Recurrent Laryngeal Nerve Dysfunction Research Articles

Complications of Thyroidectomy and Learning Curve for Thyroid Surgeons: An Institutional Experience.

To study the complications of thyroidectomy and the various methods to be followed in the intra and post-operative period to prevent complications. It is a prospective study of 5years and 9months duration from 1/1/2015 to 31/9/2020 done in a tertiary care hospital. A total of 268 patients were included in this study. Adequate measures were taken intraoperatively to prevent any complications and the patients were observed post-operatively for development and management of any complications. The patients were followed up regularly. Out of the 268 thyroidectomies performed in our study following which 5 patients had hemorrhage, 19 patients had temporary recurrent laryngeal nerve dysfunction, 3 patients developed respiratory obstruction, 12 patients developed transient parathyroid insufficiency, 62 patients developed thyroid insufficiency,1 patient had permanent parathyroid insufficiency, permanent recurrent laryngeal nerve dysfunction was seen in 7 patients, 3 patients developed seroma formation, 7 patients developed post-operative hypertrophic scar and 3 developed keloid. Sound anatomical knowledge, meticulous surgical technique and effective protocol for the management of complication can reduce the postoperative morbidity of the patient.

A Narrative Review of Preventive Central Lymph Node Dissection in Patients With Papillary Thyroid Cancer -A Necessity or an Excess.

ObjectiveThis review article summarises the latest evidence for preventive central lymph node dissection in patients with papillary thyroid cancer taking into account the possible complications and risk of recurrence.BackgroundPapillary thyroid cancer is the most frequent histological variant of malignant neoplasms of the thyroid gland. It accounts for about 80-85% of all cases of thyroid cancer. Despite good postoperative results and an excellent survival rate in comparison with many other malignant diseases, tumor metastases to the cervical lymph nodes are frequent. Most researchers agree that the presence of obvious metastases in the lymph nodes requires careful lymph node dissection. It was suggested to perform preventive routine lymphadenectomy in all patients with malignant thyroid diseases referred to surgery.MethodsIt was performed the literature review using the “papillary thyroid cancer”, “central lymph node dissection”, “hypocalcemia”, “recurrent laryngeal nerve paresis”, “metastasis”, “cancer recurrence” along with the MESH terms. The reference list of the articles was carefully reviewed as a potential source of information. The search was based on Medline, Scopus, Google Scholar, eLibrary engines. Selected publications were analyzed and their synthesis was used to write the review and analyse the role of preventive central lymph node dissection in patients with papillary thyroid cancer.ConclusionsThe necessity of preventive central lymph node dissection in patients with differentiated papillary thyroid carcinoma is still controversial. There is much evidence that it increases the frequency of transient hypocalcemia. Due to the fact that this complication is temporary, its significance in clinical practice is debatable. It can also be assumed that an extant of surgery in the neck area is associated with an increased risk of recurrent laryngeal nerve injury. However, most studies indicate that this injury is associated more with thyroidectomy itself than with lymph node dissection. Recurrent laryngeal nerve dysfunction is also a temporary complication in the vast majority of cases. At the same time, a large amount of data shows that central lymph node dissection reduces the risk of thyroid cancer recurrence in two times.

How the Severity and Mechanism of Recurrent Laryngeal Nerve Dysfunction during Monitored Thyroidectomy Impact on Postoperative Voice.

