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Tabriz N, Muehlbeyer S, Weyhe D, Uslar V. Risk Factors for Recurrent Laryngeal Nerve Palsy in Thyroid Surgery: A Single Center Experience of 1147 Procedures with Intermittent Intraoperative Neuromonitoring. J Pers Med 2024; 14:714. [PMID: 39063968 PMCID: PMC11278352 DOI: 10.3390/jpm14070714] [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: 05/27/2024] [Revised: 06/29/2024] [Accepted: 06/30/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND Recurrent laryngeal nerve (RLN) palsy is one possible complication during thyroid surgery. Intraoperative neuromonitoring and visualization of the nerve during surgery are standard procedures to reduce the risk of RLN palsy. This study aims to investigate new factors for RLN palsy and review ones that are already known in the literature to help surgeons prepare for the procedure. METHODS A retrospective study design was used to analyze the data of 1147 patients from a certified center for thyroid surgery. All patients underwent either total thyroidectomy or hemithyroidectomy from 2016 to 2020. The acquired information was analyzed descriptively. A logistic regression was used to analyze the independent variables of interest with the binary variable RLN palsy (yes/no). For the second aim of this study, a multiple logistic regression was applied to analyze the combined significant known and new risk factors. RESULTS Surgery indication for Graves' disease (OR 14.34, p < 0.001), thyroid cancer (OR 2.39, p = 0.012), and recurrent goiter (OR 5.57, p < 0.001) increased the risk for RLN palsy significantly compared to nodular goiter in hemithyroidectomy. The duration of surgery correlated positively with a higher risk for RLN palsy (OR 1.009, p = 0.005). For gender, BMI, resection weight, left or right nerve at risk, and surgeon experience, no significant differences were found. CONCLUSION Operations for Graves' disease, thyroid cancer, and recurrent goiter have the highest risk for RLN palsy and surgeons should be alerted. The longer the operation, the higher the risk of RLN palsy. The correlation between surgery method (hemithyroidectomy vs. thyroidectomy) and RLN palsy should be carefully considered due to possible bias.
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Affiliation(s)
- Navid Tabriz
- School VI-School of Medicine and Health Sciences, Carl von Ossietzky Universitat Oldenburg, Ammerlander Heerstrasse 114-118, 26129 Oldenburg, Germany; (N.T.); (D.W.); (V.U.)
| | - Selma Muehlbeyer
- University Hospital for Visceral Surgery, Pius-Hospital Oldenburg, Carl von Ossietzky Universitat Oldenburg, Georgstrasse, 12, 26121 Oldenburg, Germany
| | - Dirk Weyhe
- School VI-School of Medicine and Health Sciences, Carl von Ossietzky Universitat Oldenburg, Ammerlander Heerstrasse 114-118, 26129 Oldenburg, Germany; (N.T.); (D.W.); (V.U.)
| | - Verena Uslar
- School VI-School of Medicine and Health Sciences, Carl von Ossietzky Universitat Oldenburg, Ammerlander Heerstrasse 114-118, 26129 Oldenburg, Germany; (N.T.); (D.W.); (V.U.)
