Factors In fluencing Recurrent Laryngeal Nerve Injury on Post-operative Thyroidectomy

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Anawat Wanthanamaneekul


Background: The recurrent laryngeal nerve injury is a major complication after thyroidectomy and the main cause of vocal fold paralysis associated with hoarseness, dysphagia and aspiration. If vocal fold paralysis from transient the recurrent laryngeal nerve injury is recovery in six month. So that, the experienced of neck surgeons was performed, procedure carefully and prevent complication.
Objective: The study aimed to determine factors influencing transient recurrent laryngeal nerve injury postoperative thyroidectomy in Chaiyaphum hospital.
Methods: This is a retrospective cohort study with 251 the reviewed medical Records those patients more than 15 years old who had thyroid surgery between 1st. January 2016 to 20th. December 2018. Before surgery, all samples were diagnosed carcinoma with fine needle aspiration (FNA), examining the RLN with the fiber optic laryngoscope (FOL) were done. After surgery, all samples were follow up check 1 week, who have hoarseness, difficulty swallowing, choking, difficulty breathing, follow up the treatment every month until up to 6 months with the fiber optic laryngoscope (FOL) to evaluate the vocal cords paralysis in the diagnosis. General data were analyzed using descriptive statistics, time for transient vocal palsy from recurrent laryngeal nerve used median survival time and predictive factors for recurrent transient laryngeal nerve injury using Cox proportional hazard regression (p-value<0.05).
Results: There were 251 patients included to analysis, mean age 49.4 ± 14.2 years, females 88.4%, history of diabetes mellitus 5.6%, Right Lobectomy 46.2%, Total thyroidectomy 15.1, meantime used for surgery 1.4 ± 0.9 hours, mean total Blood loss 128.1 ± 74.7 milliliters, mean lent of stay 5.4 ± 2.0 days, thyroidectomy patient’s 16.3% and undergoing paralysis vocal cord 12 case (29.3%), total thyroidectomy patient’s 11 case (26.8%), subtotal thyroidectomy patient’s 1 case (2.4%). From the Cox proportional hazard regression, predictors that influence unilateral recurrent laryngeal nerve injury were carcinoma 55.2% (95% CI, 6.7 to 55.0), total thyroidectomy 13.3% (95% CI, 2.7 to 65.2), significant. (p-value<0.05) but other factors no significant. (p-value>0.05). Median duration of vocal cord paralysis from transient unilateral recurrent laryngeal nerve injury was 4.0 months (95% CI, 3.0 to 5.0) respectively.
Conclusion: The predictors influence unilateral Recurrent Laryngeal nerve injury were carcinoma, Total thyroidectomy, can be avoided by careful observation, investigation, visual identification, the mechanisms of
intraoperative nerve injury include division, laceration, stretching or traction, pressure, crush, electrical, heat, ligature entrapment and delicate, meticulous dissection of the nerve.
Keywords: Transient Recurrent, Laryngeal nerve injury, Thyroidectomy


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1. Ríos A, Rodríguez JM, Balsalobre MD, Tebar FJ, Parrilla P. The value of various definitions of intrathoracic goiter for predicting intra-operative and postoperative complications. urgery 2010;147(2):233-8.

2. Lynch J, Parameswaran R. Management of unilateral recurrent laryngeal nerve injury after thyroid surgery: A review. Head Neck 2017;39(7):1470-8.

3. Moulton-Barrett R, Crumley R, Jalilie S, Segina D, Allison G, Marshak D, et al. Complications of thyroid surgery. Int Surg 1997;82(1):63-6.

4. al-Suliman NN, Ryttov NF, Qvist N, Blichert-Toft M, Graversen HP. Experience in a specialist thyroid surgery unit: a demographic study, surgical complications, and outcome. Eur J Surg 1997;163(1):13-20.