Simple SummaryRecurrent laryngeal nerve (RLN) dysfunction remains a major source of morbidity after thyroid surgery. Intraoperative neuromonitoring can qualify and quantify RLN function according to the laryngeal electromyography (EMG) response evoked by electrical stimulation of the RLN. To the best of our knowledge, this is the first report to discuss the severity and mechanism of RLN dysfunction and postoperative voice in patients who have received monitored thyroidectomy. For optimal voice and swallowing outcomes after thyroid surgery, thermal injury must be avoided, especially when using energy-based devices, and mechanical injury must be identified early to avoid a more severe dysfunction. Adherence to standard intraoperative neuromonitoring (IONM) procedures for thyroid surgery is suggested, including standard procedures for acquiring and interpreting intraoperative RLN signals, for identifying and classifying RLN injury mechanisms, for performing laryngeal examinations and comprehensive voice assessments (subjective and objective voice analysis) before and after surgery, and for performing standard follow-up procedures.Intraoperative neuromonitoring can qualify and quantify RLN function during thyroid surgery. This study investigated how the severity and mechanism of RLN dysfunction during monitored thyroid surgery affected postoperative voice. This retrospective study analyzed 1021 patients that received standardized monitored thyroidectomy. Patients had post-dissection RLN(R2) signal <50%, 50–90% and >90% decrease from pre-dissection RLN(R1) signal were classified into Group A-no/mild, B-moderate, and C-severe RLN dysfunction, respectively. Demographic characteristics, RLN injury mechanisms(mechanical/thermal) and voice analysis parameters were recorded. More patients in the group with higher severity of RLN dysfunction had malignant pathology results (A/B/C = 35%/48%/55%, p = 0.017), received neck dissection (A/B/C = 17%/31%/55%, p < 0.001), had thermal injury (p = 0.006), and had asymmetric vocal fold motion in long-term postoperative periods (A/B/C = 0%/8%/62%, p < 0.001). In postoperative periods, Group C patients had significantly worse voice outcomes in several voice parameters in comparison to Group A/B. Thermal injury was associated with larger voice impairments compared to mechanical injury. This report is the first to discuss the severity and mechanism of RLN dysfunction and postoperative voice in patients who received monitored thyroidectomy. To optimize voice and swallowing outcomes after thyroidectomy, avoiding thermal injury is mandatory, and mechanical injury must be identified early to avoid a more severe dysfunction.

Introducing routine intraoperative nerve monitoring in a high-volume endocrine surgery centre: a health technology assessment.

We sought to analyse the effect of the introduction of intraoperative nerve monitoring (IONM) in our routine surgical practice and to provide a circumstantial analysis of direct costs of IONM in total thyroidectomy and of indirect costs associated with vocal fold palsy, as centred in the health care system of Italy. We retrospectively compared outcomes of 232 total thyroidectomies performed between November 2017 and October 2019, respectively, before (109 TT-Group A) and after (123 TT-Group B) adopting IONM technology in November 2018. We analysed the costs of IONM per procedure and rate and costs of vocal fold palsy events (temporary and permanent). Overall, there were 61 thyroid cancers (32 in Group B) and 171 multinodular goitres (91 in Group B). We recorded 5 cases of vocal fold palsy (4.6%-4 transient, 1 permanent) in Group A and none in Group B (p = 0.016). IONM consumables cost 219 eur per case. Healthcare and social cost of Vocal fold palsy ranged between 3200 eur (function recovery < 1month postoperatively) and over 32,000 eur (permanent event). When only direct costs are considered, IONM can hardly be cost effective. In this study, cost of IONM implementation was offset by the absence of complications attributable to recurrent laryngeal nerve dysfunction.

Efficiency of vocal cord medialization for recurrent laryngeal nerve dysfunction following pulmonary resections

Efficiency of vocal cord medialization for recurrent laryngeal nerve dysfunction following pulmonary resections

Long-Term Results of Treating With Ethanol Ablation 15 Adult Patients With cT1aN0 Papillary Thyroid Microcarcinoma.

