title: Should we routinely expose recurrent laryngeal nerve(s) during thyroid surgery?
abstract: OBJECTIVE
  To compare the frequency of recurrent laryngeal nerve(s) (RLNs) palsy after various thyroid procedures with and without identification of recurrent laryngeal nerve during the operation.
  
  
  METHODS
  Randomized controlled trial.
  
  
  METHODS
  Department of Surgery, Military Hospital, Rawalpindi, from August 2008 to April 2010.
  
  
  METHODS
  Patients undergoing indirect laryngoscopy with normal vocal cords and those with carcinoma and re-do surgery having normal vocal cord were included in the study. Patients with hoarseness of voice, abnormal vocal cord movements and with solitary nodule in the isthmus were excluded. These patients were randomly divided into 2 groups of 50 each using random number tables. RLN was identified by exposing the inferior thyroid artery and traced along its entire course in group-A. Whereas, in group-B, nerves were not identified during the operations. Immediate postoperative direct laryngoscopy was performed by a surgeon with the help of an anaesthesiologist for the assessment of vocal cords. Patients with persistent hoarseness of voice were followed-up with indirect laryngoscopy at 3 and 6 months.
  
  
  RESULTS
  Temporary unilateral recurrent laryngeal nerve palsies occurred in 2 (4%) patients in group-A where the voice and cord movements returned to normal in 6 months. In group-B, it occurred in 8 (16%) patients, 2 bilateral (4%) injuries requiring tracheostomy and 6 unilateral injuries (12%). Among the 2 bilateral recurrent laryngeal nerve injuries, the tracheostomy was removed in one case after 6 months with persistent hoarseness of voice but no respiratory difficulty during routine activities. Tracheostomy was permanent in the other case. Among the 6 cases of unilateral nerve injuries, the voice improved considerably in 4 cases within 6 months but in 2 cases hoarseness persisted even after 6 months. Frequency of recurrent laryngeal nerve palsies was significantly lower in group-A as compared to group-B (p = 0.046).
  
  
  CONCLUSIONS
  For safe thyroid surgery, recurrent laryngeal nerve(s) should be routinely exposed in its entire course.
authors: Department of Surgery, Military Hospital, Street 8, Valley Road, Rawalpindi. maqbool957@hotmail.com
authors: Maqbool
authors: M
authors: Ahmed
authors: Aurangzeb
authors: Safdar
authors: S
authors: Abbas
authors: Muhammad
authors: M
authors: Boota
authors: Muhammad
authors: M
authors: Ashfaq
authors: Asif Zaman
authors: AZ
authors: Rashid
authors: Muhammad Azhar
authors: MA
authors: Qureshi
authors: Nauman
authors: N
authors: Iqbal
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007828:Laryngoscopy; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D011183:Postoperative Complications; D012009:Recurrent Laryngeal Nerve; D061226:Recurrent Laryngeal Nerve Injuries / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D013961:Thyroid Gland / Q000601:surgery*; D013965:Thyroidectomy / Q000009:adverse effects / Q000379:methods*; D014139:Tracheostomy; D016896:Treatment Outcome; D014826:Vocal Cord Paralysis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D055815:Young Adult