5. Altorjay A, Tihanyi Z, Luka F, Juhász A, Bencsik Z, Rüll M, et al. Place and value of the recurrent laryngeal nerve (RLN) palpatory method in preventing RLN palsy during thyroid surgery. Head Neck 2009;31(4):538-47.

6. Efremidou EI, Papageorgiou MS, Liratzopoulos N, Manolas KJ. The efficacy and safety of total thyroidectomy in the management of benign thyroid disease: a review of 932 cases. Can J Surg 2009;52(1):39-44.

7. Jeannon JP, Orabi AA, Bruch GA, Abdalsalam HA, Simo R. Diagnosis of recurrent laryngeal nerve palsy after thyroidectomy: a systematic review. Int J Clin Pract 2009;63(4):624-9.

8. Sywak MS, Yeh MW, Sidhu SB, Barraclough BH, Delbridge LW. New surgical consultants: is there a learning curve? ANZ J Surg 2006;76(12):1081-4.

9. Zakaria HM, Al Awad NA, Al Kreedes AS, Al-Mulhim AM, Al-Sharway MA, Hadi MA, et al. Recurrent laryngeal nerve injury in thyroid surgery. Oman Med J 2011;26(1):34-8.

10. Rosen CA, Simpson CB. Operative Techniques in Laryngology. Pennsylvania: Springer-Verlag Berlin Heidelberg; 2008:135-50.

11. Nwanmegha Young HM, Sasaki CT. Anatomy of the larynx. In: Fried MP., editor. Clinical Layngology. New york: Thieme; 2015:1-3.

12. Thompson NW, Demers M. Exposure is not necessary to avoid the recurrent laryngeal nerve during thyroid operations. In: Simmons RL, Udekwu AO, eds. Debates in Clinical Surgery. Vol. 1. Chicago: Year Book; 1990:207–19.

13. Kaplan EL, Kadowaki MH, Schark C. Routine exposure of the recurrent laryngeal nerve is important during thyroidectomy. In: Simmons RL, Udekwu AO, eds. Debates in Clinical Surgery. Vol. 1. Chicago: Year Book; 1990:191–206.

14. Gardner GM, Benninger MS, Vocal fold paralysis. In: Rubin JS, Sataloff RT, Korovin, editors. Diagnosis and treatment of voice disorder. 3rd ed. San Diago: Plural publishing Inc.; 2006:471-91.

15. Brok HA, Copper MP, Stroeve RJ, Ongerboer de Visser BW, Venker-van Haagen AJ, Schouwenburg PF. Evidence for recurrent laryngeal nerve contribution in motor innervation of the human cricopharyngeal muscle. Laryngoscope 1999;109(5):705-8.

16. Simpson CB, Cheung EJ. Evaluation of vocal fold paralysis. In: Sulica L, Blitzer A, editors. Vocal fold paralysis. Heidelberg: Springer-Verlag Berlin Heidelberg; 2006:55-62.

17. Dinc T, Kayilioglu SI, Simsek B, Guldogan CE, Gulseren MO, Saylam B, et al. The evaluation of the complications observed in patients with bilateral total and bilateral near total thyroidectomy. Ann Ital Chir 2017;88:198-201.

18. Formanez AJ. Vocal fold paralysis with intraoperative recurrent laryngeal nerve identification versus non-identification of recurrent laryngeal nerve in total thyroidectomy: a retrospective cohort study. Philip J Otolaryngol Head Neck Surg 2016; 31(1):22-25.

19. Sarma MK, Kakati K, Sharma K, Goswami S Ch. Recurrent laryngeal nerve injury (RLNI) in thyroid surgery and its prevention. Int J Res Med Sci 2015;3(7):1632-6.

20. กลุ่มงานโสต ศอ นาสิก โรงพยาบาลชัยภูมิ. สถิติผู้ใช้บริการ ปี 2559-2561. ม.ป.ท.: 2561.

21. American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer, Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 2009;19(11):1167-214.

