Thyroid and parathyroid surgery intraoperative nerve monitoring and management of iatrogenic vocal cord paralysis

Ricard Simo*, Iain J. Nixon, Enyinnaya Ofo

*Corresponding author for this work

Research output: Chapter in Book/Report/Conference proceedingChapter

Abstract

Thyroid and parathyroid surgeries are common procedures undertaken worldwide by a variety of surgeons ranging from highly specialised endocrine and head-and-neck surgeons in high-volume centres to surgeons in district general hospitals. Recurrent laryngeal nerve (RLN) injury is a well-known and serious complication of thyroid and parathyroid surgery and can lead to serious consequences in addition to important medicolegal implications. The general basic principles of thyroid and parathyroid surgery include the removal of the involved pathological tissue, with preservation of the functioning vital structures including the external branch of the superior laryngeal nerve (EBSLN) and the recurrent laryngeal nerve (RLN). Over the years surgeons have developed strategies to avoid damage of above-mentioned anatomical structures culminating in the development of intraoperative neuromonitoring (IONM). Despite of the use of IONM, the rate of recurrent laryngeal nerve palsy (RLNP) is clearly underestimated. The true rate varies widely according to the method of laryngeal examination. The average incidence of temporary RLNP following thyroid surgery is 9.8% with a 2.3% rate of permanent RLNP. The risk factors for RLNP include malignant histology, neck dissection and revision surgery. Additionally it appears that high-volume departments doing more than 150 thyroid procedures per year seem to perform significantly better.

Original languageEnglish
Title of host publicationNeurolaryngology
PublisherSpringer International Publishing
Pages81-98
Number of pages18
ISBN (Electronic)9783319617244
ISBN (Print)9783319617220
DOIs
Publication statusPublished - 30 Oct 2017

Keywords

  • Iatrogenic vocal cord paralysis
  • Intraoperative neuromonitoring
  • Parathyroid surgery
  • Recurrent laryngeal nerve
  • Recurrent laryngeal nerve paralysis
  • Superior laryngeal nerve
  • Thyroid surgery

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