Vocal fold immobility after thyroidectomy with intraoperative recurrent laryngeal nerve monitoring.

Irene De Pedro Netto,Ronaldo Nunes Toledo,Luiz Paulo Kowalski,Elisabete Carrara-De-Angelis,Priscila Salgado,Pablo Rodrigo Rocha Ferraz,Jose Guilherme Vartarian,José Ricardo Gurgel Testa,Juliana Bueno Meirelles De Azevedo

doi:10.1590/s1516-31802007000300011

Irene De Pedro Netto, Ronaldo Nunes Toledo + Show 7 more

Open Access

https://doi.org/10.1590/s1516-31802007000300011

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Abstract

Intraoperative nerve monitoring has emerged as a valuable tool to facilitate recurrent laryngeal nerve identification during thyroid surgery, thereby avoiding its injury. The aim was to evaluate vocal fold mobility in patients who underwent thyroidectomy with intraoperative nerve monitoring. Cohort formed by a consecutive series of patients, at a tertiary cancer hospital. The subjects were patients who underwent thyroidectomy using intraoperative laryngeal nerve monitoring, between November 2003 and January 2006. Descriptive analysis of the results and comparison with a similar group of patients who did not undergo nerve monitoring were performed. A total of 104 patients were studied. Total thyroidectomy was performed on 65 patients. Vocal fold immobility (total or partial) was detected in 12 patients (6.8% of the nerves at risk) at the first postoperative evaluation. Only six (3.4% of the nerves at risk) continued to present vocal fold immobility three months after surgery. Our previous series with 100 similar patients without intraoperative nerve monitoring revealed that 12 patients (7.5%) presented vocal fold immobility at the early examination, and just 5 (3.1%) maintained this immobility three months after surgery, without significant difference between the two series. In this series, the use of intraoperative nerve monitoring did not decrease the rate of vocal fold immobility.

Highlights

Thyroidectomy is one of the most frequent head and neck surgical procedures worldwide.[1]
Total thyroidectomy was performed on 65 patients
Investigation of possible associations between vocal fold immobility and certain demographic, clinical and surgical variables showed that none of these variables were significantly associated with postoperative vocal fold mobility alteration (Table 1)

Summary

Introduction

Thyroidectomy is one of the most frequent head and neck surgical procedures worldwide.[1] Among the potential surgical complications, recurrent laryngeal nerve (RLN) injury with consequent vocal fold immobility may be a debilitating complication leading to voice changes. It may give rise to the risk of respiratory distress and potential risk of laryngeal aspiration, leading to significant negative impact on patients’ daily lives.[1,2,3,4,5] Injury to the laryngeal nerve may be secondary to direct trauma, unintentional sectioning, stretching, ligature entrapment or thermal or electrical injury.[2] The increasing of the surgical team’s experience, together with careful dissection and direct viewing of the RLN, has been considered to be the best approach towards avoiding such injuries.[3,6] In recent years, the development of intraoperative laryngeal nerve monitoring has emerged as a valuable tool for facilitating RLN identification, with the aim of decreasing nerve injuries.[7] there is a lack of prospective randomized trials for confirming such assertions. Several reports have described the benefits of intraoperative laryngeal nerve monitoring in patients who underwent thyroid surgery, in cases of reoperation and large goiters.[3,4,8] there are other series that have failed to confirm such benefits.[2,5,9]

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