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TM R, Krishnan K, Thiagarajan S, Balaji A, Chaukar D. Results of Swallowing Assessment in the Immediate Postoperative Period in Patients Following Surgery for Thyroid Malignancies. Indian J Otolaryngol Head Neck Surg 2023; 75:1474-1479. [PMID: 37636624 PMCID: PMC10447709 DOI: 10.1007/s12070-023-03608-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 02/17/2023] [Indexed: 03/06/2023] Open
Affiliation(s)
- Rukmangathan TM
- MASLP Speech and Swallowing Therapist Division. of Head & Neck Oncology, Tata Memorial Hospital, Mumbai, India
| | - Kartik Krishnan
- Division of Head & Neck Oncology, Dept. of Surgical Oncology, Tata Memorial Hospital, Mumbai, India
| | - Shivakumar Thiagarajan
- Division of Head & Neck Oncology, Dept. of Surgical Oncology, Tata Memorial Hospital, Mumbai, India
| | - Arun Balaji
- Mr. Arun Balaji MASLP Speech and Swallowing Therapist Division. of Head & Neck Oncology, Tata Memorial Centre, Mumbai, India
| | - Devendra Chaukar
- Division of Head & Neck Oncology, Dept. of Surgical Oncology, Tata Memorial Hospital, Mumbai, India
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Wolff S, Gałązka A, Borkowski R, Dedecjus M. Factors Associated With Injury to Recurrent Laryngeal Nerve in Patients Undergoing Surgery for Thyroid Cancer: A Single-centre Study Using Translaryngeal Ultrasound. J Voice 2022:S0892-1997(22)00240-5. [PMID: 36216721 DOI: 10.1016/j.jvoice.2022.08.009] [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: 05/18/2022] [Revised: 08/04/2022] [Accepted: 08/04/2022] [Indexed: 11/05/2022]
Abstract
AIMS Intraoperative injury to the recurrent laryngeal nerve (RLN) is a serious complication occurring more frequently in patients with thyroid cancer than in those with benign thyroid diseases. However, data on the risk factors for RLN injury among patients with thyroid cancer are scarce. Currently, RLN injury is diagnosed by laryngoscopy, but translaryngealultrasonography (TLUS), which is less invasive, appears to have a similar accuracy. Herein, we analysed risk factors ofintraoperative RLN injury in patients with thyroid cancer and assessed the diagnostic performance of TLUS. PATIENTS AND METHODS In this prospective study, we enrolled patients undergoing surgery for thyroid cancer from October 2020 to October 2021. Medical and surgical variables were analysed as risk factors of RLN injury. TLUS was compared with laryngoscopy in diagnosing RLN injury. RESULTS There were 185 patients who underwent 196 surgeries. Of all surgeries, 23 (11.7%) caused RLN injury ascertained on laryngoscopy. Compared with laryngoscopy, TLUS displayed high sensitivity (97.7%; 95%CI: 94.3%-99.4%) and specificity (100%; 95% CI: 82.4%-100%). Before surgery, medical and surgical characteristics did not differ significantly between patients with or without RLN injury, but RLN entrapment by tumour was more frequent in those with the injury (P < 0.001). The risk of RLN injury was increased in patients undergoing thyroidectomy with lateral neck dissection (OR = 4.53; 95% CI: 1.29-14.32) and in those with lymph node metastases (OR = 2.76; 95% CI: 1.03-7.01). CONCLUSION Intraoperative RLN injury in patients with thyroid cancer is more common after operations requiringgreater resections and with lymph node involvement. TLUS could be used to diagnose RLN injury.
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Affiliation(s)
- Sylwia Wolff
- Department of Endocrine Oncology and Nuclear Medicine, National Institute of Oncology, Warsaw, Poland
| | - Adam Gałązka
- Department of Head and Neck Cancer Clinic, National Institute of Oncology Maria Sklodowska-Curie Memorial Institute, Warsaw, Poland.
| | - Rafał Borkowski
- Department of Endocrine Oncology and Nuclear Medicine, National Institute of Oncology, Warsaw, Poland
| | - Marek Dedecjus
- Department of Endocrine Oncology and Nuclear Medicine, National Institute of Oncology, Warsaw, Poland
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Importance of Intraoperative Neuromonitoring Parameters in Predicting Temporary Recurrent Laryngeal Nerve Palsy Following Thyroid Surgery for Malignancy. Indian J Surg Oncol 2022; 13:218-224. [PMID: 35462654 PMCID: PMC8986907 DOI: 10.1007/s13193-021-01490-7] [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: 05/30/2021] [Accepted: 12/13/2021] [Indexed: 10/19/2022] Open
Abstract
Recurrent laryngeal nerve (RLN) palsy is one of the feared complications following thyroid surgery. Intraoperative neuromonitoring (IONM) has been used as an adjunct to reduce this complication. In the present study, we attempted to evaluate the IONM parameters such as latency, current requirement, and baseline amplitude that could predict temporary RLN palsy along with factors that could influence these parameters during thyroid surgery. This was a retrospective study of patients who underwent hemi, total, or completion thyroidectomy for cancer at our institute between June 1, 2017 to May 31, 2019 in whom IONM was used during surgery. The study consisted of 84 consecutive patients with 138 nerves at risk. The RLN palsy rate in our study was 5% (n = 7). Patients with low baseline amplitude and/or requiring higher current to maintain normal baseline amplitude were often associated with temporary RLN palsy. In the multivariate analysis, age > 40 years (p = 0.001, OR = 4.14) influenced the baseline EMG amplitude the most. The intraoperative current management was influenced by advanced pT stage (p = 0.001, OR = 2.87), and structural nerve injury (p = 0.001, OR = 3.15). Patients with low baseline amplitude and/or requiring higher current to maintain normal baseline amplitude were often associated with temporary RLN palsy. Factors such as age, pT stage, and structural nerve injury influenced the IONM stimulation and recording parameters.
