title: Laryngeal complications after thyroidectomy: is it always the surgeon?
abstract: OBJECTIVE
  Laryngeal dysfunction after thyroidectomy is a common complication. However, few data are available to differentiate whether these complications result from injury to the recurrent nerve or to the vocal folds from intubation.
  
  
  METHODS
  University medical center.
  
  
  METHODS
  Seven hundred sixty-one patients who underwent surgery to the thyroid gland from 1990 to 2002. Of these patients, 8.4% underwent a revision thyroidectomy.
  
  
  METHODS
  Preoperative and postoperative laryngostroboscopic examination.
  
  
  METHODS
  Laryngostroboscopic evaluation of laryngeal complications.
  
  
  RESULTS
  The overall rate of laryngeal complications was 42.0% (320 patients). Complications from an injury to the vocal folds occurred in 31.3% of patients. Weakness or paresis of the recurrent nerve was initially present in 6.6% and was related to the nerves at risk. This rate was higher in revision thyroidectomies than in primary surgical interventions (6.2% vs 11.6%; P = .04). The rate of laryngeal injuries was higher in patients older than 65 years (39.8% vs 30.8%; P = .03).
  
  
  CONCLUSIONS
  These data suggest that laryngeal complications after thyroidectomies are primarily caused by injury to the vocal folds from intubation and to a lesser extent by injury to the laryngeal nerve. We recommend documentation of informed consent, especially for patients who use their voice professionally, such as singers, actors, or teachers.
authors.affiliation: Institute for Musicians' Medicine, Freiburg University Medical Center, Breisacher Str 60, 79106 Freiburg, Germany. matthias.echternach@uniklinik-freiburg.de
authors.forename: Matthias
authors.initials: M
authors.lastname: Echternach
authors.forename: Christoph A
authors.initials: CA
authors.lastname: Maurer
authors.forename: Christoph
authors.initials: C
authors.lastname: Maurer
authors.forename: Thomas
authors.initials: T
authors.lastname: Mencke
authors.forename: Martin
authors.initials: M
authors.lastname: Schilling
authors.forename: Thomas
authors.initials: T
authors.lastname: Verse
authors.forename: Bernhard
authors.initials: B
authors.lastname: Richter
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D006801:Humans; D007818:Laryngeal Diseases / Q000209:etiology*; D007828:Laryngoscopy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D061226:Recurrent Laryngeal Nerve Injuries; D012086:Reoperation; D013959:Thyroid Diseases / Q000601:surgery; D013965:Thyroidectomy / Q000009:adverse effects*; D014826:Vocal Cord Paralysis / Q000453:epidemiology / Q000209:etiology; D014827:Vocal Cords / Q000293:injuries*; D055815:Young Adult