BackgroundCurrently acceptable management options for patients with adult papillary thyroid microcarcinoma (APTM) range from immediate surgery, either unilateral lobectomy or bilateral lobar resection, to active surveillance (AS). An alternative minimally invasive approach, originally employed for eliminating neck nodal metastases, may be ultrasound-guided percutaneous ethanol ablation (EA). Here we present our experience of definitively treating with EA 15 patients with APTM.Patients and MethodsDuring 2010 through 2017, the 15 cT1aN0M0 patients selected for EA were aged 36 to 86 years (median, 45 years). Tumor volumes (n = 17), assessed by sonography, ranged from 25 to 375 mm3 (median, 109 mm3). Fourteen of 15 patients had 2 ethanol injections on successive days; total volume injected ranged from 0.45 to 1.80 cc (median, 1.1 cc). All ablated patients were followed with sonography and underwent recalculation of tumor volume and reassessment of tumor perfusion at each follow-up visit.ResultsThe ablated patients have now been followed for 10 to 100 months (median, 64 months). There were no complications and no ablated patient developed postprocedure recurrent laryngeal nerve dysfunction. All 17 ablated tumors shrank (median 93%) and Doppler flow eliminated. Median tumor volume reduction in 9 identifiable avascular foci was 82% (range, 26%-93%). After EA, 8 tumors (47%) disappeared on sonography after a median of 10 months. During follow-up no new PTM foci and no nodal metastases have been identified.ConclusionsDefinitive treatment of APTM by EA is effective, safe, and inexpensive. Our results suggest that, for APTM patients who do not wish neck surgery and are uncomfortable with AS, EA represents a well-tolerated and minimally invasive outpatient management option.

Voice outcome after type-1 thyroplasty for unilateral vocal cord paralysis: our experience at tertiary care hospital

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Vocal cord paralysis is a clinical sign caused by paralysis of intrinsic muscles of larynx due to dysfunction of recurrent laryngeal nerve or injury to the vagus nerve. One of the common and effective methods of medialization is by using silicone implants. This study was aimed at prospectively assessing and analysing the vocal outcomes and quality of life of patients in type 1 medialization thyroplasty using silicone implants.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Prospective study of 18 months was done on 17 patients with unilateral vocal cord paralysis. Surgical procedure for the patients was standardized by using silicon implant to medialize the cord. The parameters used for the pre and post treatment objective analysis were stroboscopic analysis, psychoacoustic evaluation, maximum phonation time (MPT) and patient’s self-assessment. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; In our study all 17 patients with unilateral vocal cord paralysis who were subjected to vocal cord medialization using silicone implant showed a statistically highly significant improvement in all the parameters of assessment. The mean preoperative MPT was 7.260 and post-operative MPT showed significant improvement and was 17.428 seconds. mean preoperative GRBAS score was 11.695 and post-operative was 3.826. Similarly, pre op vocal handicap index was 31.173 which decreased significantly after the procedure was 7.695.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; In the present study, we obtained favourable results of medialization thyroplasty as expressed by objective analysis of voice including GRABS score and acoustic analysis as well as maximum phonation time apart from traditional voice recording.&lt;/p&gt;&lt;p&gt; &lt;/p&gt;

Preoperative and Intraoperative Methods of Parathyroid Gland Localization and the Diagnosis of Parathyroid Adenomas.

Accurate pre-operative determination of parathyroid glands localization is critical in the selection of minimally invasive parathyroidectomy as a surgical treatment approach in patients with primary hyperparathyroidism (PHPT). Its importance cannot be overemphasized as it helps to minimize the harmful side effects associated with damage to the parathyroid glands such as in hypocalcemia, severe hemorrhage or recurrent laryngeal nerve dysfunction. Preoperative and intraoperative methods decrease the incidence of mistakenly injuring the parathyroid glands and allow for the timely diagnosis of various abnormalities, including parathyroid adenomas. This article reviews 139 studies conducted between 1970 and 2020 (49 years). Studies that were reviewed focused on several techniques including application of carbon nanoparticles, carbon nanoparticles with technetium sestamibi (99m Tc-MIBI), Raman spectroscopy, near-infrared autofluorescence, dynamic optical contrast imaging, laser speckle contrast imaging, shear wave elastography, and indocyanine green to test their potential in providing proper parathyroid glands’ localization. Apart from reviewing the aforementioned techniques, this study focused on the applications that helped in the detection of parathyroid adenomas. Results suggest that applying all the reviewed techniques significantly improves the possibility of providing proper localization of parathyroid glands, and the application of indocyanine green has proven to be the ‘ideal’ approach for the diagnosis of parathyroid adenomas.

What is the appropriate nodular size of differentiated thyroid cancer management by Transoral Endoscopic Thyroidectomy Vestibular Approach?

