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Complete and incomplete recurrent laryngeal nerve injury after thyroid and parathyroid surgery: Characterizing paralysis and paresis

Published on Sep 1, 2019in Surgery3.476
· DOI :10.1016/j.surg.2019.05.019
Max Schneider1
Estimated H-index: 1
,
Valerie Dahm1
Estimated H-index: 1
(Medical University of Vienna)
+ 7 AuthorsMichael Hermann17
Estimated H-index: 17
Abstract
Abstract Background Injury of the recurrent laryngeal nerve and consequent disorder of vocal fold movement is a typical complication in thyroid and parathyroid surgery. During postoperative laryngoscopy we observed not only a complete standstill (vocal fold paralysis), but also a hypomobility (paresis). In this prospective study, we investigated the difference in incidence and prognosis as well as risk-factors, intraoperative neuromonitoring, and symptoms between vocal fold paralysis and vocal fold paresis. Methods Data were prospectively collected and analyzed in a single high-volume thyroid center between 2012 and 2016. Vocal fold paresis was defined as hypomobility in abduction or adduction, a reduction in range and speed of vocal fold movement. Vocal fold paralysis was defined as asymmetry and missing purposeful vocal fold movement. Results The study included 4,707 surgeries and 7,992 at-risk nerves at risk. Vocal fold paralysis was diagnosed in 374 patients (4.68% of 7,992 nerves at risk) and vocal fold paresis in 114 patients (1.43%). Exclusively in the paralysis group, 36 patients (0.45%) developed permanent loss of vocal fold function ( P P 001). Conclusion After thyroidectomy, vocal fold paresis must be distinguished from vocal fold paralysis and should be implemented as a separate outcome parameter in the postoperative quality assessment.
  • References (32)
  • Citations (1)
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References32
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Background The purpose of this study is to provide guidance for medical experts regarding malpractice claims on permanent hypoparathyroidism by analyzing the number of parathyroid glands (PGs) identified during thyroidectomy and the clinical outcome.
3 CitationsSource
#1Christine Estes (York University)H-Index: 3
#2Babak Sadoughi (York University)H-Index: 1
Last. Lucian Sulica (York University)H-Index: 5
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Objectives/Hypothesis To identify strobolaryngoscopic findings significant in the diagnosis of paresis. Study Design Retrospective cohort study. Methods Fellowship-trained laryngologists reviewed 34 videostroboscopic examinations (24 with paresis, eight without paresis, two repeat). They indicated presence or absence of paresis, including side and type, degree of confidence in diagnosis, and ranked clinical findings that influenced diagnosis by order of importance. Fleiss's κ was used to assess ...
2 CitationsSource
#1Lyndsay L. Madden (University of Pittsburgh)H-Index: 2
#2Clark A. Rosen (University of Pittsburgh)H-Index: 42
Summary Objectives Flexible laryngoscopy is the principle tool for the evaluation of vocal fold motion. As of yet, no consistent, unified outcome metric has been developed for vocal fold paralysis/immobility research. The goal of this study was to evaluate vocal fold motion assessment (inter- and intra-rater reliability) among general otolaryngologists and fellowship-trained laryngologists. Study Design Prospective video perceptual analysis study. Methods Flexible laryngoscopic examinations, wit...
5 CitationsSource
#1Anders Bergenfelz (Lund University)H-Index: 30
#2A. F. Salem (Lund University)H-Index: 1
Last. Adrenal SurgeryH-Index: 1
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Background: Vocal cord palsy occurs in 3-5 per cent of patients after thyroidectomy. To reduce this complication, intraoperative nerve monitoring (IONM) has been introduced, although its use remains controversial. This study investigated the risk of postoperative vocal cord palsy with and without the use of intermittent IONM. Methods: Patients registered in the Scandinavian Quality Register for Thyroid, Parathyroid and Adrenal Surgery, 2009-2013, were included. Early palsy of the recurrent laryn...
25 CitationsSource
#1Rick Schneider (MLU: Martin Luther University of Halle-Wittenberg)H-Index: 14
#2Carsten Sekulla (MLU: Martin Luther University of Halle-Wittenberg)H-Index: 25
Last. Henning Dralle (MLU: Martin Luther University of Halle-Wittenberg)H-Index: 69
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Background Continuous monitoring of electromyographic (EMG) amplitudes of the vocal muscles detects impending injury of the recurrent laryngeal nerve (RLN) during thyroid operations earlier than intermittent EMG monitoring. This may alert the surgeon to stop a manoeuvre causing stretching or pressure on the RLN, with better recovery of nerve function. Methods Patients with intact preoperative RLN function who underwent thyroid surgery for benign disease between January 2011 and September 2014 un...
