Nerve Injury In Thyroid Surgery Research Articles

Efficacy of prevention of recurrent laryngeal nerve injury in thyroid surgery

To evaluate the effectiveness of prevention of recurrent laryngeal nerve injury depending on thyroid gland lesion and extent of surgery. There were 2412 thyroid surgeries between 2000 and 2020. Patients were divided into the main group (1689 patients) and the control group (729 patients). Patients with nodular thyroid gland lesions prevailed in both groups (987 (58.4%) and 415 (56.9%), respectively). All ones underwent atraumatic extrafascial desection and thyroid resection (ultrasonic scalpel). He upper laryngeal nerve injury occurred in 35 cases (1.4%). The number of surgeries with thyroid remnant preservation was significantly lower in the main group. The number of procedures with subtotal thyroid resection and thyroidectomy increased by 2.4 times (from 414 to 1010 operations, p<0.05). Improvement of surgical treatment of thyroid gland lesions consisting in new operative technique of recurrent laryngeal nerve isolation using ultrasonic scalpel reduces the incidence of recurrent laryngeal nerve injury from 2.3% to 1%. At the same time, the number of extended procedures in the main group significantly exceeded that in the control group (by 2.5 times).

Alternative Sources of Cautery in Thyroid Surgery and the Risk of Recurrent Laryngeal Nerve Injury: A Retrospective, Risk-Adjusted Analysis From the National Surgical Quality Improvement Program.

A risk-adjusted analysis was completed using data from the National Surgical Quality Improvement Program (NSQIP) to compare the rates of recurrent laryngeal nerve injury in thyroid surgery using traditional versus alternative sources of cautery (defined as Harmonic Scalpel© and LigaSure©). A retrospective cohort study was completed using the NSQIP database on adult patients who underwent total thyroidectomy, subtotal thyroidectomy, or completion thyroidectomy between 2016 and 2018. The primary outcome measure was recurrent laryngeal nerve injury. The exposure variable was use of conventional or alternative sources of cautery. Multivariable linear and logistic regression analyses were performed to control for potentially confounding variables. A total of 13,961 cases were analyzed; 9450 used alternative sources of cautery compared to 4511 where traditional cautery was used. There was no significant difference in rates of postoperative recurrent laryngeal nerve injury between the 2 sources of cautery compared. Risk of recurrent laryngeal nerve injury should not be a factor when choosing method of cautery for thyroid surgery. Therefore, other factors like cost-effectiveness can be considered.

Recurrent and superior laryngeal nerve injury in thyroid surgery: literature review

Laryngeal nerve injury is considered one of the most common complications after thyroidectomy. It is associated with decreased quality of life because it will result in hoarseness of voice and aspiration. Identification of the risk factors and procedures to decrease the injury is crucial for handling laryngeal nerve injury. We searched the MEDLINE database using PubMed. Two independent reviewers reviewed the resulting papers and reviewed them based on our inclusion criteria. Based on the review results, the incidence of recurrent laryngeal nerve injury is higher than the external branch of the superior laryngeal nerve, but it is mainly due to under-reporting of the external branch of superior laryngeal nerve injury. Cancer surgery, surgeon experience, workload, re-operative procedures, and extent of surgery increased the incidence of the laryngeal nerve injury. Handling of these risk factors combined with visual dissection and inspection and/or intraoperative nerve monitoring decreased the incidence of the nerve injury. In conclusion, laryngeal nerve injury is a common post thyroidectomy complication. Anatomical dissection and visual inspection combined with intraoperative nerve monitoring is the most suitable option in high-risk thyroid surgeries.

Bilateral Cricoarytenoid Joint Ankylosis with a Perplexing Etiology

Bilateral Cricoarytenoid Joint Ankylosis with a Perplexing Etiology

Recurrent laryngeal nerve injury in thyroid surgery: Clinical pathways and resources consumption.

The impact of recurrent laryngeal nerve (RLN) injury management in thyroid surgery seems to be relevant to patients, National Healthcare System (NHS), and society. We studied resource consumption in the management of patients with RLN injury versus noninjured patients investigating 3 perspectives (patients, NHS, and society) in 5 clinical pathways. Direct medical costs supported by the NHS range from a minimum of euro (€) 79.46 to a maximum of € 3261.95. From the patient's perspective, the direct medical costs supported by the patient increased from a minimum of € 3.60 to a maximum of € 499.45. Productivity losses were accounted in € 156 per day per patient. From the NHS perspective, the percentage increase ranged from 43.25% to 98.14%. From the patient's perspective, it ranged from 51.52% to 80.60%. The analysis shows a significant economic impact of RLN injury management, which varies depending on the damage, duration, and severity. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1708-1716, 2016.

Prevention of recurrent laryngeal nerve injury in thyroid surgery

RLN injury is an important and rather frequent complication of thyroid surgery. Risk factors for nerve palsy should be considered. Deep knowledge of the surgical anatomy of the nerve is required to protect it from injury. Anatomical landmarks and surgical techniques that are helpful for investigation and identification of the RLN are very important. Exploration, visual identification and anatomical dissection of the nerve constitute the gold standard technique to prevent its injury.

