English

Abstract

BACKGROUND From the last century to modern days, there has been a paradigm shift in the field of thyroid surgery. Initially what was a dreadful surgery with multi fold serious complications, now with the advent of modern surgical technique (bipolar to nerve monitoring & emerging use of microscope), and better knowledge of anatomy, it has become one of the most frequently performed surgeries worldwide with very few complications. In spite of all these, postoperative complications like recurrent laryngeal nerve (RLN) palsy is still mostly feared by surgeons and still is one of the most frequent complications. METHODS This was a prospective nonrandomised controlled trial conducted among 60 study participants in the Department of Otorhinolaryngology and Head & Neck Surgery, of a tertiary care centre in West Bengal from July 2016 to June 2018. In this study two different surgical techniques were applied in two patient groups. In one group subcapsular dissection of thyroid gland was done without exploration of recurrent laryngeal nerve course in neck; and in another group, the complete course of the aforesaid nerve in the neck was explored and preserved. The postoperative functional status of RLN was assessed by fibreoptic laryngoscopy immediately after recovery from anaesthesia and in postoperative follow ups. We wanted to compare the outcome (in terms of functional status of RLN) in these two groups. RESULTS 3 patients (10 % cases) of nerve palsy were seen among 30 patients of subcapsular dissection group, whereas only one case (3.3 %) of nerve palsy was seen amongst 30 cases of complete exploration of recurrent laryngeal nerve. CONCLUSIONS Thyroidectomy with meticulous exploration of the recurrent laryngeal nerve was found to be a superior method as compared to the subcapsular dissection. KEYWORDS Recurrent Laryngeal Nerve, Subcapsular Dissection, Complete Exploration, Thyroidectomy