Hostname: page-component-586b7cd67f-gb8f7 Total loading time: 0 Render date: 2024-11-22T15:18:09.620Z Has data issue: false hasContentIssue false

The circumstances in which recurrent laryngeal nerve palsy occurs after surgery for benign thyroid disease: a retrospective study of 1026 patients

Published online by Cambridge University Press:  14 June 2021

D Lenay-Pinon
Affiliation:
ENT and Head and Neck Department, Amiens University Hospital, Amiens, France
A Biet-Hornstein
Affiliation:
ENT and Head and Neck Department, Amiens University Hospital, Amiens, France
V Strunski
Affiliation:
ENT and Head and Neck Department, Amiens University Hospital, Amiens, France
C Page*
Affiliation:
ENT and Head and Neck Department, Amiens University Hospital, Amiens, France Infectious Agents, Resistance and Chemotherapy, University of Picardy Jules Verne, Amiens, France
*
Author for correspondence: Professor Cyril Page, Service d'ORL et de chirurgie de la face et du cou, Centre Hospitalier Universitaire Amiens-Picardie, Hôpital Sud, F-80054 Amiens Cedex, France Email: [email protected]

Abstract

Objective

To evaluate the circumstances in which recurrent laryngeal nerve palsy occurs after thyroid surgery.

Methods

This study assessed 1026 patients who underwent surgery for benign thyroid disease over a seven-year period in a retrospective, single-centre study.

Results

With a total of 1835 recurrent laryngeal nerves at risk, there were 38 cases (2.07 per cent) of transient recurrent laryngeal nerve palsy and 8 (0.44 per cent) of permanent recurrent laryngeal nerve palsy. No explanation was found for 10 of the 46 cases of recurrent laryngeal nerve palsy. Among the 38 other cases, the probable causes included poor identification of the recurrent laryngeal nerve during surgery, involuntary resection of the nerve and several other factors.

Conclusion

Apart from accidental resection of the recurrent laryngeal nerve during thyroid surgery, the causes of post-operative recurrent laryngeal nerve palsy are often unclear and likely multifactorial. Poor identification of the recurrent laryngeal nerve during surgery is still the main cause of post-operative recurrent laryngeal nerve palsy, even when intra-operative neuromonitoring is used.

Type
Main Articles
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press.

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Prof C Page takes responsibility for the integrity of the content of the paper

