Recurrent laryngeal nerve injury (RLNI) in thyroid surgery and its prevention

Abstract

Background: Vocal cord paresis or paralysis due to iatrogenic injury of the recurrent laryngeal nerve (RLNI) is one of the main problems in thyroid surgery. Although many procedures have been introduced to prevent the nerve injury, still the incidence of recurrent laryngeal nerve palsy varies between 1.5-14%. The aim of the present study is to assess the risk factors of recurrent laryngeal nerve injury during thyroid surgery. Methods: This was a prospective, observational study conducted in the Department of ENT and Head & Neck Surgery, Gauhati Medical College & Hospital, Guwahati for a period of 3 years from 1 st October, 2010 to 30 th September, 2013. Factors predisposing to recurrent laryngeal nerve injury were evaluated such as pathology of the lesions and the type of operations and identification of recurrent laryngeal nerve intra-operatively. Preoperative and postoperative indirect laryngoscopic examinations were performed for all patients. Results: A total of 171 cases of thyroid surgery were performed during the study period. Majority of patients were females. The most common pathology observed in the thyroid gland for which surgery was indicated, according to preoperative FNAC report, was colloid goitre. RLN injury was observed in 3 cases (1.75%) in our study which occurred post hemi thyroidectomy. All these cases had unilateral vocal cord palsy. Conclusion: RLN palsy is one of the common complications after thyroid surgery. Most of the palsy is transient. Meticulous thyroid dissection and identification of RLN during surgery can reduce the rate of RLN palsy.