Recurrent laryngeal nerve identification in thyroidectomy by intraoperative staining with methylene blue

Abstract

Abstract:Background: Unrecognized transection of the recurrent laryngeal nerve (RLN) or its motor branch could result in an unexpected permanent palsy. So, for a safe thyroid operation, intraoperative assurance of anatomical and functional RLN integrity is a necessity. Aim of work: To evaluate the recognition and protection of RLN by staining the RLN intraoperatively with methylene blue (MB) in one side and comparing it with the identification alone in the other side visually during total thyroidectomy. Subjects and methods: A case control study (retrospective study) carried out in the department of surgical oncology Zagazig university hospitals and Ismailia teaching oncology hospital during the period from November 2018 to August 2019. The study included 112 patients with bilateral thyroid disease who will do total thyroidectomy. The patients were subdivided into two groups depending on the MB use. Complete history taking was taken from all subjects. General examination of all body systems and local examination of the neck were done. We also did full lab investigations, neck U/S then the operations were performed. Results: We detected transient vocal cord palsy 10 sides (8.6%) of visual identification alone, while in MB sides no case was detected with the same lesion. Conclusion: Recognition of RLN intraoperatively by MB staining is cheap and widely available technique and can decrease the stress during thyroidectomy, especially when Intra Operative Nerve Monitoring (IONM) is absent.