Thyroid nodular disease is a common problem in clinical practice. Incidental thyroid nodules are more frequently diagnosed because of the increased access to radiologic investigations [1]. Though thyroid nodules are common, malignant cases (4.0% to 6.5% of all thyroid nodules) are clinically significant and must be precisely diagnosed. Improvements in surgical techniques have reduced perioperative morbidities. The rates of permanent recurrent laryngeal nerve (RLN) dysfunction and hypoparathyroidism are &lt;1% in experienced hands [2]. Recently, Anuwong reported that transoral endoscopic thyroidectomy vestibular approach (TOETVA) done for 60 selected cases has a low complication rate comparable to that of the conventional open thyroidectomy [3]. In this technique, endoscopic trocars were placed through a central incision in the oral vestibule and bilateral incisions in both sides of the oral commissure. The plane under the superficial fascia is entered away from the lower margin of mandibular bone to avoid damage of the marginal branch of the facial nerve as well as the facial Vessels. However, retrieval of large thyroid specimens through the central incision of the TOETVA necessitated breaking it down into smaller fragments to avoid damage of the mental nerve. This can be problematic for a suspicious or malignant differentiated thyroid cancer (DTC), whose capsule should remain intact for a precise histopathologic examination [4,5]. Imprecise pathologic diagnosis negatively impacts further treatment, follow up and prognosis. However, in this technique of TOETVA, the thyroid specimen was all put and fragmented in the retrieval bag. Supposedly, the cancer should not be spilt out during the procedure of pull out. Thyroglobulin (TG) level 3-4 weeks post-surgery can be used to assess the size of the residual thyroid mass either locally or distally, and guide remnant I-131 ablation therapy [6]. Hence, we presume the prognosis of DTC would be affected by the procedure of fragmentation of TOETVA. In this issue, we would like to establish the critical largest diameter for DTC to be removed safely (with mental nerve preservation) and completely by the TOETVA technique. In our experience, we believe that the ideal nodular size should be &lt;2.5cm to achieve safety and carcinologic goals.

Completion thyroidectomy: A risky undertaking?

BackgroundCompletion thyroidectomy (cT) is sometimes necessary after thyroid lobectomy (TL), and it remains controversial whether 2-stage thyroidectomy adds operative risk. This study compares complication rates for TL, total thyroidectomy (TT), and cT. MethodsUsing a cohort design, we reviewed 100 consecutive cases each of TL, TT, and cT. Complications examined included reoperation for hematoma, temporary/permanent recurrent laryngeal nerve (RLN) dysfunction, and hypoparathyroidism. ResultsTwo patients had reoperation for hematoma, both in the TT cohort (p = 0.33). No patients in any cohort had permanent hypoparathyroidism or RLN injury, but transient RLN paresis occurred in three (3%) TL, two (2%) TT, and no (0%) cT patients (p = 0.38). Transient hypoparathyroidism occurred in 3% following TT versus 0% after cT (p = 0.12). Overall complication rate was higher after TT (7%) compared to TL (3%) and cT (0%, p = 0.02). ConclusionsAt a high-volume center, the observed complication rates were equivalently low for TL, TT, and cT. SummaryCompletion thyroidectomy is occasionally needed after lobectomy, but its procedure-specific risks are not well characterized. In a cohort study at a high-volume center, operative outcomes for patients undergoing thyroid lobectomy, total thyroidectomy, and completion thyroidectomy were compared and equivalently low complication rates were observed for all 3 procedures.

SUN-501 Parathyroid Autoinfarction Presents as a Neck Mass and Resolution of Hypercalcemia

