Impact of recurrent laryngeal nerve monitoring on resolution of vocal cord palsy post thyroidectomy
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Background: Transient or permanent vocal cord palsy (VCP) is a major concern after thyroidectomy. The use of recurrent laryngeal nerve (RLN) monitoring may provide added reassurance during performance of thyroid surgery, however, its superiority over nerve visualization alone has not been conclusively proven. We wished to investigate impact of neural monitoring rates on incidence of postoperative VCP, and on recovery of vocal function among anatomically preserved RLNs.
Methods: Retrospective review of prospective database of 980 thyroidectomies performed by a single surgeon between 2009 and 2017, inclusive. All patients underwent preoperative and postoperative laryngoscopy.
Results: There were 655 nerves-at-risk (NAR) operated without neural monitoring (group 1), and 856 NAR with neural monitoring (group 2). 22 NAR (11 from each group) were excluded due to deliberative sacrifice (9), pre-existing VCP (5), or no postoperative laryngoscopy (8). There were 3 (0.5%) inadvertant RLN injuries in group 1, and one (0.1%) in group 2 (p=0.3). 25 (4.5%) NARs in group 1, and 49 (5.7%) in group 2, had transient neuropraxia with complete recovery (p=0.09). In addition, there were 6 NARs in group 1 which were confirmed to be preserved intact intraoperatively, but had postoperative VCP and did not regain normal mobility within 6 months, versus 2 such cases in group 2. Group 2 had a lower total incidence of permanent VCP or incomplete vocal cord recovery than group 1 (1.4% versus 0.3%, p=0.04).
Conclusion: Neural monitoring may be associated with lower incidence of long-term dysfunction of preserved RLNs during thyroidectomy.
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- Jeff Blumberg