References

Fortuny, JV, Guigard, S, Karenovics, W, Triponez, F. Surgery of the thyroid: recent developments and perspective. Swiss Med Wkly 2015;145:w14144Google ScholarPubMed
Christou, N, Mathonnet, M. Complications after total thyroidectomy [in French]. J Visc Surg 2013;150:249–56CrossRefGoogle Scholar
Richer, SL, Randolph, GW. Management of the recurrent laryngeal nerve in thyroid surgery. Oper Tech Otolaryngol 2009;20:2934CrossRefGoogle Scholar
Dralle, H, Sekulla, C, Haerting, J, Timmermann, W, Neumann, HJ, Kruse, E et al. Risk factors of paralysis and functional outcome after recurrent laryngeal nerve monitoring in thyroid surgery. Surgery 2004;136:1310–22CrossRefGoogle ScholarPubMed
Steurer, M, Passler, C, Denk, DM, Schneider, B, Niederle, B, Bigenzahn, W. Advantages of recurrent laryngeal nerve identification in thyroidectomy and parathyroidectomy and the importance of preoperative and postoperative laryngoscopic examination in more than 1000 nerves at risk. Laryngoscope 2002;112:124–33CrossRefGoogle ScholarPubMed
Klopp, N, Biet, A, Guillaume-Souaid, G, Strunski, V, Page, C. Intra-operative neuromonitoring of the vagus nerve during thyroidectomy. A prospective study. Clin Otolaryngol 2016;41:454–60CrossRefGoogle Scholar
Jeannon, JP, Orabi, AA, Bruch, GA, Abdalsalam, HA, Simo, R. Diagnosis of recurrent laryngeal nerve palsy after thyroidectomy: a systematic review. Int J Clin Pract 2009;63:624–9CrossRefGoogle ScholarPubMed
Association Francophone de Chirurgie Endocrinienne: http://www.chirurgie-endocrinienne.net/download/afce/CRO_Thyroidectomie.pdf [15 September 2021]Google Scholar
Enomoto, K, Uchino, S, Watanabe, S, Enomoto, Y, Noguchi, S. Recurrent laryngeal nerve palsy during surgery for benign thyroid diseases: risk factors and outcome analysis. Surgery 2014;155:522–8CrossRefGoogle ScholarPubMed
Serpell, JW, Lee, JC, Yeung, MJ, Grodski, S, Johnson, W, Bailey, M. Differential recurrent laryngeal nerve palsy rates after thyroidectomy. Surgery 2014;156:1157–66CrossRefGoogle ScholarPubMed
Laccourreye, O, Malinvaud, D, Ménard, M, Bonfils, P. Unilateral laryngeal immobility after surgery of the thyroid gland [in French]. J Chir (Paris) 2009;146:553–8CrossRefGoogle Scholar
Dralle, H, Lorenz, K, Manchens, A. Verdicts on malpractice claims after thyroid surgery: emerging trend and future directions. Head Neck 2012;34:1591–6CrossRefGoogle Scholar
Myssiorek, D. Recurrent laryngeal nerve paralysis: anatomy and etiology. Otolaryngol Clin North Am 2004;37:2544CrossRefGoogle ScholarPubMed
Snyder, SK, Lairmore, TC, Hendricks, JC, Roberts, JW. Elucidating mechanisms of recurrent laryngeal nerve injury during thyroidectomy and parathyroidectomy. J Am Coll Surg 2008;206:123–30CrossRefGoogle ScholarPubMed
Tresallet, C, Chigot, JP, Menegaux, F. How to prevent recurrent nerve palsy during thyroid surgery? [in French] Ann Chir 2006;131:149–53Google Scholar
Rosato, L, Avenia, N, Bernante, P, De Palma, M, Gulino, G, Nasi, PG et al. Complications of thyroid surgery: analysis of a multicentric study on 14,934 patients operated on in Italy over 5 years. World J Surg 2004;28:271–6CrossRefGoogle Scholar
Daher, R, Lifante, JC, Voirin, N, Peix, JL, Colin, C, Kraimps, JL et al. Is it possible to limit the risks of thyroid surgery? Ann Endocrinol (Paris) 2015;76:1S1626CrossRefGoogle ScholarPubMed
Chiang, FY, Lin, JC, Wu, CW, Lee, KW, Lu, SP, Kuo, WR et al. Morbidity after total thyroidectomy for benign thyroid disease: comparison of Graves’ disease and non-Graves’ disease. Kaohsiung J Med Sci 2006;22:554–9CrossRefGoogle ScholarPubMed
Biet, A, Zaatar, R, Strunski, V, Page, C. Postoperative complications in total thyroidectomy for Graves disease: comparison with multinodular benign goiter surgery [in French]. Ann Otolaryngol Chir Cervicofac 2009;126:190–5CrossRefGoogle Scholar
Page, C, Cuvelier, P, Biet, A, Strunski, V. Value of intra-operative neuromonitoring of the recurrent laryngeal nerve in total thyroidectomy for benign goitre. J Laryngol Otol 2015;129:553–7CrossRefGoogle ScholarPubMed
Page, C, Foulon, P, Strunski, V. The inferior laryngeal nerve: surgical and anatomic considerations. Report of 251 thyroidectomies. Surg Radiol Anat 2003;25:188–91CrossRefGoogle ScholarPubMed
Hermann, M, Alk, G, Roka, R, Glaser, K, Freissmuth, M. Laryngeal recurrent nerve injury in surgery for benign thyroid diseases: effect of nerve dissection and impact of individual surgeon in more than 27,000 nerves at risk. Ann Surg 2002;235:261–8CrossRefGoogle Scholar
Randolph, GW, Dralle, H, International Intraoperative Monitoring Study Group; Abdullah, H, Barczynski, M, Bellantone, R, et al. Electrophysiologic recurrent laryngeal nerve monitoring during thyroid and parathyroid surgery: international standards guideline statement. Laryngoscope 2011;121(suppl 1):S116CrossRefGoogle ScholarPubMed
Klopp-Dutote, N, Biet, A, Guillaume-Souaid, G, Strunski, V, Page, C. Intraoperative neuromonitoring of the vagus nerve during thyroidectomy. A prospective study. Clin Otolaryngol 2016;41:454–60CrossRefGoogle ScholarPubMed