Background: Parathyroid autoinfarction or “parathyroid apoplexy” is a phenomenon in which parathyroid gland become spontaneously hemorrhagic or infarcted. Parathyroid autoinfarction is rare. Few cases were reported previously. Here we describe a case of Parathyroid autoinfarction. Clinical case: A 42-year old female patient with history of Graves’ disease on Methimazole found to have high calcium on routine blood work. Her calcium was 11.1 mg/dl. (Normal range: 8.2- 10.6 mg/dl), albumin 4.3 gm/dl. (Normal range: 3.5-5.7 gm/dl). Reviewing her charts revealed hypercalcemia for several years. Ranges between (10.1 and 11.2 mg/dl) with an average of 10.7mg/dl. Primary hyperparathyroidism was suspected. She was supposed to have full evaluation of hypercalcemia including PTH measurement, Vit D and urinary calcium on her coming follow up appointment. However, prior to her follow up, she presented to Emergency room with three-day history of right sided neck pain, hoarseness and difficulty swallowing. On exam, she had very tender neck on the right side with palpable swelling. CT scan of the neck with contrast showed 3.1 cm x 1.2 cm x 1.7 cm hypo enhances solid mass posterior to the right thyroid lobe and within the region of the tracheoesophageal groove which could contribute to recurrent laryngeal nerve dysfunction. Labs showed a drop of calcium level to 8.9 mg/dl, albumin:3.5 mg/dl, and PTH :31 Pg /ml (normal range :12-88 Pg /ml). US guided FNA biopsy of the mass showed scant connective tissue and parathyroid tissue. Due to the concern of laryngeal nerve compromise, she underwent surgical removal of the mass. Surgical pathology showed enlarged parathyroid gland with hemorrhagic infarction. Based on clinical presentation and histopathology, diagnosis of parathyroid autoinfarction was made. Conclusion: Rapid reduction of calcium in patient with primary hyperparathyroidism should raise suspicion of parathyroid autoinfarction, especially if local neck symptoms are present. Though spontaneous resolution of primary hyperparathyroidism following parathyroid autoinfarction is possible, recurrence can occur. Parathyroidectomy is more common approach than conservative management. Surgery should be considered if recurrent laryngeal nerve is compromised by mass effect of infarcted gland.

Transaxillary robotic-assisted thyroid surgery: technique and results of a preliminary experience on the Da Vinci Xi platform

BackgroundRobotic thyroidectomy by transaxillary approach (RATS) is regarded as a feasible and safe alternative procedure in selected patients with benign disease or thyroid cancer of low risk, facilitating thyroidectomy with respect to conventional endoscopic approach and offering improved cosmetic results. The Da Vinci Xi surgical system (Intuitive Surgical, Sunnyvale, CA, USA) presents technical advantages over its previous generations, including overhead docking, more compact robotic arms, extended range of motion, and ability for camera to be docked in any arm. This construct supports dissection in smaller spaces with less arm interference and improved view. We present an initial experience of RATS on DVSS Xi in an academic Centre in Italy.MethodsWe conducted a prospective observational study, involving patients with thyroid disease and treated between April 2016 and January 2018. A modified thyroidectomy retractor (Modena retractor, CEATEC Medizintechnik, Germany) was used to lift a musculocutaneous flap and operate gasless. Instrument placement was recorded for each procedure. Each procedure description was broken down into three phases, creation of working space, machine docking with instrument positioning and endoscopic operating technique. Duration of cases was recorded. Patients selected were young women, BMI < 30, thyroid nodule < 5 cm, cytology TIR2 to TIR4 (TIR4:only nodules < 1 cm diameter).ResultsTwelve RATS were performed within the learning curve for the robotic technique, 10 lobectomies and 2 total thyroidectomies. No patients required reintervention. Mean duration of surgery was 198.9 min for lobectomy and 210 for thyroidectomy. The same surgical team performed all procedures. No patients presented surgery-related complications, mean stay was 3 days. Decrease in operating time was observed after 8 cases along with more precise preparation of working space. Four arms were used in the first 10 procedures then only three. No recurrent laryngeal nerve dysfunction, no seroma or haematoma were recorded. One patient had transient hypocalcaemia after total thyroidectomy.ConclusionsSince the early phases of a preliminary experience RATS appeared a safe alternative to open thyroidectomy. Uptake of technique was quick on Xi platform with few technical tweaks over techniques described for Si machines. Careful patient selection is crucial.Trial registrationRetrospectively registered on 20 july 2018 . Trial registration number: researchregistry4272.The Research Registry: https://www.researchregistry.com/browse-the-registry#home/registrationdetails/5b517f08dbc2045aefd7f9b4/

Thoracoscopic clipping of patent ductus arteriosus: position of surgery in the era of transcatheter procedures

