[The post-operative recurrent laryngeal nerve paralysis and its course (author's transl)]

Benign diseases of the thyroid may also be the cause of pre-operative paralysis of the recurrent laryngeal nerves. the frequency of palsies in uncomplicated strumectomies is approximately 4 to 5%. A markedly higher risk exists in endothoracic goitres which must be delivered by thoracotomy, in recurrencies and thyroiditis. Dissection, crush lesions, strain and nerves mistakenly pulled into a ligature are the most frequent causes of injury; haematoma, oedema, heat by diathermy, lesions caused by a scar and a neuritis of the nerve are less common. 30 to 50% of unilateral laryngeal nerve palsies are without symptoms. An exact examination, however, reveals some alterations of the voice. A logopedic treatment combined with electro-therapy accelerates the compensation of the intact vocal cord. In bilateral paralysis of the recurrent laryngeal nerves a tracheotomy is necessary because of respiratory distress. After 6 to 9 months a glottis-widening procedure may be performed since no further recovery can be expected. A unilateral paralysis has a recovery rate of 40%; therefore in 2 to 3% of uncomplicated strumectomies a definite paralysis of the recurrent laryngeal nerve is observed.