title: Analysis of the Istanbul Forensic Medicine Institute expert decisions on recurrent laryngeal nerve injuries due to thyroidectomy between 2008-2012.
abstract: OBJECTIVE
  The aim of this study was to evaluate the approach of Forensic Medicine Institution for recurrent laryngeal nerve injuries. In addition, parameters that were taken into consideration by Forensic Medicine Institution in the differentiation of complication and malpractice were evaluated.
  
  
  METHODS
  The files of 38 patients, with recurrent laryngeal nerve injury following thyroidectomy, that were referred to Istanbul Forensic Medicine Institute with request of expert opinion between 2008-2012 were retrospectively investigated. Data regarding expert decisions, age, gender, diagnosis, hospital type, preoperative vocal cord examination, intraoperative nerve monitoring (IONM), identification of nerve injury during operation, repair of nerve during operation, and type of injury were assessed.
  
  
  RESULTS
  Surgeons were found to be faulty in all files with bilateral nerve injury, however, one-sided injury files were considered as a medical complication. Twenty-one (55.2%) patients were female, and 17 (44.8%) were male, with a mean age of 35,8 in women, and 34,1 in men. None of these patients had undergone preoperative vocal cord assessment. The recurrent laryngeal nerve was intraoperatively identified in 21 (55.2%) patients, while it was not seen in 17 (44.8%) patients. IONM was not applied in any patients. There was no attempt for nerve repair during any operation. Nineteen patients had unilateral, and 19 patients had bilateral nerve damage.
  
  
  CONCLUSIONS
  Bilateral recurrent laryngeal nerve injuries are considered as malpractice, when imaging or pathology reports fail to state a cause for difficulty in nerve identification.
authors.affiliation: Department of General Surgery, Forensic Medicine Institute, İstanbul, Turkey.
authors.forename: M Arif
authors.initials: MA
authors.lastname: Karakaya
authors.affiliation: Clinic of Gastroenterology, Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey.
authors.forename: Okay
authors.initials: O
authors.lastname: Koç
authors.affiliation: Department of General Surgery, İstanbul University İstanbul School of Medicine, İstanbul, Turkey.
authors.forename: Feza
authors.initials: F
authors.lastname: Ekiz
authors.affiliation: Clinic of General Surgery, Kartal Dr. Lütfi Kırdar Training and Research Hospital, İstanbul, Turkey.
authors.forename: A Feran
authors.initials: AF
authors.lastname: Ağaçhan
authors.affiliation: Clinic of General Surgery, Kartal Dr. Lütfi Kırdar Training and Research Hospital, İstanbul, Turkey.
authors.forename: Nuri Emrah
authors.initials: NE
authors.lastname: Göret
keywords: Recurrent laryngeal nerve; complications; forensic medicine; thyroidectomy