, Mishra, Aseem1
, Deshmukh, Anuja1
, Pai, Prathamesh1
1 Department of Head Neck surgery, Tata memorial Centre, Mumbai, India
Total thyroidectomy with appropriate dissection of the central and lateral compartments is the treatment of choice for node positive thyroid cancer. Dissection along the recurrent laryngeal nerve (RLN) can lead to vocal cord dysfunction and hoarseness even without nerve sacrifice. A number of interventions have been described to rehabilitate such patients. However, there is very sparse literature available on the recovery of these nerves and the median time to recovery of function.
We performed a retrospective study on prospectively collected data in152 thyroidectomy patients with 268 recurrent laryngeal nerves at risk, in patients operated at a tertiary cancer centre. All patients underwent a Hopkin’s examination (indirect laryngoscopy) to document vocal cord function in the post-operative period irrespective of voice change. All patients had a follow up Hopkins examination to assess recovery of vocal cord function
The immediate post-operative recurrent laryngeal nerve palsy rate was 11 %. Thirty three percent of these were in redo surgeries. Central compartment nodes were positive in 80% of patients in this cohort. With a median follow up of 23.5 months, 66.7% of these nerves recovered function (p<0.0001, Binomial Exact test). The median duration of recovery was 9.6 months. The incidence of permanent RLN palsy was 3.7%
Vocal cord dysfunction recovered in most patients without documented RLN sacrifice. In the absence of severe complications like aspiration or stridor, a policy of watchful observation for at least a period of 10 months prior to any intervention is recommended.