Efficacy of Intraoperative Injection Laryngoplasty for Vocal Fold Paralysis during Thyroidectomy

This study aimed to investigate the efficacy and safety of simultaneous injection laryngoplasty (IL) during thyroid surgery.

We analyzed the data of 13 patients who underwent immediate IL at the time of recurrent laryngeal nerve (RLN) damage during thyroidectomy and completed voice evaluations within 1 month, 1-3 months, and 3-6 months after IL. Voice parameters and adverse events were evaluated for 6 months following immediate IL. Additionally, a second group of 12 patients who underwent postoperative IL between 2 and 6 months after thyroidectomy was included for comparison of voice outcomes. All patients were confirmed to have an intact contralateral vocal fold based on preoperative laryngeal stroboscopy and intraoperative neuromonitoring.

All patients who received intraoperative IL showed unilateral vocal fold fixation but not any glottal insufficiency after the surgery. After immediate IL, voice parameters gradually improved up to 3-6 months. There was a significant improvement seen in jitter % (P = 0.008), shimmer % (P = 0.010), and cepstral spectral index of dysphonia in vowel samples(CSID_V) (P = 0.004) in 3-6 months compared to those in 1 month. Similarly, shimmer % (P = 0.016), cepstral peak prominence in sentence sample (CPP_S) (P = 0.016), and CSID_V (P = 0.014) showed significant improvement at 3-6 months compared to those at 1-3 months. No adverse events were observed during follow-up after intraoperative IL. Moreover, except for jitter %, there were no significant differences in efficacy and safety compared to the postoperative IL group.

During thyroidectomy, performing simultaneous IL can enhance voice outcomes in cases of unilateral RLN damage. This procedure may be considered as an option for treating vocal fold paralysis during thyroidectomy in order to mitigate the potential complications of vocal fold paralysis in the early postoperative period.