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Does the recurrent laryngeal nerve recover function after initial dysfunction in patients undergoing thyroidectomy?
Author(s) -
Pantvaidya Gouri,
Mishra Aseem,
Deshmukh Anuja,
Pai Prathamesh S.,
D'Cruz Anil
Publication year - 2018
Publication title -
laryngoscope investigative otolaryngology
Language(s) - English
Resource type - Journals
ISSN - 2378-8038
DOI - 10.1002/lio2.167
Subject(s) - medicine , recurrent laryngeal nerve , surgery , thyroidectomy , vocal cord paralysis , dissection (medical) , retrospective cohort study , incidence (geometry) , vocal cord dysfunction , palsy , cord , anesthesia , paralysis , thyroid , physics , alternative medicine , asthma , optics , pathology
Objective Total thyroidectomy with or without central compartment dissection is the treatment of choice for thyroid carcinoma. Extensive dissection along the recurrent laryngeal nerve (RLN) can lead to vocal cord fixity and hoarseness even without nerve sacrifice. Recovery rates after surgery for thyroid cancers have not been well documented. The aim of the study is to analyze the incidence of vocal cord palsy (VCP) and its recovery rates in patients operated for thyroid cancers. Methodology : We performed a retrospective study on prospectively collected data in 152 thyroidectomy patients with 254 RLNs at risk. All patients underwent a laryngoscopic examination to document vocal cord function in the immediate postoperative period and on subsequent follow‐up. Incidence of VCP, recovery rates, univariate and multivariate analysis to identify risk factors for permanent VCP were calculated using binary logistic regression. Results In our study, 28% patients underwent redo surgeries and 74% patients had dissection of the central compartment. The immediate postoperative RLN palsy rate was 11.2%, with a palsy rate of 9% and 16.2% in the per primum and redo surgery cohorts. On follow‐up, there was complete recovery of VCP in 66.7% of these nerves. The incidence of permanent RLN palsy was 3.9%. The mean time to recovery was 9.6 months. Conclusion Vocal cord dysfunction recovered in most patients in this high‐risk cohort. There was a significant recovery even in the redo surgery group and a policy of watchful waiting is recommended in the absence of severe symptoms. Level of Evidence III

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