Comparison of the Frequency of Recurrent Laryngeal Nerve Injury with and without Exploration of the Nerve in Thyroidectomy

Background & Aims: Surgeons are not willing to participate in thyroid surgeries due to dangerous, although rare, complications of the procedure. Post thyroidectomy complications are divided in early and late onset; hypocalcemia, bleeding, thyroid storm and recurrent laryngeal nerve (RLN) injury are the most important ones. This study was performed to compare the frequency of recurrent laryngeal nerve injury with and without nerve exploration in the thyroidectomy operation. Methods: In this Cohort study, we evaluated ۵۶۶ cases underwent thyroidectomy during about ۶ years (۲۰۰۵-۲۰۱۱) in two centers, Bahonar and Afzalipour hospitals, in Kerman, Iran. Results: A total of ۵۶۶ patients, ۱۲۴ men (۲۱.۹%) and ۴۴۲ women (۷۸.۱%) with the mean age of ۴۰.۲۶ years and the mean hospitalization period of ۳.۳۵ days were evaluated. ۳۸۲ patients (۶۷.۵%) underwent total or subtotal thyroidectomy and ۱۸۴ (۳۲.۵%) underwent lobectomy and isthmectomy. ۱۲۴ patients (۲۱.۹%) had malignant and ۴۴۲ (۷۸.۱%) had benign lesions. The most common found malignancy was papillary thyroid carcinoma (PTC), where as the most found benign lesion was multinodular guiter (MNG). Recurrent laryngeal nerve exploration was done for ۳۳۷ patients (۵۹/۵%). Totally, ۶ cases (۱.۱%) showed Recurrent laryngeal nerve injury (۱ in exploration and ۵ in non exploration group) from which, ۴ had permanent hoarseness and ۲ had permanent dysphonia. Also, malignancy and radical neck dissection had significant effect on nerve injury but re-operation and unilateral or bilateral surgery had not. Conclusion: Recurrent laryngeal nerve identification and exploration decreased the incidence of nerve injury significantly. We believe that recurrent laryngeal nerve identification and exploration during thyroidectomy is the best procedure to decrease the risk of nerve injury.

Keywords:

Recurrent laryngeal nerve injury , Thyroidectomy , Hoarsness , Dysphony , Recurrent laryngeal , nerve exploration