Recurrent laryngeal nerve paralysis in patients with papillary thyroid carcinomas: evaluation and management of resulting vocal dysfunction.
BACKGROUND
Recurrent laryngeal nerve paralysis (RLNP) occurs in patients with thyroid malignancy. This study prospectively evaluated vocal function and management outcomes of patients with papillary thyroid carcinomas (PTCs) and RLNP.


METHODS
Of 319 PTC patients, 256 underwent total thyroidectomy with or without neck dissection, 42 underwent lobectomy, and 21 underwent reoperation for recurrent cancers. All patients underwent laryngoscopy and vocal function measurements before and after surgery. Patients with RLNP and poor vocal function underwent voice surgery.


RESULTS
Temporary and permanent RLNP rates were 2.8% and .9% at nerve-at-risk-based analysis, respectively. Of 28 patients with tumor invasion of RLN, 14 had preoperative RLNP, with 9 of 14 showing voice changes. RLNP was detected in 9 of 291 (3.1%) patients without documented nerve injury; 8 recovered. Nine of 15 patients with RLN section had poor vocal function, which improved in 8 patients after medialization of the unilateral vocal fold.


CONCLUSIONS
Patients with PTC may have vocal dysfunction from cancer or surgery-related RLNP. Vocal evaluation and management may help improve their vocal function, thus enhancing their quality of life.
Department of Otolaryngology, Asan Medical Centre, University of Ulsan, College of Medicine, Songpa-Gu, Seoul, Republic of Korea. rohjl@amc.ac.kr
Jong-Lyel
JL
Roh
Yeo-Hoon
YH
Yoon
Chan Il
CI
Park
D000231:Adenocarcinoma, Papillary / Q000150:complications / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012009:Recurrent Laryngeal Nerve; D013964:Thyroid Neoplasms / Q000150:complications / Q000601:surgery*; D013965:Thyroidectomy; D016896:Treatment Outcome; D014826:Vocal Cord Paralysis / Q000209:etiology; D014827:Vocal Cords; D014833:Voice Quality