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

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Anawat Wanthanamaneekul

Abstract

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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