To describe single-center evolution of the procedure and to evaluate the results of thoracoscopic clipping of patent ductus arteriosus (PDA) with diameter over 3,0 mm in term infants weighting over 4,0 kg. Thoracoscopic clipping of PDA has been performed in 140 patients for the period from March 2012 to March 2018 in Meshalkin National Medical Research Center. Mean age was 4.0 years (range 3 months - 13 years), mean body mass index - 15.4±2.2 kg/m2. PDA size 3.5-10 mm, Qp/Qs >1,3/1,0, weight 4.0-40 kg. Mean PDA size was 4.6±0.9 mm (range 3.5-8.0 mm), mean pulmonary artery pressure - 34.3±5.8 mm Hg, mean systemic/pulmonary flow Qp/Qs - 1.6±0.3. All patients underwent successful PDA closure through four-port technique under endotracheal general anesthesia and no need for pleural drainage. Mean procedure time was 24.5±15.5 min. In 29 (20,7%) cases we used titanium clips, in 11 (79.3%) - polymer locking ligating clips. There was 1 conversion to mini-thoracotomy. There were no deaths, bleeding or any other life-threatening complications. 94 (67.1%) patients were weaned from ventilator within operating theatre, in other 46 (32.9%) patients mean ventilation time in ICU was 1.3±1.0 hours. In-hospital postoperative complications: pneumothorax - 2 (1.4%) cases, recurrent laryngeal nerve dysfunction - 1 (0.7%), false croup - 1 (0.7%). There were 2 residual leakages in 2 (1.4%) patients in 10 and 6 months after titanium clip deployment. Both of them underwent transcatheter closure using the coil. Considering these cases all following patients underwent PDA closure by polymer locking ligating clips with no cases of residual leakage. Thoracoscopic PDA closure by polymer locking ligating clip is safe and effective technique for surgical management of PDA with diameter over 3.0 mm in term infants weighting over 4.0 kg.

Prophylactic Central Compartment Neck Dissection in Papillary Thyroid Cancer and Effect on Locoregional Recurrence.

Prophylactic central compartment neck dissection (pCCND) in addition to total thyroidectomy (TT) includes removal of central compartment lymph nodes in the absence of clinical involvement on preoperative and intraoperative evaluation. The data regarding the influence of pCCND on oncologic outcomes and surgical complication rates is mixed and, therefore, is the focus of this analysis. A systematic review of the literature on total thyroidectomy with prophylactic central compartment neck dissection (TT + pCCND) from January 1990 to October 2017 identified 221 abstracts of which 17 met inclusion criteria and were reviewed (1 randomized-control trial, 13 retrospective cohort studies, and 3 meta-analyses). TT + pCCND was found to detect occult lymph node metastasis in approximately 50% of patients who had no clinical evidence of lymph node metastasis on preoperative imaging. Permanent hypoparathyroidism occurs more frequently following TT + pCCND (TT = 1.55% vs. TT + pCCND = 3.45%), but the rates of permanent recurrent laryngeal nerve dysfunction are similar (TT = 0.89% vs. TT + pCCND = 0.96%). The locoregional recurrence rates across all 14 studies included in this analysis was 6.75% for TT alone and 4.55% for TT + pCCND. The rate of locoregional recurrence was significantly lower in patients who underwent pCCND in a few studies and one meta-analysis, but were not significantly different in the majority of studies. TT + pCCND in clinically node-negative papillary thyroid cancer will detect occult lymph node metastasis in approximately half of patients. This may change their postoperative management with regard to adjuvant radioiodine therapy. There is a higher risk of hypoparathyroidism with pCCND, and the effect on rates of locoregional recurrence remains uncertain.

