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Recurrent laryngeal nerve damage and phonetic modifications after total thyroidectomy: surgical malpractice only or
Lodovico Rosato1, Maria Teresa Carlevato, Giorgio De Toma
1Department of Surgery, Endocrine Surgical Unit, Ivrea Hospital, Piazza della Credenza, Ivrea, 2-10015, Italy, presidente@clubdelleuec.it
World Journal of Surgery
|May 17, 2005
Summary
Voice and swallowing problems after total thyroidectomy (TT) are common, affecting about one-third of patients. These issues can arise from nerve function changes or surgical side effects, not just malpractice.
Area of Science:
- Otolaryngology
- Endocrine Surgery
- Vocal Cord Function
Background:
- Phonation and swallowing modifications post-total thyroidectomy (TT) are often wrongly attributed to surgical errors.
- Pre-existing voice and swallowing impairments are common in patients undergoing TT.
Purpose of the Study:
- To analyze the incidence and causes of voice and swallowing impairments following TT, excluding direct operative nerve damage.
- To differentiate between complications directly from nerve injury and other functional issues.
Main Methods:
- Retrospective analysis of 208 patients who underwent TT between 1999-2001.
- Pre- and postoperative clinical and instrumental nose and throat examinations (NTE) were performed.
- Patients with confirmed operative damage to laryngeal nerves were excluded.
Main Results:
- Over one-third of patients had preoperative voice/swallowing issues.
- Approximately one-third experienced new or persistent symptoms post-TT.
- Common postoperative issues included vocal cord hypomobility, hypotonia, and scarring/adhesions.
Conclusions:
- Functional laryngeal problems post-TT can occur even without direct nerve damage.
- Postoperative impairments may stem from the operation itself (e.g., edema, scarring) or temporary events (e.g., neuritis).
- Thorough preoperative assessment and patient counseling regarding potential sequels are crucial.