title: A palsied recurrent laryngeal nerve should be explored and evaluated by intraoperative neuromonitoring during secondary thyroidectomy: report of two cases.
abstract: BACKGROUND
  Our aim was to evaluate the findings of intraoperative nerve monitoring (IONM) in two cases with preoperative vocal cord palsy. Case 1: a 61-year-old female with recurrent goiter underwent secondary thyroidectomy. The preoperative evaluation of the vocal cords revealed right vocal cord paralyses without atrophy. The right recurrent laryngeal nerve (RLN) was found to be anatomically intact and preserved. The electrical responses of the vocal cords were elicited via IONM. Case 2: a 26-year-old male, who presented with preoperative right vocal cord palsy with atrophy, underwent completion thyroidectomy secondary to papillary carcinoma. The right RLN was explored and found to be tied and interrupted. There was no signal from the RLN with IONM.
  
  
  CONCLUSIONS
  Even in cases with vocal cord palsy detected preoperatively, the nerve should be explored intraoperatively, and should never be sacrificed before an evaluation by nerve monitoring. A palsied RLN which has electrical activity should be protected to maintain the vocal cord's neural tone and to prevent its atrophy.
authors.affiliation: , Atakent Mahallesi. 3. Etap. Manolya çıkmazı. No: 2E/1 Blok: D21/1 Daire:1, Kucukcekmece, 34303, Istanbul, Turkey. drmuludag@hotmail.com.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Uludag
authors.affiliation: Department of General Surgery, Sisli Etfal Training and Research Hospital, Halaskargazi caddesi Etfal sokak. Sisli, 34820, Istanbul, Turkey.
authors.forename: Gurkan
authors.initials: G
authors.lastname: Yetkin
authors.affiliation: Department of General Surgery, Sisli Etfal Training and Research Hospital, Halaskargazi caddesi Etfal sokak. Sisli, 34820, Istanbul, Turkey.
authors.forename: Ebru S
authors.initials: ES
authors.lastname: Oran
authors.affiliation: Department of General Surgery, Sisli Etfal Training and Research Hospital, Halaskargazi caddesi Etfal sokak. Sisli, 34820, Istanbul, Turkey.
authors.forename: Nurcihan
authors.initials: N
authors.lastname: Aygun
authors.affiliation: Department of General Surgery, Sisli Etfal Training and Research Hospital, Halaskargazi caddesi Etfal sokak. Sisli, 34820, Istanbul, Turkey.
authors.forename: Fevzi
authors.initials: F
authors.lastname: Celayir
authors.affiliation: Department of General Surgery, Sisli Etfal Training and Research Hospital, Halaskargazi caddesi Etfal sokak. Sisli, 34820, Istanbul, Turkey.
authors.forename: Abdulcabbar
authors.initials: A
authors.lastname: Kartal
authors.affiliation: Department of General Surgery, Bahcesehir University Medical Faculty, Goztepe, Istanbul, Turkey.
authors.forename: Adnan
authors.initials: A
authors.lastname: Isgor
mesh_terms: D000328:Adult; D005260:Female; D006042:Goiter / Q000150:complications / Q000601:surgery*; D006801:Humans; D007431:Intraoperative Complications / Q000175:diagnosis*; D064795:Intraoperative Neurophysiological Monitoring / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D013965:Thyroidectomy / Q000379:methods*; D014826:Vocal Cord Paralysis / Q000175:diagnosis* / Q000209:etiology
keywords: Intraoperative neuromonitoring; Palsied recurrent laryngeal nerve; Secondary thyroidectomy