title: "Mystic" transient recurrent nerve palsy after thyroid surgery.
abstract: BACKGROUND
  The mechanism of transient recurrent laryngeal nerve (RLN) palsy remains unclear.
  
  
  METHODS
  Samples were harvested from the RLN adjacent thyroid capsule and perineural fascia during 223 lobectomies and 89 RLNs from cadavers were used for histologic and immunohistologic evaluation. Intraoperative chromoendoscopic features of the RLN were compared with postoperative ear, nose, and throat examinations.
  
  
  RESULTS
  Those nerves that macroscopically seem to be single-branched (35 of 89 = 39.3%), microscopically consist of multiple fascicles in most of the cases (23 of 35 = 65.7%), resembling a plexus more than a single cord. Chronic lymphocytic infiltration of the thyroid capsule adjacent to the RLN was present in 29% (65 of 223) of the cases. The perineural fascia showed lymphocytic (18 of 223 = 8.1%) or granulocytic (7 of 223 = 3.1%) infiltration.
  
  
  CONCLUSIONS
  The origin of transient RLN palsy is multifactorial: plexus shaped microscopic nerve structure with or without branches, frame-like adventitial tissue, variable epineurium, inflammatory changes that involve not only the thyroid capsule but the perineural fascia, resultant nerve edema, and diffuse microhemorrhages by injury of fragile capillaries.
authors: Department of Surgery, St. George University Teaching Hospital, H-8000 Székesfehérvár, Seregélyesi út 3., Hungary. altorjay@mail.fmkorhaz.hu
authors: Aron
authors: A
authors: Altorjay
authors: Miklós
authors: M
authors: Rüll
authors: Balázs
authors: B
authors: Paál
authors: Géza
authors: G
authors: Csáti
authors: Anna
authors: A
authors: Szilágyi
mesh_terms: D000328:Adult; D000368:Aged; D002102:Cadaver; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D061226:Recurrent Laryngeal Nerve Injuries / Q000209:etiology* / Q000601:surgery; D013961:Thyroid Gland / Q000601:surgery; D013965:Thyroidectomy / Q000009:adverse effects*; D016896:Treatment Outcome; D014826:Vocal Cord Paralysis / Q000209:etiology* / Q000601:surgery