title: Transcutaneous Ultrasonography in Early Postoperative Diagnosis of Vocal Cord Palsy After Total Thyroidectomy.
abstract: OBJECTIVE
  This study evaluated the efficiency of transcutaneous laryngeal ultrasonography (TLUS) as an alternative to direct flexible laryngoscopy (DFL) in the early postoperative screening of vocal cord palsy (VCP) after total thyroidectomy, performed for benign and non-extensive malignant disease.
  
  
  METHODS
  A prospective study was performed on patients who underwent total thyroidectomy between October 2013 and January 2015 at the Nantes University Hospital (France). Patients underwent DFL on postoperative day 1 performed by an otolaryngologist, followed by TLUS performed by a radiologist on postoperative day 1 or 2.
  
  
  RESULTS
  One hundred and three (103) patients were included in this study, 17.5% were male and 82.5% were female, with a mean age of 51 ± 12 years. Nine patients (9.5%) were diagnosed with postoperative VCP using DFL of these cases 2 were not completely resolved at 3 months postoperatively. Three cases of VCP (33%) were diagnosed using TLUS. TLUS had a sensitivity of 33% and a negative predictive value (NPV) of 95% for the diagnosis of postoperative VCP. Vocal cords (VC) were unassessable in 27.2% of patients. Unassessable VC were significantly associated with male gender (p = 0.0001), age (p = 0.0001), weight (p = 0.002), operating time (p = 0.032), postoperative drainage (p = 0.001), and thyroid weight (p = 0.001). Independent risk factors in the multivariate analysis were male gender (p = 0.0001) and age (p = 0.0001). In the group of women under 50-year old, TLUS had a sensitivity of 50% and a NPV of 97.4%.
  
  
  CONCLUSIONS
  TLUS sensitivity is insufficient in early postoperative screening of VCP after thyroid surgery. Ultrasonographic VCP diagnosis should be confirmed with DFL.
authors.affiliation: Service de Clinique Chirurgicale Digestive et Endocrinienne, CHU Nantes, 1 place Alexis Ricordeau, 44093, Nantes Cedex 1, France.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Borel
authors.affiliation: Service de Radiologie et Imagerie Médicale, CHU Nantes, Nantes, France.
authors.forename: Anne-Sophie
authors.initials: AS
authors.lastname: Delemazure
authors.affiliation: Service d'Oto-Rhino-Laryngologie, CHU Nantes, Nantes, France.
authors.forename: Florent
authors.initials: F
authors.lastname: Espitalier
authors.affiliation: Service de Clinique Chirurgicale Digestive et Endocrinienne, CHU Nantes, 1 place Alexis Ricordeau, 44093, Nantes Cedex 1, France.
authors.forename: Andrew
authors.initials: A
authors.lastname: Spiers
authors.affiliation: Service de Clinique Chirurgicale Digestive et Endocrinienne, CHU Nantes, 1 place Alexis Ricordeau, 44093, Nantes Cedex 1, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Mirallie
authors.affiliation: Service de Clinique Chirurgicale Digestive et Endocrinienne, CHU Nantes, 1 place Alexis Ricordeau, 44093, Nantes Cedex 1, France. claire.blanchard@chu-nantes.fr.
authors.forename: Claire
authors.initials: C
authors.lastname: Blanchard
mesh_terms: D042241:Early Diagnosis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging*; D011184:Postoperative Period; D011446:Prospective Studies; D012307:Risk Factors; D013959:Thyroid Diseases / Q000601:surgery; D013965:Thyroidectomy / Q000009:adverse effects*; D013997:Time Factors; D014463:Ultrasonography; D014826:Vocal Cord Paralysis / Q000000981:diagnostic imaging* / Q000209:etiology; D014827:Vocal Cords / Q000000981:diagnostic imaging*