The Recurrent Laryngeal Nerve and Thyroid Surgery; Who to Scope, When to Visualize, Who to Stimulate

Abstract

Thyroid surgery is a common general and specialist surgical procedure. Recurrent laryngeal nerve injury during thyroid surgery, though rare, is the most feared surgical complication. Various steps and perioperative assessments can minimize recurrent laryngeal nerve injury. In this opinion article, two clinical vignettes are used at the introduction to discuss this topic. Literature is reviewed and conclusions made in the aspects of intra-operative recurrent laryngeal nerve exposure, the utility of intra-operative nerve monitoring and the use of peri-operative laryngoscopy where indicated. In conclusion, the literature shows that nerve exposure during thyroidectomy is a must. Nerve monitoring does not reduce the incidence of recurrent laryngeal nerve injury. All patients with pre-operative voice changes, cancer, prior head and neck surgery and those due for re-do thyroidectomy require pre-operative laryngocsopy.