Prevention of superior laryngeal nerve injury in thyroid surgery

The external branch of the superior laryngeal nerve (EBSLN) injury is an important and not uncommon, though frequently overlooked, complication of thyroid surgery. Deep knowledge of the anatomy of the region of the superior thyroid pole and the EBSLN is important. Careful dissection in the area of the superior pole and individual exposure and independent ligation of the superior thyroid artery branches close to the thyroid capsule is essential to avoid such an injury. Visual identification of the nerve may be useful but is not always possible, and neuromonitoring can be helpful. Existing data in the literature are conflicting as concerns the benefits provided by nerve stimulation in terms of nerve identification and transient or permanent injury prevention. Further prospective randomized studies are necessary in order to draw definitive conclusions.

Electrophysiological neuromonitoring of the laryngeal nerves in thyroid and parathyroid surgery: A review.

Recurrent laryngeal nerve (RLN) injury is one of the most common complications of thyroid surgery. Injury to the external branch of the superior laryngeal nerve is less obvious and affects the voice variably; however, it can be of great significance to professional voice users. Recent literature has led to an increase in the use of neuromonitoring as an adjunct to visual nerve identification during thyroid surgery. In our review of the literature, we discuss the application, efficacy and safety of neuromonitoring in thyroid surgery. Although intraoperative neuromonitoring (IONM) contributes to the prevention of laryngeal nerves injury, there was no significant difference in the incidence of RLN injury in thyroid surgery when IONM was used compared with visual identification alone. IONM use is recommended in high risk patients; however, there are no clear identification criteria for what constitutes "high risk". There is no clear evidence that IONM decreases the risk of laryngeal nerve injury in thyroid surgery. However, continuous IONM provides a promising tool that can prevent imminent nerve traction injury by detecting decreased amplitude combined with increased latency.

Outcomes of Visual Identification and Protection of the Recurrent Laryngeal Nerve during Thyroid Surgery

Routine Identification of Recurrent Laryngeal Nerve during Thyroid and Parathyroid Surgery | Prevention of Recurrent Laryngeal Nerve Injury in Thyroid Surgery | Recurrent Laryngeal Nerve Injury in Thyroid Surgery

Recurrent laryngeal nerve injury in thyroid surgery: a review

Recurrent laryngeal nerve palsy (RLNP) is an important and potentially catastrophic complication of thyroid surgery. Permanent RLNP occurs in 0.3-3% of cases, with transient palsies in 5-8%. A literature review and analysis of recent data regarding RLNP in thyroid surgery was performed, with particular focus on the identification of high-risk patients, the role of intraoperative identification and dissection of the nerve, and the role of intraoperative neuromonitoring (IONM) and optimal perioperative nerve assessment. In conjunction with the review, data from the Monash University/Alfred Hospital Endocrine Surgery Unit between January 2007 and October 2011 were retrospectively analysed, including 3736 consecutive nerves at risk (NAR). The current literature and our data confirm that patients undergoing re-operative thyroid surgery and thyroid surgery for malignancies are at increased risk of RLNP. Intraoperative visualization and capsular dissection of the RLN remain the gold standard for intraoperative care during thyroid surgery for reducing RLNP risk. IONM should not be used as the sole mechanism for identifying and preserving the nerve, although it can be used to aid in the identification and dissection of the nerve, and may aid in nerve protection in high-risk cases including cancer surgery and re-operative surgery.

Recurrent Laryngeal Nerve Injury in Thyroid Surgery

Vocal cord paresis or paralysis due to iatrogenic injury of the recurrent laryngeal nerve (RLNI) is one of the main problems in thyroid surgery. Although many procedures have been introduced to prevent the nerve injury, still the incidence of recurrent laryngeal nerve palsy varies between 1.5-14%. The aim of the present study is to assess the risk factors of recurrent laryngeal nerve injury during thyroid surgery. Patients who had thyroid surgery between 1990 and 2005 and were admitted to the surgical department of King Fahd hospital of the University, Al-Khobar, Saudi Arabia were enrolled for this retrospective review, Factors predisposing to recurrent laryngeal nerve injury were evaluated such as pathology of the lesions and the type of operations and identification of recurrent laryngeal nerve intra-operatively. Preoperative and postoperative indirect laryngoscopic examinations were performed for all patients. 340 patients were included in this study. Transient unilateral vocal cord problems occurred in 11 (3.2%) cases, and in 1 (0.3%) case, it became permanent (post Rt. Hemithyroidectomy). Bilateral vocal cord problems occurred in 2 cases (0.58%), but none became permanent. There were significant increases in the incidence of recurrent laryngeal nerve injury in secondary operation (21.7% in secondary vs. 2.8% in primary, p=0.001), total/near total thyroidectomy (7.2% in total vs. 1.9% in subtotal, p=0.024), non-identification of RLN during surgery (7.6% in non-identification vs. 2.6% in identification, p=0.039) and in malignant disease (12.8% in malignant vs. 2.9% in benign, p=0.004). However, there was no significant difference in the incidence of recurrent laryngeal nerve injury with regards to gender (4.1% in male vs 3.8% in female, p=0.849). The present study showed that thyroid carcinoma, re-operation for recurrent goiter, non-identification of RLN and total thyroidectomy were associated with a significantly increased risk of operative recurrent laryngeal nerve injury.