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Cozzi AT, Ottavi A, Lozza P, Maccari A, Borloni R, Nitro L, Felisati EG, Alliata A, Martino B, Cacioppo G, Fuccillo M, Rosso C, Pipolo C, Felisati G, De Pasquale L, Saibene AM. Intraoperative Neuromonitoring Does Not Reduce the Risk of Temporary and Definitive Recurrent Laryngeal Nerve Damage during Thyroid Surgery: A Systematic Review and Meta-Analysis of Endoscopic Findings from 73,325 Nerves at Risk. J Pers Med 2023; 13:1429. [PMID: 37888040 PMCID: PMC10607766 DOI: 10.3390/jpm13101429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 09/19/2023] [Accepted: 09/22/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND While intraoperative neuromonitoring (IONM) helps the early identification of recurrent laryngeal nerve (RLN) damage, IONM's role in RLN damage prevention is not defined, given the lack of large studies on the subject. METHODS In a PRISMA-compliant framework, all original thyroid surgery prospective studies providing early postoperative endoscopic data for all patients were pooled in a random-effects meta-analysis. We compared the temporary (and definitive where available) RLN damage rates according to IONM use and IONM type (intermittent, I-IONM, or continuous, C-IONM). RESULTS We identified 2358 temporary and 257 definitive RLN injuries in, respectively, 73,325 and 66,476 nerves at risk. The pooled temporary and definitive RLN injury rates were, respectively, 3.15% and 0.422% considering all procedures, 3.29% and 0.409% in cases using IONM, and 3.16% and 0.463 in cases not using IONM. I-IONM and C-IONM, respectively, showed a pooled temporary RLN injury rate of 2.48% and 2.913% and a pooled definitive injury rate of 0.395% and 0.4%. All pooled rates had largely overlapping 95% confidence intervals. CONCLUSIONS Our data suggest that IONM does not affect the temporary or definitive RLN injury rate following thyroidectomy, though its use can be advised in selected cases and for bilateral palsy prevention.
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Affiliation(s)
- Anna Teresa Cozzi
- Otolaryngology Unit, Santi Paolo e Carlo Hospital, Department of Health Sciences, Università Degli Studi di Milano, 20142 Milan, Italy; (A.T.C.); (A.O.); (P.L.); (A.M.); (R.B.); (L.N.); (E.G.F.); (A.A.); (B.M.); (G.C.); (M.F.); (C.R.); (C.P.); (G.F.)
| | - Alice Ottavi
- Otolaryngology Unit, Santi Paolo e Carlo Hospital, Department of Health Sciences, Università Degli Studi di Milano, 20142 Milan, Italy; (A.T.C.); (A.O.); (P.L.); (A.M.); (R.B.); (L.N.); (E.G.F.); (A.A.); (B.M.); (G.C.); (M.F.); (C.R.); (C.P.); (G.F.)
| | - Paolo Lozza
- Otolaryngology Unit, Santi Paolo e Carlo Hospital, Department of Health Sciences, Università Degli Studi di Milano, 20142 Milan, Italy; (A.T.C.); (A.O.); (P.L.); (A.M.); (R.B.); (L.N.); (E.G.F.); (A.A.); (B.M.); (G.C.); (M.F.); (C.R.); (C.P.); (G.F.)
| | - Alberto Maccari
- Otolaryngology Unit, Santi Paolo e Carlo Hospital, Department of Health Sciences, Università Degli Studi di Milano, 20142 Milan, Italy; (A.T.C.); (A.O.); (P.L.); (A.M.); (R.B.); (L.N.); (E.G.F.); (A.A.); (B.M.); (G.C.); (M.F.); (C.R.); (C.P.); (G.F.)
| | - Roberto Borloni
- Otolaryngology Unit, Santi Paolo e Carlo Hospital, Department of Health Sciences, Università Degli Studi di Milano, 20142 Milan, Italy; (A.T.C.); (A.O.); (P.L.); (A.M.); (R.B.); (L.N.); (E.G.F.); (A.A.); (B.M.); (G.C.); (M.F.); (C.R.); (C.P.); (G.F.)
