Review A rticle
Dutta H Sinha B K Baskota D K Ganesh Man Singh Memorial Academy of ENT and Head & Neck Studies, Institute of Medicine (IOM), Maharajgunj, Kathmandu, Nepal. Correspondence to: Dr. Heempali Dutta Department of ENT-HNS Ganesh Man Singh Bhawan, TU Teaching Hospital Institute of Medicine,Kathmandu, Nepal. e-mail:firstname.lastname@example.org
RECURRENT LARYNGEAL NERVE PALSY AFTER THYROID SURGERY AND LITERATURE REVIEW Objective : To observe the recurrent laryngeal nerve (RLN) status after thyroid surgery done for various types of thyroid pathology. Material and Methods: It was a prospective observational study done from 1st of November 2006 to 31st of October 2010 in Ganesh Man Singh Memorial Acadamy of ENT & HN Studies, Institute of Medicine, Tribhuvan University Teaching Hospital, Maharajgung, Kathmandu. Patients undergoing different types of thyroid surgeries for both malignant and non malignant thyroid pathology were included in the study. The status of recurrent laryngeal nerve during surgery and early postoperative period were observed. Results : There were total 112 cases of thyroid surgery done over a period of four year. Recurrent laryngeal nerve ( RLN) palsy was observed in 15 cases in immediate postoperative period . Out of which, 10 cases fully recovered within 3 weeks of surgery and 5 cases didnt show any recovery. In 2 cases, recurrent laryngeal nerve was sacrificed because it was involved by the thyoid malignancy. The nerve was not identified in 5 cases because it was involved by the disease in 2 cases and in remaining 3 cases anatomy was distorted due to large size of thyroid mass. Conclusion: RLN palsy is one of the common complication after thyroid surgery. Most of the palsy are recovered within immediate postoperative periods. Meticulous surgical dissection and identification of nerve may decrease the rate of RLN palsy. K e y w o r d s : recurrent laryngeal nerve, thyroid, palsy.
INTRODUCTION: Thyroid surgery is one of the common surgeries performed in head and neck region. Recurrent laryngeal nerve paralysis is one of the most frequent and serious complications after thyroid operation. Permanent nerve palsy may occur in 0% to 2.1%, with an average of approximately 0.5% to 1%. Temporary palsy varies from 2.9% to over 10%1. The right-sided nerve is at higher risk due to its wide anatomical variation as compared to the left one. This complication rate can be minimized by accurate anatomical knowledge and meticulous surgical technique. The aim of this study is to assess the recurrent laryngeal nerve status during intraoperative period and early postoperative period. MATERIALS AND METHODS: This was a prospective observational study done from 1st of November 2006 to 31st of October 2010 in Ganesh Man Singh Memorial Acadamy of ENT & HN Studies, Institute of Medicine, Tribhuvan University Teaching Hospital, Maharajgung, Kathmandu,Nepal. Patients undergoing thyroid surgeries for both malignant and non malignant conditions were included in the study. Patients who had preoperative recurrent laryngeal palsy were excluded from the study as well as the patients undergoing isthmusectomy and enucleation of cyst were also excluded because recurrent laryngeal were not identified and handled in these cases. All the surgeries were performed by senior surgeon. The recurrent laryngeal nerve was identified in tracheoesophageal groove and preserved. The status of nerve during intraoperative period , type of thyroid surgery were noted. The vocal cord mobility was assessed during six days of hospital stay and on 3rd week of surgery. Postoperative vocal cord palsy was defined as the presence of an immobile vocal cord or the decreased movement of the vocal cord during phonation. RESULTS: A total no of 112 cases of thyroid surgery were performed over a period of four years. Six cases were excluded from the study. Among excluded cases, one patient underwent enucleation of cyst, two patients had isthmusectomy where...
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