Prospective analysis of type I thyroplasty using gore-tex implant

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Vocal cord paralysis is a clinical sign caused by paralysis of intrinsic muscles of larynx due to dysfunction of recurrent laryngeal nerve. There are several methods available surgically for the medialisation of the abducted vocal cord. One of the common effective modality is the Gore-Tex medialisation thyroplasty. The results depend on a number of factors including the surgical expertise and extrusion of the Gore –Tex implant. This study is aimed at analysis of all Gore-Tex medialisation thyroplasty done at our centre. Prospectively asses and analyze the vocal outcomes and quality of life of patients in type 1 medialisation thyroplasty using Gore-Tex implant.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Prospective study of 48 months on 30 patients with unilateral vocal cord paralysis. Surgical procedure for the patients was standardized by using Gore-Tex implant to medialize the cord. Video-Laryngoscopy at end of 1&lt;sup&gt;st&lt;/sup&gt; month and stroboscopy &amp;amp; voice analysis at end of 3&lt;sup&gt;rd&lt;/sup&gt; month post treatment, the parameters used for the pre and post treatment objective analysis are a) stroboscopic analysis, b) psychoacoustic evaluation, c) maximum phonation time, d) patient’s self-assessment. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; In our study of 30 patients with a follow up period of 48 months, we can conclude as follows – a)unilateral vocal cord paralysis does not have age or gender specificity, b)statistically significant vocal cord palsy affects the left side more by 70%, c)post op Gore-tex medialisation thyroplasty showed a statistically highly significant improvement in psychoacoustic, mean phonation time, d)post op Gore-Tex medialisation thyroplasty showed a statistically significant improvement in videostroboscopic analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Psycho acoustic, mean phonation time analysis would complement each other in the assessment of the medialisation thyroplasty thus obviating videostroboscopy.&lt;/p&gt;

Laryngeal pathology in the early postoperative period after thyroid surgery

This article presents the results of analysis of observation of 390 patients which underwent thyroid surgery: the frequency of the recurrent laryngeal nerve dysfunction, significant predictive factors, frequency and timing of vocal folds mobility restoration. The authors provide evaluation of the dynamics of laryngostroboscopic pattern in compliance with the voice computer analysis and specify the reasons of dysphonia after thyroid surgery.

Evaluation of Pharyngeal Function in Dogs with Laryngeal Paralysis Before and After Unilateral Arytenoid Lateralization.

To evaluate pharyngeal and laryngeal function using esophagography, topical pharyngeal/laryngeal sensitivity testing, and electromyography (EMG) in normal and dogs with idiopathic laryngeal paralysis (ILP) before and after unilateral arytenoid lateralization. Prospective controlled cohort study. Dogs with laryngeal paralysis (ILP; n = 8) and age/breed-matched (AB, n = 8) and young breed-matched dogs (B, n = 8) were recruited. Evaluation consisted of esophagography, topical pharyngeal/laryngeal sensitivity testing, and electrodiagnostic testing. Esophagography was performed with liquid and canned phases. Pharyngeal and laryngeal sensitivity was tested by applying a cotton-tipped applicator to the mucosa of pharynx/larynx at anesthetic induction. In all dogs, electrophysiological testing included EMG, direct evoked muscle potentials, motor nerve conduction velocities, and F wave testing. These were performed in the thoracic/pelvic limbs, extrinsic laryngeal muscles, epaxial, and masticatory muscles. Topical pharyngeal and laryngeal sensitivity testing was decreased in LP dogs compared with age-matched healthy control dogs. Esophagram showed dysmotility in the cranial and caudal esophagus. Gastroesophageal reflux was significantly higher in ILP dogs compared with the other 2 groups (P < .03). In all affected dogs, EMG abnormalities were limited to the interosseous muscles of both pelvic and thoracic limbs bilaterally. Dogs with ILP not only have recurrent laryngeal nerve (RLN) and pararecurrent laryngeal nerve (pRLN) dysfunction, but may also have concurrent cranial laryngeal nerve dysfunction.

Medicolegal Aspects of Iatrogenic Dysphonia and Recurrent Laryngeal Nerve Injury.