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Mohammad R, Huh G, Cha W, Jeong WJ. Recurrent Laryngeal Nerve Paralysis Following Thyroidectomy: Analysis of Factors Affecting Nerve Recovery. Laryngoscope 2022; 132:1692-1696. [PMID: 35043983 DOI: 10.1002/lary.30024] [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: 06/05/2021] [Revised: 12/19/2021] [Accepted: 01/04/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Paralysis of the recurrent laryngeal nerves (RLNs), albeit decreased over the years, leaves the surgeon helpless as there is not much that can be done once it occurs. Nimodipine has been suggested as a remedy that could accelerate the recovery of the nerve. Our study aimed to examine the factors that affect the recovery rate (RR) and time to recovery (TTR) of post-thyroidectomy RLN paralysis, with an emphasis on the use of nimodipine. METHODS A total of 197 patients who had undergone thyroid and parathyroid surgeries were retrospectively reviewed from October 2016 to August 2019. Patients who had RLN paralysis following surgery were assessed. The medical records were retrospectively analyzed to look for possible factors that may influence RLN recovery. RESULTS A total of 289 nerves were at risk. Temporary RLN paralysis rate was 7.9% while 1.7% was permanent. Age (odds ratio [OR] = 4.8) and intra-operative extra-thyroid extension (OR = 9.0) were independent risk factors for RLN paralysis. The rate of recovery was 82.1%. Loss of signal (LOS; P = .066) was a factor trending for an impact on RR but not nimodipine (P > .05). The mean TTR was 32 days. LOS, nimodipine, and steroid use, among others, were factors trending for an impact on the TTR. CONCLUSION Although not reaching statistical significance, nimodipine and steroids might influence TTR but not the RR. Larger studies are warranted to address the effect of nimodipine on the outcome of RLN paralysis. LEVEL OF EVIDENCE 4 Laryngoscope, 2022.
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Affiliation(s)
- Ramla Mohammad
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea.,Department of Otolaryngology and Head and Neck Surgery, Jaber Al-Ahmad Hospital, Ministry of Health, South Surra, Kuwait
| | - Gene Huh
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Wonjae Cha
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Woo-Jin Jeong
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
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Effects of Central Neck Dissection on Complications in Differentiated Thyroid Cancer. MEDICAL BULLETIN OF SISLI ETFAL HOSPITAL 2021; 55:310-317. [PMID: 34712071 PMCID: PMC8526218 DOI: 10.14744/semb.2021.80588] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 07/31/2021] [Indexed: 01/07/2023]
Abstract
Objective It is still controversial whether performing central neck dissection (CND) in addition to total thyroidectomy (TT) increases the risk of complications. In the present study, we aimed to evaluate the effect of CND on the development of complications in differentiated thyroid cancer (DTC) compared to TT. Material and Methods The data of 186 patients (136 females and 50 males) with a mean age of 48.73±14.78 (range, 17-82) whom were operated for DTC were evaluated retrospectively. The patients were divided into two groups; TT (Group 1) and CND±TT/Completion thyroidectomy±lateral neck dissection (Group 2). Results There were 117 (91 F, 26 M) patients in Group 1 and 69 (45 F, 24 M) patients in Group 2. Parathyroid auto transplantation (PA) was significantly higher in Group 2 compared to Group 1 (42% vs. 6%) (p=0.000). Total (58% vs. 21.4%, respectively; p=0.000) and transient hypoparathyroidism (52.2% vs. 20.5%, respectively; p=0.000) were significantly higher in Group 2 than in Group 1, but permanent hypoparathyroidism rates were statistically not significant (5.8% vs. 0.9%, respectively; p=0.064). In the multinomial logistic regression analysis, CND alone was determined as an independent risk factor for increased both total and transient hypoparathyroidism. The relative risk (RR) of CND