| | - Letizia Nitro
- Otolaryngology Unit, Santi Paolo e Carlo Hospital, Department of Health Sciences, Università Degli Studi di Milano, 20142 Milan, Italy; (A.T.C.); (A.O.); (P.L.); (A.M.); (R.B.); (L.N.); (E.G.F.); (A.A.); (B.M.); (G.C.); (M.F.); (C.R.); (C.P.); (G.F.)
| | - Elena Giulia Felisati
- Otolaryngology Unit, Santi Paolo e Carlo Hospital, Department of Health Sciences, Università Degli Studi di Milano, 20142 Milan, Italy; (A.T.C.); (A.O.); (P.L.); (A.M.); (R.B.); (L.N.); (E.G.F.); (A.A.); (B.M.); (G.C.); (M.F.); (C.R.); (C.P.); (G.F.)
| | - Andrea Alliata
- Otolaryngology Unit, Santi Paolo e Carlo Hospital, Department of Health Sciences, Università Degli Studi di Milano, 20142 Milan, Italy; (A.T.C.); (A.O.); (P.L.); (A.M.); (R.B.); (L.N.); (E.G.F.); (A.A.); (B.M.); (G.C.); (M.F.); (C.R.); (C.P.); (G.F.)
| | - Barbara Martino
- Otolaryngology Unit, Santi Paolo e Carlo Hospital, Department of Health Sciences, Università Degli Studi di Milano, 20142 Milan, Italy; (A.T.C.); (A.O.); (P.L.); (A.M.); (R.B.); (L.N.); (E.G.F.); (A.A.); (B.M.); (G.C.); (M.F.); (C.R.); (C.P.); (G.F.)
| | - Giancarlo Cacioppo
- Otolaryngology Unit, Santi Paolo e Carlo Hospital, Department of Health Sciences, Università Degli Studi di Milano, 20142 Milan, Italy; (A.T.C.); (A.O.); (P.L.); (A.M.); (R.B.); (L.N.); (E.G.F.); (A.A.); (B.M.); (G.C.); (M.F.); (C.R.); (C.P.); (G.F.)
| | - Manuela Fuccillo
- Otolaryngology Unit, Santi Paolo e Carlo Hospital, Department of Health Sciences, Università Degli Studi di Milano, 20142 Milan, Italy; (A.T.C.); (A.O.); (P.L.); (A.M.); (R.B.); (L.N.); (E.G.F.); (A.A.); (B.M.); (G.C.); (M.F.); (C.R.); (C.P.); (G.F.)
| | - Cecilia Rosso
- Otolaryngology Unit, Santi Paolo e Carlo Hospital, Department of Health Sciences, Università Degli Studi di Milano, 20142 Milan, Italy; (A.T.C.); (A.O.); (P.L.); (A.M.); (R.B.); (L.N.); (E.G.F.); (A.A.); (B.M.); (G.C.); (M.F.); (C.R.); (C.P.); (G.F.)
| | - Carlotta Pipolo
- Otolaryngology Unit, Santi Paolo e Carlo Hospital, Department of Health Sciences, Università Degli Studi di Milano, 20142 Milan, Italy; (A.T.C.); (A.O.); (P.L.); (A.M.); (R.B.); (L.N.); (E.G.F.); (A.A.); (B.M.); (G.C.); (M.F.); (C.R.); (C.P.); (G.F.)
| | - Giovanni Felisati
- Otolaryngology Unit, Santi Paolo e Carlo Hospital, Department of Health Sciences, Università Degli Studi di Milano, 20142 Milan, Italy; (A.T.C.); (A.O.); (P.L.); (A.M.); (R.B.); (L.N.); (E.G.F.); (A.A.); (B.M.); (G.C.); (M.F.); (C.R.); (C.P.); (G.F.)
| | - Loredana De Pasquale
- Thyroid and Parathyroid Surgery Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, Università Degli Studi di Milano, 20142 Milan, Italy;
| | - Alberto Maria Saibene
- Otolaryngology Unit, Santi Paolo e Carlo Hospital, Department of Health Sciences, Università Degli Studi di Milano, 20142 Milan, Italy; (A.T.C.); (A.O.); (P.L.); (A.M.); (R.B.); (L.N.); (E.G.F.); (A.A.); (B.M.); (G.C.); (M.F.); (C.R.); (C.P.); (G.F.)
