Transient bilateral vocal fold paralysis after total thyroidectomy

Dy, Alexander Edward S.; Lapeña, José Florencio F.

doi:10.5606/kbbihtisas.2016.43077

Cited by 3 publications

(2 citation statements)

References 14 publications

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“…Dy and Lapeña reported a case of transient bilateral vocal fold paralysis after total thyroidectomy and asked whether branched recurrent laryngeal nerves may be a risk factor for transient and permanent vocal cord paresis after surgery. 19 We set out to address the divergence between superior-inferior and inferior-superior approaches. However, our study cannot favor either approach as it showed no significant difference between both approaches in terms of postoperative hoarseness and hypocalcemia and the status quo remains.…”

Section: Discussionmentioning

confidence: 99%

Recurrent Laryngeal Nerve Paralysis and Hypocalcemia in Superior to Inferior Compared to Inferior to Superior Dissection Approaches in Thyroidectomy

Yu¹

2018

Philipp J Otolaryngol Head Neck Surg

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Objective: To compare the incidence of recurrent laryngeal nerve injury and hypocalcemia in patients who underwent thyroidectomy using a superior-inferior versus an inferior to superior approach in identifying the recurrent laryngeal nerve in a tertiary government hospital between January 2012 to December 2016. Methods Design: Retrospective Cohort Study Setting: Tertiary Government Hospital Patients: Records of two hundred forty-one (241) adult patients who underwent surgery for thyroid diseases in the department of Otorhinolaryngology – Head and Neck Surgery between January 2012 and December 2016 were evaluated. Records of patients with postoperative hoarseness after total thyroidectomy or lobectomy with isthmusectomy and hypocalcemia after total thyroidectomy were reviewed, and operative techniques analyzed for the approaches to recurrent laryngeal nerve identification. Results: Records of 119 patients (aged 20-73; median 41-years-old) meeting inclusion and exclusion criteria were analyzed. Of 57 thyroidectomies using a superior-inferior approach, 42 were bilateral, totaling 99; of 62 using an inferior-superior approach, 40 were bilateral, totaling 102. There was a higher incidence of post-operative complications among those who underwent inferior-superior dissection than those who underwent superior-inferior dissection. Chi square test showed the former approach (versus the latter) had 4.86 times the relative risk (RR) of permanent RLN injury (1.9%, 0.0475 to 5.5914, p=.3058), 1.62 times the RR of transient RLN injury (5%, 0.3971 to 6.5889, p=.5021), 1.92 times the RR of permanent hypocalcemia (1.9%, 0.0.1806 to 21.2838, p=.5910), and 2.06 times the RR of transient hypocalcemia (17%, 0.9055 to 4.4333, P=.0738). However, there was no significant difference between the two approaches with regard to hoarseness (independent t test, t value 0.90; p = .367) or hypocalcemia (t=0.428; p= .796). Conclusion: There is no significant difference in the incidence of recurrent laryngeal nerve injury and hypocalcemia in patients who underwent thyroidectomy using a superior-inferior versus an inferior to superior approach in identifying the recurrent laryngeal nerve. Intraoperatively, surgeons may shift from one approach to the other as needed, and we recommend that they be well versed in both approaches and fully knowledgeable of the various anatomical courses of the recurrent laryngeal nerve and locations of parathyroid gland. Keywords: recurrent laryngeal nerve injuries, thyroid neoplasms, thyroidectomy, vocal cord paralysis, hypoparathyroidism, hypocalcemia

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Section: Discussionmentioning

confidence: 99%

Recurrent Laryngeal Nerve Paralysis and Hypocalcemia in Superior to Inferior Compared to Inferior to Superior Dissection Approaches in Thyroidectomy

Yu¹

2018

Philipp J Otolaryngol Head Neck Surg

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“…• Bilateral RLN palsy as a complication of thyroid surgery is seen exclusively in total thyroidectomy, and has been described in numerous studies [2,3] .…”

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confidence: 99%