Thyroid tumors with preoperative recurrent laryngeal nerve palsy: clinicopathologic features and treatment outcome.
BACKGROUND
The aim of this present study is to define the significance of recurrent laryngeal nerve palsy (RLNP) detected before surgery for thyroid diseases with regard to the incidence of malignancy, histopathologic distribution, extrathyroidal invasion, management, and prognosis.


METHODS
Six hundred and twenty-two patients underwent operation for various thyroid disease and were treated by the same surgeon. The study was confined to 16 (3%) patients who suffered from a thyroid tumor with preoperative RLNP.


RESULTS
Of these 16 patients, 1 had benign thyroid disease, while the other 15 had malignancy (94%). Among the 15 cancer patients, 14 had extrathyroidal invasion and needed more extensive surgical procedures than total thyroidectomy. The recurrent laryngeal nerve could be dissected from the thyroid neoplasm in 3 patients, 2 of whom experienced recovery of this nerve's function postoperatively.


CONCLUSIONS
Thyroid tumor associated with RLNP is strongly suggestive of malignancy. The RLN should be preserved if it has not been invaded by the tumor, because it offers a good chance of functional recovery postoperatively. Well-differentiated thyroid cancer accounts for only half of these patients who tend to present at an older age and feature a much higher incidence of upper aerodigestive tract invasion. The operations for these patients often are complex and should be performed by experienced surgeons. Radical excision of a resectable anaplastic or squamous cell carcinoma of the thyroid gland offers the chance, albeit small, of long-term survival in this study.
Chiang
Feng-Yu
FY
Department of Otolaryngology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan.
Lin
Jen-Chih
JC
Lee
Ka-Wo
KW
Wang
Ling-Feng
LF
Tsai
Kuo-Bow
KB
Wu
Che-Wei
CW
Lu
Shang-Pin
SP
Kuo
Wen-Rei
WR
D000368:Aged; D002291:Carcinoma, Papillary / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D005260:Female; D006801:Humans; D007823:Laryngeal Nerves / Q000473:pathology / Q000502:physiology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D013961:Thyroid Gland / Q000473:pathology / Q000601:surgery; D013964:Thyroid Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000601:surgery*; D013965:Thyroidectomy / Q000379:methods*; D016896:Treatment Outcome; D014826:Vocal Cord Paralysis / Q000209:etiology* / Q000473:pathology / Q000601:surgery*