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Ryu CH, Lee SJ, Cho JG, Choi IJ, Choi YS, Hong YT, Jung SY, Kim JW, Lee DY, Lee DK, Lee SJ, Lee YC, Lee YS, Nam IC, Park KN, Park YM, Sung ES, Son HY, Seo IH, Lee BJ, Lim JY. Care and Management of Voice Change for Thyroid Surgery: Korean Society of Laryngology, Phoniatrics and Logopedics Clinical Practice Guideline. Clin Exp Otorhinolaryngol 2021; 15:24-48. [PMID: 34098629 PMCID: PMC8901944 DOI: 10.21053/ceo.2021.00633] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 05/31/2021] [Indexed: 11/22/2022] Open
Abstract
Voice change is a common complaint after thyroid surgery and has significant impacts on quality of life. The Korean Society of Laryngology, Phoniatrics, and Logopedics set up a task force team to establish guideline recommendations on education, care, and management related to thyroid surgery. The guideline recommendations include preoperative voice education, management of anticipated voice change during surgery, and comprehensive voice care after thyroid surgery, including in-depth information and up-to-date knowledge based on validated literature. The committee constructed 14 key questions (KQ) in three categories: preoperative (KQ1-2), intraoperative (KQ 3-8), and postoperative (KQ 9-14) management and developed 18 evidence-based recommendations. The Delphi survey reached an agreement on each recommendation. Detailed evidence profiles are presented for each recommendation. The level of evidence for each recommendation is classified into high, moderate, and low-quality. The recommendation's strengths are adjusted to consider the level of evidence resulting in the recommendation and are divided into strong and weak. The guidelines are primarily targeted toward physicians who treat thyroid surgery patients and speech-language pathologists participating in patient care. These guidelines will also help primary care physicians, nurses, healthcare policymakers, and patients improve their understanding of voice changes and voice care after thyroid surgery.
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Affiliation(s)
| | - Chang Hwan Ryu
- Department of Otorhinolaryngology Head and Neck Surgery, National Cancer Center, Goyang, Korea
| | - Seung Jin Lee
- Division of Speech Pathology and Audiology, Research Institute of Audiology and Speech Pathology, College of Natural Sciences, Hallym University, Chuncheon, Korea
| | - Jae-Gu Cho
- Department of Otorhinolaryngology Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
| | - Ik Joon Choi
- Department of Otorhinolaryngology Head and Neck Surgery, Korea Cancer Center Hospital, Korea Institute of Radiological Medical Sciences, Seoul, Korea
| | - Yoon Seok Choi
- Department of Otorhinolaryngology Head and Neck Surgery, Yeungnam University, College of Medicine, Daegu, Korea
| | - Yong Tae Hong
- Department of Otorhinolaryngology Head and Neck Surgery, College of Medicine, Jeonbuk National University Hospital, Jeonju, Korea
| | - Soo Yeon Jung
- Department of Otorhinolaryngology Head and Neck Surgery, Ewha Womans University, College of Medicine, Seoul, Korea
| | - Ji Won Kim
- Department of Otorhinolaryngology Head and Neck Surgery, Inha University, College of Medicine, Incheon, Korea
| | - Doh Young Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Seoul National University, College of Medicine, Seoul, Korea
| | - Dong Kun Lee
- Department of Otorhinolaryngology Head and Neck Surgery, College of Medicine, Dong-A University, Busan, Korea
| | - Sang Joon Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Dankook University, College of Medicine, Cheonan, Korea
| | - Young Chan Lee
- Department of Otorhinolaryngology Head and Neck Surgery, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Yong Sang Lee
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Inn Chul Nam
- Department of Otorhinolaryngology Head and Neck Surgery, The Catholic University of Korea, College of Medicine, Seoul, Korea
| | - Ki Nam Park
- Department of Otorhinolaryngology Head and Neck Surgery, Soonchunhyang University, College of Medicine, Bucheon, Korea
| | - Young Min Park
- Department of Otorhinolaryngology Head and Neck Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Eui-Suk Sung
- Department of Otorhinolaryngology Head and Neck Surgery, Pusan National University School of Medicine, Busan, Korea
