Recurrent Laryngeal Nerve Injury after Thyroid Surgery with Routine Identification of the Recurrent Laryngeal Nerve


Objective:The aim of this study is to evaluate the risk of recurrent laryngeal nerve palsy (RLNP) after thyroid surgery with routine identification of the recurrent laryngeal nerve (RLN) intra operatively. Patients and Methods:Our study involved 379 patients who underwent 151 Near Total Thyroidectomy, 107 Sub Total Thyroidectomy, 82 total lobectomies and 39 total thyroidectomies, treated by three surgeons. Individually temporary and permanent RLNP rates were analyzed for patient groups which more classified into primary operation for benign thyroid disease, Thyroid cancer, Graves disease, and reoperation. Two RLNs in 12 thyroid cancer patients already invaded were excluded from analysis. Results:Three patients developed RLNP postoperatively. Complete recovery of RLN function was documented for all (100 %) of these cases whose RLN integrity had been ensured intraoperatively. Recovery from temporary RLNP was insured within 4 weeks to 3 months (mean 2 months). Overall rate of temporary and permanent RLNP was 0.795 %and 0.00%, respectively. The rates of temporary RLNP were 10%, 5.26%, 1.2%and 0.0% for groups classified according to thyroid cancer, reoperation, Graves' disease and benign thyroid disease, respectively. Conclusions:Thyroidectomy is a routine and safe surgical procedure with a low morbidity and negligible mortality when performed by trained surgeons and most of the complications of thyroidectomy may be avoided by careful surgical technique. Significantly higher RLNP rates were demonstrated after operations for thyroid cancer, recurrent goiter and Graves' disease . Total lobectomy with routine identification of the RLN is quite safe and we suggest considering it as a basic procedure in a thyroid operation.