Microsurgical technique as a method for prevention of recurrent laryngeal nerve injury in thyroid surgery. Review of seven consecutive cases.
BACKGROUND
Vocal cord paresis or paralysis due to iatrogenic injury of the recurrent laryngeal nerve is one of the main problems in thyroid surgery. Although many procedures have been introduced to prevent the nerves from lesion the incidence of recurrent laryngeal nerve palsy varies between 1.5-14%. The aim of the study was to evaluate the role of the microsurgical technique as a method, which can help the surgeon to identify the recurrent laryngeal nerve in the operative field.


METHODS
Fourteen nerves in 7 patients were identified with Zeiss multidiscipline universal surgical microscope with a 250-mm ocular lens. All were female patients with mean age of 35 years (Range 16-53) and diagnosis papillary cancer. They were admitted and operated in the Department of Ear, Nose, and Throat Diseases of the Higher Medical Institute in Plovdiv, Bulgaria.


RESULTS
In all patients the recurrent laryngeal nerves were successfully identified along their whole length from the inferior thyroid artery to their entering the laryngeal muscles. None of the patients had temporary or permanent vocal cord palsy.


CONCLUSIONS
Microsurgical technique could be a procedure of great value for prevention of the recurrent laryngeal nerves during thyroid surgery, especially in reoperations, thyroid cancer or retrosternal goitre.
Doikov
I Y
IY
Medical University, Department of Ear-Nose-Throat Diseases, 15A Vassil Aprilov St., 4000 Plovdiv, Bulgaria.
Yovchev
I P
IP
Konsulov
S S
SS
D000293:Adolescent; D000328:Adult; D020209:Cranial Nerve Injuries / Q000209:etiology* / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control*; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D012009:Recurrent Laryngeal Nerve / Q000033:anatomy & histology; D061226:Recurrent Laryngeal Nerve Injuries; D013965:Thyroidectomy / Q000009:adverse effects / Q000379:methods*