| | - Hee Young Son
- Department of Otorhinolaryngology Head and Neck Surgery, Dongnam Institute Of Radiological & Medical Sciences, Busan, Korea
| | - In Hyo Seo
- Voice & Speech Clinic, College of Medicine, Dankook University, Cheonan, Korea
| | - Byung-Joo Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Pusan National University School of Medicine, Busan, Korea
| | - Jae-Yol Lim
- Department of Otorhinolaryngology Head and Neck Surgery, Yonsei University College of Medicine, Seoul, Korea
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The American Association of Endocrine Surgeons Guidelines for the Definitive Surgical Management of Thyroid Disease in Adults. Ann Surg 2020; 271:e21-e93. [PMID: 32079830 DOI: 10.1097/sla.0000000000003580] [Citation(s) in RCA: 222] [Impact Index Per Article: 55.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To develop evidence-based recommendations for safe, effective, and appropriate thyroidectomy. BACKGROUND Surgical management of thyroid disease has evolved considerably over several decades leading to variability in rendered care. Over 100,000 thyroid operations are performed annually in the US. METHODS The medical literature from 1/1/1985 to 11/9/2018 was reviewed by a panel of 19 experts in thyroid disorders representing multiple disciplines. The authors used the best available evidence to construct surgical management recommendations. Levels of evidence were determined using the American College of Physicians grading system, and management recommendations were discussed to consensus. Members of the American Association of Endocrine Surgeons reviewed and commented on preliminary drafts of the content. RESULTS These clinical guidelines analyze the indications for thyroidectomy as well as its definitions, technique, morbidity, and outcomes. Specific topics include Pathogenesis and Epidemiology, Initial Evaluation, Imaging, Fine Needle Aspiration Biopsy Diagnosis, Molecular Testing, Indications, Extent and Outcomes of Surgery, Preoperative Care, Initial Thyroidectomy, Perioperative Tissue Diagnosis, Nodal Dissection, Concurrent Parathyroidectomy, Hyperthyroid Conditions, Goiter, Adjuncts and Approaches to Thyroidectomy, Laryngology, Familial Thyroid Cancer, Postoperative Care and Complications, Cancer Management, and Reoperation. CONCLUSIONS Evidence-based guidelines were created to assist clinicians in the optimal surgical management of thyroid disease.
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Genç A, Çelik SU, Genç V, Gökmen D, Tur BS. The effects of cervical kinesiotaping on neck pain, range of motion, and disability in patients following thyroidectomy: a randomized, double-blind, sham-controlled clinical trial. Turk J Med Sci 2019; 49:1185-1191. [PMID: 31340634 PMCID: PMC7018358 DOI: 10.3906/sag-1812-55] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Background/aim This was a randomized, double-blind, sham-controlled study.Thyroidectomy is a frequently performed surgical procedure and head and neck extension during this operation facilitates surgery. Patients may experience postoperative neck pain and cervical range of motion (ROM) limitation due to the surgical position following thyroidectomy. It was aimed herein to investigate the short-term effects of kinesiotaping (KT) applied to the cervical spine on neck pain, ROM, and disability in patients following thyroidectomy. Materials and methods A total of 74 patients were randomly assigned to be treated with either KT (Group 1, n = 37) or sham taping (Group 2, n = 37) using a computer-generated random number list. Neck pain, cervical ROM, and neck disability were evaluated with a visual analog scale (VAS), inclinometer, and the Neck Disability Index (NDI) questionnaire, respectively. Results There were no significant differences with respect to age, sex, educational background, or body mass index between the groups.While there were no significant differences with respect to improvement of the VAS and change of the ROM and NDI values between the groups, patients in Group 1 needed less paracetamol than patients in Group 2 (P = 0.011). Conclusion This study showed that cervical KT application following thyroidectomy does not have a positive effect on neck pain, ROM, or disability, but nonetheless, it reduces analgesic consumption.
