiseksiyon ile Görülmesi ve Korunması

Akbulut

Gökçe

Bayar³

et al. 2021

Ankara Eğitim Ve Araştırma Hastanesi Tıp Dergisi

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Recurrent laryngeal nerve (RLN) injury is the most feared complication of thyroid surgery. Hydrodissection; separation of tissues by fluids is described in laparoscopic cholecystectomy, cataract surgery, carpal tunnel syndrome treatment where meticulous dissection must be carried out. In this study, we aimed to assess the incidence of RLN damage observed in our series by hydrodissection of RLN during thyroid surgery. MATERIAL AND METHOD:Thirty four consecutive patients underwent thyroidectomy for various thyroid diseases in 18 months were included in the study. All the patients' demographic variables (age, sex), operation type (bilateral total thyroidectomy, hemithyroidectomy (total lobectomy and isthmectomy), completion total thyroidectomy, whether central neck compartment dissection was performed), pathology reports, nerves at risk were noted retrospectively.RESULTS: Only in one case, temporary unilateral RLN paralysis causing hoarseness was observed, after total thyroidectomy performed for voluminous toxic multinodular goitre. CONCLUSION:Hydrodissection is an easily applicable, non timeconsuming and cheap technique. This preliminary study may be followed by further researches with larger sample sizes.

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

Cited by 6 publications

References 16 publications

Descriptive Analytical Study of Recurrent Laryngeal Nerve Palsy in Thyroidectomy- Identified versus Non-Identified Recurrent Laryngeal Nerve

Descriptive Analytical Study of Recurrent Laryngeal Nerve Palsy in Thyroidectomy- Identified versus Non-Identified Recurrent Laryngeal Nerve

Incidence of Vocal Cord Palsy in Patients Undergoing Thyroid Surgery for Benign Causes and the Impact of Age, Gender, Type of Thyroid Surgery, and an Indication of Surgery on It

Rekürren Laringeal Sinirin Hidrodiseksiyon ile Görülmesi ve Korunması

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