Risk factors for transient vocal cord palsy after thyroidectomy

Sancho, José Luis Valero; Pascual-Damieta, M; Pereira, José António; Carrera, María; Fontané, J; Sitges‐Serra, Antonio

doi:10.1002/bjs.6173

Cited by 94 publications

(87 citation statements)

References 16 publications

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“…Transient vocal cord dysfunction was twice as common in extralaryngeal-branched nerves (15.8% versus 8.1%, P = 0.022). 46 The incidence and importance of this variant is confirmed in other studies. 8,47 We have recently demonstrated that the anterior branch of an extralaryngeal bifurcated RLN carries the motor fibres for all intrinsic laryngeal muscles.…”

Section: Graves' Diseasesupporting

confidence: 60%

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Recurrent laryngeal nerve injury in thyroid surgery: a review

Hayward

Grodski

Yeung

et al. 2012

ANZ Journal of Surgery

207

129

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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.

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Section: Graves' Diseasesupporting

confidence: 60%

“…It is thought that two-thirds of transient palsies will recover within 4 weeks. 46 Dionigi et al reported that 89% of all partial palsies were resolved within 12 months. 32 Several groups support diagnosis of permanent RLNP after 12 months of serial examination with ongoing dysfunction.…”

Section: Perioperative Evaluation Of Rln Functionmentioning

confidence: 99%

Recurrent laryngeal nerve injury in thyroid surgery: a review

Hayward

Grodski

Yeung

et al. 2012

ANZ Journal of Surgery

207

129

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“…They stated that a major factor was that the diameter of the nerve on the left (1.6 mm) was significantly thinner than that on the right (1.7 mm) (p=0.0012). Sancho et al (8) found that the rate of vocal cord paralysis in branched nerves was two times greater thanthat in non-branched nerves (15.8% vs 8.1%, p=0.022). Also, the branching diameter was found to be significantly higher in paralyzed nerves than in functional nerves (29.4+10.4 mm vs 19.1+9.8 mm, p=0.003).…”

Section: Discussionmentioning

confidence: 97%

“…It is reported in some studies that branching is more frequent on the right side than on the left side (8,21). Beneragama and Serpell (21) defined that the anatomic course of the RLN is different on the right and left, and the relationship with the ITA is more variable on the right.…”

Section: Discussionmentioning

confidence: 99%

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Extralaryngeal division of the recurrent laryngeal nerve: A common and asymmetric anatomical variant

et al. 2017

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Results: A total of 161 recurrent laryngeal nerves were examined (82 right, 79 left). Overall, 77 (47.8%) of 161 recurrent laryngeal nerves were bifurcated before entering the larynx. There were 36 (43.9%) branching nerves on the right and 41 (51.9%) branching nerves on the left, and there was no significant difference between the sides in terms of branching (p=0.471). Among 67 patients who underwent bilateral exploration, 28.4% were found to have bilateral branching, 40.3% had unilateral branching, and the remaining 31.3% had no branching. The median branching distance was 15 mm (5-60mm). Conclusion:Extralaryngeal division of recurrent laryngeal nerve is a common and asymmetric anatomical variant. These variations can be easily recognized if the recurrent laryngeal nerve is identified at the level of the inferior thyroid artery and then dissected totally to the entry point of the larynx. Inadvertent division of a branch may lead to vocal cord palsy postoperatively, even when the surgeon believes the integrity of the nerve has been preserved.

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