To examine aspects of litigation involving iatrogenic dysphonia and injury to the recurrent laryngeal nerve in the adult population. Legal database review. Medicolegal judicial system. Jury verdicts and settlement reports listing voice impairment or recurrent laryngeal nerve dysfunction as a primary injury in adult patients were identified in the Westlaw Database. Reports were examined for plaintiff demographics, defendant specialty, procedure performed, rates of settlements and verdicts, monetary awards, primary plaintiff symptoms, and common allegations. A total of 123 jury verdict and settlement reports were identified. General surgeons (24%), otolaryngologists (20%), and anesthesiologists (18%) were involved in the majority of cases. The procedure causing the alleged injury was primarily thyroidectomy (34%), followed by intubation (18%) and spinal instrumentation (10%). The majority of cases (70%) were decided in favor of the defendant. Where monetary awards were recorded, settlements and jury verdicts in favor of the plaintiff ranged between $4250 and $3,000,000, with a mean of $788,713. In addition to voice disturbances, complaints of dyspnea and dysphagia were commonly listed alleged injuries. The only factors associated with plaintiff verdicts were general surgery specialty (odds ratio, 6.3; 95% confidence interval, 1.7-23.2) and claims of loss of consortium (odds ratio, 8.5; 95% confidence interval, 1.2-60.7). Dysphonia is a common complication in a number of procedures across multiple specialties. Although the majority of cases are decided in favor or the defendant, payments awarded can be considerable. Awareness of factors involved in these medical malpractice cases can help limit physician liability.

Long-term Results of Observation vs Prophylactic Selective Level VI Neck Dissection for Papillary Thyroid Carcinoma at a Cancer Center.

The indication for prophylactic central neck dissection in papillary thyroid cancer (PTC) is controversial. To compare long-term results of observation vs prophylactic selective level VI neck dissection for PTC. We performed a retrospective cohort study of 812 patients with PTC who were treated from January 1, 1996, through January 1, 2007, at the Department of Head and Neck Surgery and Otorhinolaryngology of A. C. Camargo Cancer Center. A group of 580 consecutive patients with previously untreated PTCs and without lymph node metastasis were eligible for the study. We collected and analyzed retrospective data from February 1, 2012, through August 31, 2013. One hundred two patients (group A) underwent total thyroidectomy with elective central neck dissection; 478 patients (group B) underwent total thyroidectomy alone. Absence of difference in rates of locoregional control and rates of major complications in group A. In group A, the rate of occult metastatic disease was 67.2%. Patients in group A exhibited higher rates of temporary hypocalcemia (46.1% vs 32.2%; P = .004) and permanent hypoparathyroidism (11.8% vs 2.3%; P < .001). We also found a significantly higher incidence of temporary (11.8% vs 6.1%; P = .04) and permanent (5.9% vs 1.5%; P = .02) recurrent laryngeal nerve dysfunction in group A. The overall recurrence rate at level VI was 1.9%. Although the risk for occult lymph node metastasis reached 67.2% in a selected group of patients, elective central neck dissection for patients with PTC increased the risk for complications and did not contribute to a decrease in local recurrence rates.

Six-Year Experience With Endoscopic Thyroidectomy: Outcomes and Safety Profile.

Though minimally invasive video-assisted thyroidectomy (MIVAT) offers many advantages over traditional thyroid surgery, its adoption in North America has been limited. This study analyzes the largest series of MIVAT in North America to explore its safety. A prospectively maintained database of all patients undergoing thyroid surgery by a single surgeon from 2003 to 2011 at an academic tertiary care medical center was evaluated. Demographic information, surgical and pathologic data, and postoperative outcomes were analyzed. Beginning in 2005, a total of 260 MIVATs were performed during the study period. Outpatient surgery was accomplished in 234 MIVATs (90%). MIVAT patients were predominantly young (46.8±14.8 years vs 52.4±14.6 years for conventional thyroidectomy) and female (88.5% vs 75.5% for conventional thyroidectomy). There were no cases of permanent hypoparathyroidism or permanent recurrent laryngeal nerve dysfunction. Observed complications included transient recurrent laryngeal nerve dysfunction (n=10; 3.8%), cellulitis (n=1; 0.4%), and temporary hypocalcemia (n=6; 2.3%). The overall complication rate for MIVAT (6.5%) was lower than the overall complication rate in conventional thyroidectomy (18.5%, P<.0001). MIVAT can be performed safely with a low complication profile in a high-volume practice. The safety of MIVAT represented by this experience supports broader adoption across surgical practices.