Bilateral Vocal Cord Palsy After Thyroid Surgery: What to Expect?
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Purpose: This study aimed to evaluate the natural course of structurally intact bilateral recurrent laryngeal nerve (RLN) injury leading to bilateral vocal cord palsy (VCP) and assess the frequency of the need for tracheostomy following thyroid surgery. Methods: This was a single-institution retrospective review of patients who developed bilateral VCP following open or endoscopic total thyroidectomy between 2003 and 2021. Results: Thirty-four of the 9,066 patients had bilateral RLN injury. Twenty-one patients with structurally intact RLN injuries were included in the study (0.23%): 14 with bilateral vocal cord (VC) paralysis (66.7%) and seven with bilateral VC paresis (33.3%). All patients underwent a total thyroidectomy with central lymph node dissection. The incidence was higher in female patients (66.7%) in their 5th and 6th decade. Final diagnoses included papillary thyroid cancer (52.4%), papillary thyroid microcancer (42.9%), and multinodular goiter (4.8%). The cause of RLN injury was idiopathic in most cases; however, some cases were due to tumor invasion, traction, thermal injury, and traumatic endotracheal intubation. Tracheostomy was required in four patients (19.05%) with bilateral VC paralysis. Complete recovery of the VCs occurred in nine patients (42.9%). In most cases, VC mobility improved within six months. Conclusion: Bilateral VCP caused by structurally intact bilateral RLN injury following thyroid surgery was transient, with a high possibility of complete recovery. The period of VC mobility recovery ranges from one day to nine months, and a mandatory tracheostomy may not be needed unless there is a definite sign of airway obstruction
Abstract
Purpose: This study aimed to evaluate the natural course of structurally intact bilateral recurrent laryngeal nerve (RLN) injury leading to bilateral vocal cord palsy (VCP) and assess the frequency of the need for tracheostomy following thyroid surgery. Methods: This was a single-institution retrospective review of patients who developed bilateral VCP following open or endoscopic total thyroidectomy between 2003 and 2021. Results: Thirty-four of the 9,066 patients had bilateral RLN injury. Twenty-one patients with structurally intact RLN injuries were included in the study (0.23%): 14 with bilateral vocal cord (VC) paralysis (66.7%) and seven with bilateral VC paresis (33.3%). All patients underwent a total thyroidectomy with central lymph node dissection. The incidence was higher in female patients (66.7%) in their 5th and 6th decade. Final diagnoses included papillary thyroid cancer (52.4%), papillary thyroid microcancer (42.9%), and multinodular goiter (4.8%). The cause of RLN injury was idiopathic in most cases; however, some cases were due to tumor invasion, traction, thermal injury, and traumatic endotracheal intubation. Tracheostomy was required in four patients (19.05%) with bilateral VC paralysis. Complete recovery of the VCs occurred in nine patients (42.9%). In most cases, VC mobility improved within six months. Conclusion: Bilateral VCP caused by structurally intact bilateral RLN injury following thyroid surgery was transient, with a high possibility of complete recovery. The period of VC mobility recovery ranges from one day to nine months, and a mandatory tracheostomy may not be needed unless there is a definite sign of airway obstruction
참고문헌 (18)
- Rosen CA, "Nomenclature proposal to describe vocal fold motion impairment", Eur Arch Otorhinolaryngol, 273, pp.1995~1999 (2016)
- Moreira A, "Investigation of recurrent laryngeal palsy rates for potential associations during thyroidectomy", ANZ J Surg, 90, pp.1733~1737 (2020)
- Sarkis LM, "Bilateral recurrent laryngeal nerve injury in a specialized thyroid surgery unit : would routine intraoperative neuromonitoring alter outcomes?", ANZ J Surg, 87, pp.364~367 (2017)
- Smaxwil C, "Neuromonitoring of the recurrent laryngeal nerve reduces the rate of bilateral vocal cord dysfunction in planned bilateral thyroid procedures", J Clin Med, 10, pp.740~ (2021)
- Christou N, "Complications after total thyroidectomy", J Visc Surg, 150, pp.249~256 (2013)
- Gardner GM, "The cost of vocal fold paralysis after thyroidectomy", Laryngoscope, 123, pp.1455~1463 (2013)
- Francis DO, "Epidemiology of vocal fold paralyses after total thyroidectomy for well-differentiated thyroid cancer in a Medicare population", Otolaryngol Head Neck Surg, 150, pp.548~557 (2014)
- Liu MY, "Traction injury of recurrent laryngeal nerve during thyroidectomy", World J Surg, 44, pp.402~407 (2020)
- Chiang FY, "The mechanism of recurrent laryngeal nerve injury during thyroid surgery--the application of intraoperative neuromonitoring", Surgery, 143, pp.743~749 (2008)
- Dionigi G, "Severity of recurrent laryngeal nerve injuries in thyroid surgery", World J Surg, 40, pp.1373~1381 (2016)
- Feehery JM, "The evolving etiology of bilateral vocal fold immobility", J Voice, 17, pp.76~81 (2003)
- Eckel HE, "Bilateral recurrent laryngeal nerve paralysis", HNO, 49, pp.166~179 (2001)
- Kokong DD, "Surgical management of vocal cord paralysis : the need for careful patient selection", Afr J Med Med Sci, 43, pp.173~178 (2014)
- Czesak MA, "Methods of surgical treatment of bilateral vocal fold paralysis", Endokrynol Pol, 71, pp.350~358 (2020)
- Chou FF, "Bilateral vocal cord palsy after total thyroidectomy-a new treatment-case reports", Int J Surg Case Rep, 38, pp.32~36 (2017)
- Maresch KJ, "AANA Journal Course-Vocal cord paralysis : implications for anesthesia care", AANA J, 89, pp.443~448 (2021)
- Dionigi G, "Postoperative laryngoscopy in thyroid surgery : proper timing to detect recurrent laryngeal nerve injury", Langenbecks Arch Surg, 395, pp.327~331 (2010)
- 홍용태, "The Phonetic Characteristics in Patients of Bilateral Vocal Fold Paralysis Without Tracheotomy", Clinical and Experimental Otorhinolaryngology, 10(3), pp.272~277 (2017), 대한이비인후과학회[DOI]