title: Is there a case for selective, rather than routine, preoperative laryngoscopy in thyroid surgery?
abstract: BACKGROUND
  According to some authors, routine preoperative laryngoscopy should be the standard of care in all patients undergoing thyroid surgery. The rationale for this approach is (I) the risk that a patient has a preoperative vocal cord palsy (VCP) without symptoms; (II) the presence of VCP preoperatively is suggestive of invasive malignancy; (III) it is relevant for the use of intraoperative nerve monitoring; and (IV) surgical strategy may be better defined if a paralysed vocal cord is detected preoperatively.
  
  
  METHODS
  This is a review of studies of patients who underwent routine preoperative laryngoscopy to anticipate preoperative VCP and that evaluated related risk factors, including previous surgery, voice function complaints, and a diagnosis of malignancy. The estimated risk of sustaining preoperative VCF in the absence of these factors was determined. The relevant current guidelines from different professional bodies are also addressed.
  
  
  RESULTS
  The level of evidence that supports routine preoperative laryngoscopy is weak. The risk of harboring preoperative VCP in the absence of previous neck or other risk-related surgery, advanced malignancy or voice symptoms is very low (0.5% of cases).
  
  
  CONCLUSIONS
  Selective rather than routine use of preoperative laryngoscopy may be acceptable provided that the risk of undetected paralysis is as low as can be reasonably ascertained from the available literature.
authors.affiliation: 1 Department of Surgery, 2 Department of Otorhinolaryngology, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain.
authors.forename: Guzmán
authors.initials: G
authors.lastname: Franch-Arcas
authors.affiliation: 1 Department of Surgery, 2 Department of Otorhinolaryngology, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: González-Sánchez
authors.affiliation: 1 Department of Surgery, 2 Department of Otorhinolaryngology, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain.
authors.forename: Yari Yuritzi
authors.initials: YY
authors.lastname: Aguilera-Molina
authors.affiliation: 1 Department of Surgery, 2 Department of Otorhinolaryngology, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain.
authors.forename: Orlando
authors.initials: O
authors.lastname: Rozo-Coronel
authors.affiliation: 1 Department of Surgery, 2 Department of Otorhinolaryngology, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain.
authors.forename: José Santiago
authors.initials: JS
authors.lastname: Estévez-Alonso
authors.affiliation: 1 Department of Surgery, 2 Department of Otorhinolaryngology, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain.
authors.forename: Ángel
authors.initials: Á
authors.lastname: Muñoz-Herrera
keywords: Laryngoscopy; preoperative period; thyroidectomy; vocal cord paralysis