22. Gürsoy A, Erdoğan MF. Ultrasonographic Approach to Thyroid Nodules: State of Art. Thyroid International 2012;3:1-17.

23. Hermann M, Alk G, Roka R, Glaser K, Freissmuth M. Laryngeal recurrent nerve injury in surgery for benign thyroid diseases: effect of nerve dissection and impact of individual surgeon in more than 27,000 nerves at risk. Ann Surg 2002;235(2):261-8.

24. Thomusch O, Machens A, Sekulla C, Ukkat J, Lippert H, Gastinger I, et al. Multivariate analysis of risk factors for postoperative complications in benign goiter surgery: prospective multicenter study in Germany. World J Surg 2000;24(11):1335-41.

25. Barczyński M, Konturek A, Cichoń S. Randomized clinical trial of visualization versus neuromonitoring of recurrent laryngeal nerves during thyroidectomy. Br J Surg 2009;96(3):240-6.

26. Mohil RS, Desai P, Narayan N, Sahoo M, Bhatnagar D, Venkatachalam VP. Recurrent laryngeal nerve and voice preservation: routine identification and appropriate assessment-two important steps in thyroid surgery. Ann R Coll Surg Engl 2011;93(1):49-53.

27. Mirghani H, Francois A, Landry G, Hans S, Menard M, Brasnu D. [Repeat of lymphatic dissection for thyroid cancers]. [Article in French] Ann Otolaryngol Chir Cervicofac 2009;126(2):37-42.

28. Sena G, Gallo G, Innaro N, Laquatra N, Tolone M, Sacco R, et al. Total thyroidectomy vs completion thyroidectomy for thyroid nodules with indeterminate cytology/follicular proliferation: a single-centre experience. BMC Surg 2019;19(1):87.

29. Lo CY, Kwok KF, Yuen PW. A prospective evaluation of recurrent laryngeal nerve paralysis during thyroidectomy. Arch Surg 2000;135(2):204-7.

30. Shameem M, Goli D. Descriptive Analytical Study of Recurrent Laryngeal Nerve Palsy in Thyroidectomy-Identified versus Non-Identified Recurrent Laryngeal Nerve . J Evid Based Med Healthc 2019;6(43): 2786-93.

31. Casella C, Pata G, Nascimbeni R, Mittempergher F, Salerni B. Does extralaryngeal branching have an impact on the rate of postoperative transient or permanent recurrent laryngeal nerve palsy World J Surg 2009;33(2):261-5.

32. Jatzko GR, Lisborg PH, Müller MG, Wette VM. Recurrent nerve palsy after thyroid operations-principal nerve identification and a literature review. Surgery 1994;115(2):139-44.

33. Fewins J, Simpson CB, Miller FR. Complications of thyroid and parathyroid surgery. Otolaryngol Clin North Am 2003;36(1):189-206.

34. Panthi N, Chettri ST, Shah SP, Poudel D, Manandhar S, Acharya K. Complications of Thyroid Surgery & Their Risk Factors: A Prospective Study at a Tertiary Care Center of Eastern Nepal. JBPKIHS 2019; 2(1):25-33.

35. Myssiorek D. Recurrent laryngeal nerve paralysis: anatomy and etiology. Otolaryngol Clin North Am 2004;37(1):25-44.

36. Witte J, Simon D, Dotzenrath C, Sensfuß J, Goretzki PE, Röher HD. Recurrent nerve palsy and hypocalcemia after surgery of benign thyroid diseases. Acta Chirurgica Austriaca 1996;28: 361-3.

37. Mra Z, Wax MK. Nonrecurrent laryngeal nerves: anatomic considerations during thyroid and parathyroid surgery. Am J Otolaryngol 1999;20(2):91-5.

38. Simsek Celik A, Erdem H, Guzey D, Celebi F, Celik A, Birol S, et al. The factors related with postoperative complications in benign nodular thyroid surgery. Indian J Surg 2011;73(1):32-6.