for total hypoparathyroidism was 5.2 times increased (odds ratio [OR]: 0.192) (p=0.007), while the RR for transient hypoparathyroidism was 3.5 times increased (OR: 0.285) (p=0.036). According to the number of nerves at risk, CND was performed in 119 neck side and only thyroidectomy was performed in 253 neck side. Total vocal cord paralysis (VCP) rate (9 [7.6%] vs. 6 [2.4%], respectively) (p=0.017) and transient VCP rate (7 [6%] vs. 4 [1.6%], respectively) (p=0.021) in patients who underwent CND were significantly higher compared to those who underwent only thyroidectomy. In multinomial logistic regression analysis performing only CND was an independent risk factor for total VCP, and increased the total VCP RR approximately 5.34 times (OR:0.184; p=0.007). Conclusion Although CND can be applied without increasing the rates of permanent hypoparathyroidism and VCP compared to TT, it increases the risk of total and transient hypoparathyroidism, total, and transient VCP. Patients undergoing CND should be followed carefully in terms of transient hypoparathyroidism.
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Zhu Y, Gao DS, Lin J, Wang Y, Yu L. Intraoperative Neuromonitoring in Thyroid and Parathyroid Surgery. J Laparoendosc Adv Surg Tech A 2021; 31:18-23. [PMID: 32614658 DOI: 10.1089/lap.2020.0293] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Yongman Zhu
- Department of Anesthesiology and The Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Dave Schwinn Gao
- Department of Anesthesiology and The Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Jiaqi Lin
- Department of Anesthesiology and The Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Yong Wang
- Department of Thyroid Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Lina Yu
- Department of Anesthesiology and The Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, People's Republic of China
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Mahoney RC, Vossler JD, Murayama KM, Woodruff SL. Predictors and consequences of recurrent laryngeal nerve injury during open thyroidectomy: An American College of Surgeons National Surgical Quality Improvement Project database analysis. Am J Surg 2020; 221:122-126. [PMID: 32811620 DOI: 10.1016/j.amjsurg.2020.07.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 07/02/2020] [Accepted: 07/11/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Recurrent laryngeal nerve (RLN) injury is a serious complication of thyroidectomy. The purpose of this study is to determine the predictors and consequences of RLN injury during thyroidectomy. METHODS A retrospective analysis was conducted using the ACS-NSQIP 2016-2017 main and thyroidectomy targeted procedure databases. Data was analyzed by multivariate logistic regression resulting in risk-adjusted odds ratios of RLN injury and morbidity/mortality. RESULTS Age ≥65, black race, neoplastic indication, total or subtotal thyroidectomy, concurrent neck surgery, operation time > median, hypoalbuminemia, and anemia were associated with RLN injury. Use of intraoperative nerve monitoring was associated with decreased RLN injuries. RLN injury is a risk factor for overall morbidity, hypocalcemia, hematoma, pulmonary morbidity, readmission, reoperation, and length of stay > median. CONCLUSION Several predictors of RLN injury during thyroidectomy are identified, while use of intraoperative nerve monitoring was associated with a decreased risk of RLN injury. RLN injury is associated increased postoperative complications.
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Affiliation(s)
- Reid C Mahoney
- Department of Surgery, John A. Burns School of Medicine, University of Hawai'i, USA
| | - John D Vossler
- Department of Surgery, John A. Burns School of Medicine, University of Hawai'i, USA
| | - Kenric M Murayama
- Department of Surgery, John A. Burns School of Medicine, University of Hawai'i, USA
| | - Stacey L Woodruff
- Department of Surgery, John A. Burns School of Medicine, University of Hawai'i, USA.
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