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Updated: Jun 25, 2026
Identification and Protection of the Recurrent Laryngeal Nerve during Transoral Robotic Thyroidectomy
Published on: October 24, 2025
Laryngeal complications after thyroidectomy: is it always the surgeon?
Matthias Echternach1, Christoph A Maurer, Christoph Maurer
1Institute for Musicians' Medicine, Freiburg University Medical Center, Breisacher Str 60, 79106 Freiburg, Germany. matthias.echternach@uniklinik-freiburg.de
Hypothesis:
Laryngeal dysfunction after thyroidectomy is a common complication. However, few data are available to differentiate whether these complications result from injury to the recurrent nerve or to the vocal folds from intubation.
Setting:
University medical center.
Patients:
Seven hundred sixty-one patients who underwent surgery to the thyroid gland from 1990 to 2002. Of these patients, 8.4% underwent a revision thyroidectomy.
Intervention:
Preoperative and postoperative laryngostroboscopic examination.
Main Outcome Measure:
Laryngostroboscopic evaluation of laryngeal complications.
Results:
The overall rate of laryngeal complications was 42.0% (320 patients). Complications from an injury to the vocal folds occurred in 31.3% of patients. Weakness or paresis of the recurrent nerve was initially present in 6.6% and was related to the nerves at risk. This rate was higher in revision thyroidectomies than in primary surgical interventions (6.2% vs 11.6%; P = .04). The rate of laryngeal injuries was higher in patients older than 65 years (39.8% vs 30.8%; P = .03).
Conclusions:
These data suggest that laryngeal complications after thyroidectomies are primarily caused by injury to the vocal folds from intubation and to a lesser extent by injury to the laryngeal nerve. We recommend documentation of informed consent, especially for patients who use their voice professionally, such as singers, actors, or teachers.
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