INCIDENCE OF VOCAL CORD PALSY IN PATIENTS UNDERGOING THYROID SURGERY FOR BENIGN CAUSES AND THE IMPACT OF AGE, GENDER, TYPE OF THYROID SURGERY, AND AN INDICATION OF SURGERY ON IT

Authors

  • Rebar Akram Kareem Sulaimani Teaching Hospital, Sulaimani, Kurdistan Region, Iraq.
  • Hiwa Asaad Abdulkareem College of Medicine, University of Sulaimani, Kurdistan Region, Iraq.

DOI:

https://doi.org/10.17656/jsmc.10356

Keywords:

Benign thyroid diseases, Recurrent laryngeal nerve, Thyroid surgery, Vocal cord palsy

Abstract

Background 

Thyroidectomy is common neck surgery, and recurrent laryngeal nerve (RLN) palsy is one of its devastating complications.

Objectives 

To know the incidence of RLN palsy in patients who underwent thyroid surgeries for benign diseases in Sulaimani city and the effect of age, gender, and indication and types of surgery on its incidence.

Patients and Methods

The prospective observational study included 112 patients admitted to the Otolaryngology/Head and Neck Surgery Department of Sulaimani Teaching Hospital and private hospitals in Sulaimani from May to October 2020. All cases of thyroidectomy for benign conditions were included. Patients with voice problems before surgery, thyroid malignancies, follow up for less than one month, and a history of aerodigestive tract surgery was excluded. Age, gender, and preoperative symptoms were recorded. Indications, type and technique of surgery, pre-and postoperative vocal cord status, and complications were evaluated. Mallampati scores were recorded.

Results

The mean ± SD (standard deviation) of patients’ ages was 43.5 ± 13.03 years, ranging from 21 to 75 years. The female to male ratio was 4.9:1, and 78 patients (69.6%) had abnormal thyroid function tests. All collected parameters from age, gender, indication and technique or type of surgery had no significant effect on postoperative vocal cord status. 

Conclusion

The association of age, gender, type and technique of the surgery, indication for surgery, and the diagnosis of thyroid problem with the development of RLN palsy were statistically not significant.

References

Mescher AL. Junqueira’s basic histology text & atlas. 12th ed. New York: McGraw-Hill Medical; 2010. p. 348-70.

Maitra A. Thyroid gland. In: chmidt W, Gruliow R, editors.Robbins and Cotran pathologic basis of disease. 8th ed. Philadelphia: Saunders Elsevier; 2010. p. 1107-30.

Ozgüner G, Sulak O. Arterial supply to the thyroid gland and the relationship between the recurrent laryngeal nerve and the inferior thyroid artery in human fetal cadavers. Clin Anat. 2014;27(8):1185-92. DOI: https://doi.org/10.1002/ca.22448

Rosai J, Tallini G. Rosai and Ackerman's surgical pathology. 10th ed. New York: Mosby Elsevier; 2011. p. 487-565. DOI: https://doi.org/10.1016/B978-0-323-06969-4.00015-5

Shao T, Qiu W, Yang W. Anatomical variations of the recurrent laryngeal nerve in Chinese patients: a prospective study of 2,404 patients. Sci Rep. 2016;6:25475. DOI: https://doi.org/10.1038/srep25475

Holm TM, Pai SI. The Superior Laryngeal Nerve. In: Miccoli P, Terris DJ, Minuto MN, Seybt MW. Thyroid Surgery: Preventing and Managing Complications. West Sussex: Willy-Blackwell; 2013. P. 129-35. DOI: https://doi.org/10.1002/9781118444832.ch14

Monaco F. Classification of thyroid diseases: suggestions for a revision. J Clin Endocrinol Metab. 2003;88(4):1428-32. DOI: https://doi.org/10.1210/jc.2002-021260

Sari S, Erbil Y, Sümer A, Agcaoglu O, Bayraktar A, Issever H, et al. Evaluation of recurrent laryngeal nerve monitoring in thyroid surgery. Int J Surg. 2010;8(6):474–8. DOI: https://doi.org/10.1016/j.ijsu.2010.06.009

Sarma MK, Kakati K, Sharma K, Goswami SC. Recurrent laryngeal nerve injury (RLNI) in thyroid surgery and its prevention. Int J Res Med Sci. 2015;3(7):1632-6. DOI: https://doi.org/10.18203/2320-6012.ijrms20150242

Kebebew E, Clark OH. Differentiated thyroid cancer: "complete" rational approach. World J Surg. 2000;24(8):942-51. DOI: https://doi.org/10.1007/s002680010165

Kerimoglu RS, Gozalan U, Kama NA. Complications of thyroid surgery: Analysis of 1159 cases. IJMMS. 2013;1:35-8.