48 CitationsSource
#1Amy P. Wu (Mount Sinai St. Luke's and Mount Sinai Roosevelt)H-Index: 1
#2Lucian Sulica (Cornell University)H-Index: 22
Objectives/Hypothesis No accepted standard exists for the diagnosis of vocal fold paresis (VFP). Laryngeal specialists are surveyed to establish expert opinion on diagnostic methodology and criteria. Study Design: Cross-sectional survey. Methods Questionnaires were distributed at laryngology conferences in fall 2013. Responses were collated anonymously and subjected to cross-tabulated data analysis. Results Fifty-eight responses completed by posttraining physicians whose practice focused in lary...
19 CitationsSource
Purpose of reviewRecent papers on incidence of unilateral paresis in general and for specific causes; techniques to assist clinical diagnosis; computer and animal modeling leading to new assessment tools; and studies on the effectiveness of clinical management.Recent findingsThere is much interest i
15 CitationsSource
#1Claudia BuresH-Index: 6
#2R. Bobak-WieserH-Index: 2
Last. Michael HermannH-Index: 17
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Background A small subset of patients may develop late-onset palsy of the recurrent laryngeal nerve (RLN) after thyroid surgery. However, no conclusive data have been published regarding the incidence of, and possible risk factors for, this complication. Methods Preoperative, intraoperative and postoperative data from consecutive patients who underwent thyroid surgery at a single centre between 1999 and 2012 were analysed. Late-onset palsy of the RLN was defined as deterioration of RLN function ...
10 CitationsSource
#1Claudia BuresH-Index: 6
#2Tobias Klatte (Medical University of Vienna)H-Index: 26
Last. Michael HermannH-Index: 17
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Background There are four major complications after thyroidectomy, including palsy of the recurrent laryngeal nerve (RLN), hypoparathyroidism, postoperative bleeding, and surgical site infection (SSI). Another clinical problem is the injury and palsy of the external branch of the superior laryngeal nerve (EBSLN). We present a 1-year analysis of our prospective data on complications and outline our guidelines for follow-up and management, including quality assessment.
8 CitationsSource
Neurogenic compromise of vocal fold function exists along a continuum encompassing variable degrees and patterns of partial denervation (paresis). Not abundantly recognized until recently, vocal fold paresis is probably a significant source of vocal disability, especially among cases that have eluded straightforward diagnosis. It presents with symptoms of glottic insufficiency, and probably follows a clinical course analogous to that of paralysis. As a result of preserved gross mobility, paresis...
10 CitationsSource
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#1Alexander H. Gunn (Duke University)H-Index: 4
#2Taofik Oyekunle (Duke University)H-Index: 2
Last. Randall P. Scheri (Duke University)H-Index: 23
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Abstract Background Recurrent laryngeal nerve (RLN) injury is a well-known, potentially serious complication of thyroid surgery. We investigated factors associated with RLN injury during thyroid surgery using a multi-institutional data set. Materials and methods Patients who underwent either lobectomy or total thyroidectomy were abstracted from the American College of Surgeons National Surgical Quality Improvement Program thyroidectomy-specific database (2016-2017). Baseline and operative factor...
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: High quality thyroid surgery implies a surgeon with an endocrine-surgical understanding aiming at best possible outcome. This includes an appropriate extent of the resection and a low rate of complications. It is important that the surgeon is involved at an early stage being part of the decision process for or against partial or total thyroidectomy. Furthermore, the surgeon should not only be able to perform thyroid and cervical lymph node sonography, but also to be capable to interpret cross-...
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#1Jacek Baj (Medical University of Lublin)H-Index: 1
#2Robert Sitarz (Medical University of Lublin)H-Index: 7
Last. Gabriella Garruti (University of Bari)H-Index: 16
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Accurate pre-operative determination of parathyroid glands localization is critical in the selection of minimally invasive parathyroidectomy as a surgical treatment approach in patients with primary hyperparathyroidism (PHPT). Its importance cannot be overemphasized as it helps to minimize the harmful side effects associated with damage to the parathyroid glands such as in hypocalcemia, severe hemorrhage or recurrent laryngeal nerve dysfunction. Preoperative and intraoperative methods decrease t...
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#1Hui Sun (JLU: Jilin University)H-Index: 8
#2Hak Jae Kim (KU: Korea University)H-Index: 108
Last. Gianlorenzo Dionigi (UNIME: University of Messina)H-Index: 34
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