N. J. Hayward BMedSci, MBBS (Hons); S. Grodski MBBS (Hons), FRACS; M. Yeung MBBS, FRACS; W. R. Johnson MBBS, FRACS; J. Serpell MD, FRACS.
Recurrent laryngeal nerve injury in thyroid surgery: a review
Article first published online: 18 SEP 2012
© 2012 The Authors. ANZ Journal of Surgery © 2012 Royal Australasian College of Surgeons
ANZ Journal of Surgery
Volume 83, Issue 1-2, pages 15–21, January-February 2013
How to Cite
Hayward, N. J., Grodski, S., Yeung, M., Johnson, W. R. and Serpell, J. (2013), Recurrent laryngeal nerve injury in thyroid surgery: a review. ANZ Journal of Surgery, 83: 15–21. doi: 10.1111/j.1445-2197.2012.06247.x
- Issue published online: 27 JAN 2013
- Article first published online: 18 SEP 2012
- Manuscript Accepted: 4 JUN 2012
- intraoperative monitoring;
- recurrent laryngeal nerve;
- recurrent laryngeal nerve palsy;
- vocal cord paralysis
Recurrent laryngeal nerve palsy (RLNP) is an important and potentially catastrophic complication of thyroid surgery. Permanent RLNP occurs in 0.3–3% of cases, with transient palsies in 5–8%. A literature review and analysis of recent data regarding RLNP in thyroid surgery was performed, with particular focus on the identification of high-risk patients, the role of intraoperative identification and dissection of the nerve, and the role of intraoperative neuromonitoring (IONM) and optimal perioperative nerve assessment. In conjunction with the review, data from the Monash University/Alfred Hospital Endocrine Surgery Unit between January 2007 and October 2011 were retrospectively analysed, including 3736 consecutive nerves at risk (NAR). The current literature and our data confirm that patients undergoing re-operative thyroid surgery and thyroid surgery for malignancies are at increased risk of RLNP. Intraoperative visualization and capsular dissection of the RLN remain the gold standard for intraoperative care during thyroid surgery for reducing RLNP risk. IONM should not be used as the sole mechanism for identifying and preserving the nerve, although it can be used to aid in the identification and dissection of the nerve, and may aid in nerve protection in high-risk cases including cancer surgery and re-operative surgery.