Yang S, Zhou L, Lu Z, Ma B, Ji Q, Wang Y. Systematic review with meta-analysis of intraoperative neuromonitoring during thyroidectomy. Int J Surg. 2017;39:104-13. DOI: https://doi.org/10.1016/j.ijsu.2017.01.086

Sturniolo G, D’Alia C, Tonante A, Gagliano E, Taranto F, Lo Schiavo MG. The recurrent laryngeal nerve is related to thyroid surgery. Am J Surg. 1999;177(6):485-8. DOI: https://doi.org/10.1016/S0002-9610(99)00101-4

Duclos A, Lifante JC, Ducarroz S, Soardo P, Colin C, Peix JL. Influence of intraoperative neuromonitoring on surgeons' technique during thyroidectomy. World J Surg. 2011;35(4):773-8. DOI: https://doi.org/10.1007/s00268-011-0963-4

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.

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 an individual surgeon in more than 27,000 nerves at risk. Ann Surg. 2002;235(2):261-8. DOI: https://doi.org/10.1097/00000658-200202000-00015

Fewins J, Simpson CB, Miller FR. Complications of thyroid and parathyroid surgery. Otolaryngol Clin North Am. 2003;36(1):189-206. DOI: https://doi.org/10.1016/S0030-6665(02)00129-9

Hisham AN, Lukman MR. The recurrent laryngeal nerve in thyroid surgery: a critical appraisal. ANZ J Surg. 2002;72(12):887-9. DOI: https://doi.org/10.1046/j.1445-2197.2002.02578.x

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. DOI: https://doi.org/10.1308/003588410X12771863936927

Erbil Y, Barbaros U, Işsever H, Borucu I, Salmaslioğlu A, Mete O, et al. Predictive factors for recurrent laryngeal nerve palsy and hypoparathyroidism after thyroid surgery. Clin Otolaryngol. 2007;32(1):32-7. DOI: https://doi.org/10.1111/j.1365-2273.2007.01383.x

Chiang FY, Lee KW, Huang YF, Wang LF, Kuo WR. Risk of vocal palsy after thyroidectomy with identification of the recurrent laryngeal nerve. Kaohsiung. J Med Sci. 2004;20(9):431-6. DOI: https://doi.org/10.1016/S1607-551X(09)70181-0

Li M, Chen S, Wang W, Chen D, Zhu M, Liu F, et al. Effect of duration of denervation on outcomes of ansa-recurrent laryngeal nerve reinnervation. Laryngoscope. 2014;124(8):1900-5. DOI: https://doi.org/10.1002/lary.24623

Lang BH, Wong CK, Tsang JS, Wong KP, Wan KY. A systematic review and meta-analysis comparing surgically-related complications between robotic-assisted thyroidectomy and conventional open thyroidectomy. Ann Surg Oncol. 2014;21(3):850-61. DOI: https://doi.org/10.1245/s10434-013-3406-7

Pope JS, Koenig SM. Pulmonary disorders in the training room. Clinics in Sports Medicine. 2005; 24:(3):541Y64. DOI: https://doi.org/10.1016/j.csm.2005.05.003

Mallampati SR, Gatt SP, Gugino LD, Desai SP, Waraksa B, Freiberger D, et al. A clinical sign to predict difficult tracheal intubation: a prospective study. Can Anaesth Soc J. 1985;32(4):429-34. DOI: https://doi.org/10.1007/BF03011357

O'Leary AM, Sandison MR, Roberts KW. History of anesthesia; Mallampati revisited: 20 years on. Can J Anaesth. 2008;55(4):250-1. DOI: https://doi.org/10.1007/BF03021512

Zakaria HM, Awad NA, Kreedes AS, Mulhim M, Sharway MA, Hadi MA, et al. Recurrent Laryngeal Nerve Injury in Thyroid Surgery. Oman Med J. 2011;26(1):34-8. DOI: https://doi.org/10.5001/omj.2011.09

Chen HC, Pei YC, Fang TJ. Risk factors for thyroid surgery-related unilateral vocal fold paralysis. Laryngoscope. 2019;129(1):275-83. DOI: https://doi.org/10.1002/lary.27336

Myssiorek D. Recurrent laryngeal nerve paralysis: anatomy and etiology. Otolaryngol Clin North Am. 2004;37(1):25-44. DOI: https://doi.org/10.1016/S0030-6665(03)00172-5

Published

2022-06-21

How to Cite

1.
Kareem R, Abdulkareem H. INCIDENCE OF VOCAL CORD PALSY IN PATIENTS UNDERGOING THYROID SURGERY FOR BENIGN CAUSES AND THE IMPACT OF AGE, GENDER, TYPE OF THYROID SURGERY, AND AN INDICATION OF SURGERY ON IT. JSMC [Internet]. 2022 Jun. 21 [cited 2024 May 28];12(2):157-63. Available from: https://jsmc.univsul.edu.iq/index.php/jsmc/article/view/jsmc-10356

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