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Affiliation(s)
- Aysun Genç
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Süleyman Utku Çelik
- Clinic of General Surgery, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Volkan Genç
- Department of General Surgery, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Derya Gökmen
- Department of Biostatistics, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Birkan Sonel Tur
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Ankara University, Ankara, Turkey
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Li X, Tian F, Wang F. The effects of black soybean (Glycine max var.) on chronic cervical pain of sedentary office workers in a northern Chinese population. Food Funct 2015; 6:3500-11. [PMID: 26295483 DOI: 10.1039/c5fo00659g] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Chronic cervical pain is a common symptom of sedentary office workers. Black soybean (Glycine max var.) has rich necessary nutrients for the therapy of chronic pain. Thus, it may ease chronic cervical pain. To prove our claim, 260 sedentary office workers with chronic pain were recruited and they consumed the defined diets at breakfast, lunch, and dinner with 1 g, 5 g and 10 g (3 g, 15 g, 30 g daily) cooked black soybean for 24 weeks. Visual analog scale (VAS), neck disability index (NDI) pain scores and short-form 36 (SF-36) health survey questionnaires were applied in the study. The levels of N-methyl-D-aspartate receptors (NMDAR) were measured. The VAS and NDI pain scores reduced and SF-36 scores increased in a 15 or 30 g black soybean daily group compared with a 3 g black soybean daily group after a 24-week therapy (P < 0.05). The 30 g black soybean daily group was better than the 15 g black soybean daily group in relieving chronic cervical pain of sedentary office workers (p < 0.05). The levels of NMDAR were lower in the 15 or 30 black soybean daily group than those in the 3 g black soybean daily group (P < 0.05). Black soybean can ameliorate chronic cervical pain by down-regulating the levels of NMDAR.
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Affiliation(s)
- Xiaochuan Li
- The Department of Hand and Foot Surgery, Shengjing Hospital of China Medical University, Shenyang 110001, China.
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Park C, Choi JB, Lee YS, Chang HS, Shin CS, Kim S, Han DW. The effect of intra-operative transcutaneous electrical nerve stimulation on posterior neck pain following thyroidectomy. Anaesthesia 2014; 70:434-9. [PMID: 25387428 DOI: 10.1111/anae.12933] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2014] [Indexed: 12/18/2022]
Abstract
Posterior neck pain following thyroidectomy is common because full neck extension is required during the procedure. We evaluated the effect of intra-operative transcutaneous electrical nerve stimulation on postoperative neck pain in patients undergoing total thyroidectomy under general anaesthesia. One hundred patients were randomly assigned to one of two groups; 50 patients received transcutaneous electrical nerve stimulation applied to the trapezius muscle and 50 patients acted as controls. Postoperative posterior neck pain and anterior wound pain were evaluated using an 11-point numerical rating scale at 30 min, 6 h, 24 h and 48 h following surgery. The numerical rating scale for posterior neck pain was significantly lower in the transcutaneous electrical nerve stimulation group compared with the control group at all time points (p < 0.05). There were no significant differences in the numerical rating scale for anterior wound pain at any time point. No adverse effects related to transcutaneous electrical nerve stimulation were observed. We conclude that intra-operative transcutaneous electrical nerve stimulation applied to the trapezius muscle reduced posterior neck pain following thyroidectomy.
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Affiliation(s)
- C Park
- Department of Anaesthesiology and Pain Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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