Recurrent laryngeal nerve palsy after thyroidectomy with routine identification of the recurrent laryngeal nerve.
BACKGROUND
The aim of this study was to assess the risk of recurrent laryngeal nerve palsy (RLNP) after thyroidectomy with routine identification of the recurrent laryngeal nerve (RLN) during the operation.


METHODS
The present study was confined to 521 patients, 348 total lobectomies and 178 total thyroidectomies, treated by the same surgeon. Temporary and permanent RLNP rates were analyzed for patient groups with stratification of primary operation for benign thyroid disease, thyroid cancer, Graves' disease, and reoperation. Measurement of the RLNP rate was based on the number of nerves at risk. Twenty-six RLNs in 20 thyroid cancer patients with intentional sacrifice were excluded from analysis.


RESULTS
Forty RLNs (40 patients) developed postoperative RLNP. Complete recovery of RLN function was documented for 35 of the 37 patients (94.6%) whose RLN integrity had been ensured intraoperatively. Recovery from temporary RLNP ranged from 3 days to 4 months (mean, 30.7 days). Overall incidence of temporary and permanent RLNP was 5.1% and 0.9%, respectively. The rates of temporary/permanent RLNP were 4.0/0.2%, 2.0/0.7%, 12.0/1.1%, and 10.8/8.1% for groups classified according to benign thyroid disease, thyroid cancer, Graves' disease, and reoperation, respectively.


CONCLUSIONS
Operations for thyroid cancer, Graves' disease, and recurrent goiter demonstrated significantly higher RLNP rates. Invasion of RLN was identified in 19.4% of patients with thyroid cancer. Postoperatively, the RLN recovered in most of the patients without documented nerve damage during the operation. Total lobectomy with routine RLN identification is recommended as a basic procedure in thyroid operations.
Chiang
Feng-Yu
FY
Department of Otolaryngology-Head and Neck Surgery, Kaohsiung Medical University, Chung-Ho Memorial Hospital, Kaohsiung, Taiwan.
Wang
Ling-Feng
LF
Huang
Yin-Feng
YF
Lee
Ka-Wo
KW
Kuo
Wen-Rei
WR
D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006042:Goiter / Q000601:surgery; D006111:Graves Disease / Q000601:surgery; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D020127:Recovery of Function; D012009:Recurrent Laryngeal Nerve / Q000033:anatomy & histology; D061226:Recurrent Laryngeal Nerve Injuries; D012086:Reoperation; D012307:Risk Factors; D013959:Thyroid Diseases / Q000601:surgery*; D013964:Thyroid Neoplasms / Q000601:surgery; D013965:Thyroidectomy / Q000009:adverse effects*; D014826:Vocal Cord Paralysis / Q000453:epidemiology* / Q000209:etiology*