Premium
Recurrent laryngeal nerve injury in thyroid surgery: a review
Author(s) -
Hayward Nathan James,
Grodski Simon,
Yeung Meei,
Johnson William R.,
Serpell Jonathan
Publication year - 2012
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/j.1445-2197.2012.06247.x
Subject(s) - medicine , recurrent laryngeal nerve , dissection (medical) , surgery , perioperative , thyroid , nerve injury , thyroidectomy , thyroid cancer
Recurrent laryngeal nerve palsy ( RLNP ) is an important and potentially catastrophic complication of thyroid surgery. Permanent RLNP occurs in 0.3–3% of cases, with transient palsies in 5–8%. A literature review and analysis of recent data regarding RLNP in thyroid surgery was performed, with particular focus on the identification of high‐risk patients, the role of intraoperative identification and dissection of the nerve, and the role of intraoperative neuromonitoring ( IONM ) and optimal perioperative nerve assessment. In conjunction with the review, data from the M onash U niversity/ A lfred H ospital E ndocrine S urgery U nit between J anuary 2007 and O ctober 2011 were retrospectively analysed, including 3736 consecutive nerves at risk ( NAR ). The current literature and our data confirm that patients undergoing re‐operative thyroid surgery and thyroid surgery for malignancies are at increased risk of RLNP . Intraoperative visualization and capsular dissection of the RLN remain the gold standard for intraoperative care during thyroid surgery for reducing RLNP risk. IONM should not be used as the sole mechanism for identifying and preserving the nerve, although it can be used to aid in the identification and dissection of the nerve, and may aid in nerve protection in high‐risk cases including cancer surgery and re‐operative surgery.