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The utility of evaluating true vocal fold motion before thyroid surgery
Tarik Y Farrag1, Robin A Samlan, Frank R Lin
1Johns Hopkins University School of Medicine, Department of Otolaryngology-Head & Neck Surgery, Baltimore, MD 21287-0910, USA.
The Laryngoscope
|February 10, 2006
Summary
Preoperative vocal fold (VF) examination is crucial before thyroid surgery, as some patients with VF motion impairment may not have voice symptoms. This screening helps in patient counseling and surgical planning to prevent recurrent laryngeal nerve (RLN) injury.
Area of Science:
- Otolaryngology
- Head and Neck Surgery
- Surgical Oncology
Background:
- Vocal fold (VF) mobility assessment is vital before thyroid surgery to anticipate potential recurrent laryngeal nerve (RLN) injury.
- Preoperative voice changes or complaints are often considered indicators of VF dysfunction.
Purpose of the Study:
- To determine the effectiveness of screening laryngoscopic examinations in identifying vocal fold (VF) mobility issues prior to thyroid surgery.
- To assess the correlation between voice symptoms and actual VF mobility impairment.
Main Methods:
- A retrospective review of 340 patients undergoing thyroid surgery between 1998 and 2005.
- Analysis of preoperative laryngoscopy reports (mirror, fiberoptic, videostroboscopic) and voice complaint data.
- Correlation of VF mobility findings with intraoperative RLN status, preoperative diagnosis, and postoperative histopathology.
Main Results:
- Seven of 22 patients (32%) with preoperative VF motion impairment were asymptomatic, challenging the assumption that immobility always causes voice problems (P=.009).
- Screening using voice symptoms had 68% sensitivity, 91% specificity, 31% PPV, and 98% NPV for predicting VF motion impairment.
- Five asymptomatic patients with VF impairment had benign, slowly progressive disease; six had fiberoptic evaluations.
- Impaired mobility was contralateral to the thyroid lesion in 22.5% of cases, differing significantly from the ipsilateral hypothesis (P=.05).
Conclusions:
- Vocal fold (VF) motion impairment can occur in asymptomatic patients undergoing thyroid surgery.
- Impaired vocal fold (VF) mobility may be contralateral to the thyroid lesion.
- Preoperative laryngoscopy aids in patient counseling regarding surgical risks and informs surgical planning to minimize iatrogenic recurrent laryngeal nerve (RLN) injury.
