Technical Aspects of Transcutaneous Laryngeal Ultrasonography: A Review

Vocal fold palsy is a crucial complication of thyroidectomy. Although laryngoscopic examination is the gold standard for vocal fold assessment, there is a growing interest in incorporating transcutaneous laryngeal ultrasonography (TLUSG) in the peri-operative period. This review provides a detailed technical report on how to efficiently perform TLUSG assessment of the vocal folds.

The ultrasonographic assessment of vocal folds is based on the recognition and observation of one of three structures: false vocal folds, true vocal folds, and arytenoid cartilages. These structures can be visualized either through the anterior (transverse) approach or the lateral (sagittal) approach. The movement of vocal fold structures is elicited and assessed using three maneuvers, namely passive breathing, active phonation or Valsalva maneuver. This examination can allow adequate visualization and assessment of vocal fold function in the majority of the patients in the peri-operative period.

This review provides a step-by-step description and algorithmic approach to TLUSG assessment of the vocal folds. It details the common pitfalls and modifications of TLUSG required to assist surgeons, anesthesiologists, and endocrinologists in incorporating this examination in their practice.