Paralysis of the Recurrent Laryngeal Nerve Following ThyreoidectomyA Study of Paralyses Occuring Postoperatively

Abstract

In the years 1954–1957, 593 patients with goitre, among them an unusually large proportion (78%) of adenomatous goitres, were operated in Falun Hospital. The complication of recurrent laryngeal nerve paralysis occurred in 56 cases (9.4%). Routine pre- and postoperative laryngoscopy was carried out as well as direct laryngoscopy immediately before the end of the operation. The majority of paralyses were not seen at the end of operation but were first noticed at the subsequent examination in the Ear, Nose and Throat Department. The reason for this is discussed and the possibilities of traction, contusion and secondary oedema in the nerve are pointed out as important aetiological factors. Attention is drawn to the similarity to peripheral facial paralysis. Support for this theory is obtained from anatomical studies of the course of the recurrent nerve and in particular its passage through a tense band of connective tissue just before its entry into the larynx. Fifty-three of the cases have been followed up. Restoration of nerve function after more than six to seven months has not been seen in any case. A full recovery took place in 21 cases (39%). Twenty-nine of the remaining 32 cases with total or partial paralysis improved clinically. A third of these 32 patients complained of a greater or lesser degree of trouble arising from the nerve injury. In some cases the patient was compelled to change employment because of the impairment in voice.