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Identification and Protection of the Recurrent Laryngeal Nerve during Transoral Robotic Thyroidectomy

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Risk factors for transient vocal cord palsy after thyroidectomy.

J J Sancho¹, M Pascual-Damieta, J A Pereira

¹Endocrine Surgery Unit, Department of Surgery, Hospital del Mar, Barcelona, Spain. jjsancho@gmail.com

The British Journal of Surgery

|July 12, 2008

Summary

This summary is machine-generated.

Surgical injury to the inferior laryngeal nerve (ILN) during thyroidectomy can cause vocal cord dysfunction (VCD). Branched ILNs are more susceptible to injury and double the risk of VCD.

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Area of Science:

Otolaryngology
Thyroid Surgery
Nerve Anatomy

Background:

Transient recurrent laryngeal nerve palsy occurs in 5-10% of patients post-thyroidectomy.
Understanding the impact of inferior laryngeal nerve (ILN) injury on vocal cord dysfunction (VCD) is crucial.

Purpose of the Study:

To assess the impact of surgical injury and extralaryngeal branching of the ILN on VCD.
To determine the relationship between ILN anatomy and post-thyroidectomy vocal cord function.

Main Methods:

Prospective study of 188 patients undergoing total or lobar thyroidectomy (302 ILNs).
Recorded ILN anatomy, extralaryngeal branching, and degree of injury using the Laryngeal Nerve Injury Score (LNIS).
Performed fibreoptic laryngoscopy to assess VCD post-surgery.

Main Results:

37.4% of ILNs exhibited extralaryngeal branching.
VCD developed in 10.9% of patients (4.3% paresis, 6.6% paralysis), with most recovering fully.
VCD was significantly more frequent in patients with branched ILNs (15.8% vs. 8.1%, P=0.022).
Branched nerves had higher injury scores (LNIS 0.94 vs. 0.51, P<0.001) and were twice as likely to be associated with VCD (OR 2.2).

Conclusions:

Extralaryngeal branching of the ILN is common and associated with increased surgical injury.
Branched ILNs are significantly more likely to result in vocal cord dysfunction after thyroidectomy.