Immediate revision in patients with bilateral laryngeal nerve palsy after operation of thyroid gland and parathyroid glands
Abstract
Aim of the present study was to determine whether immediate revision surgery could have any benefit for patients with iatrogenic bilateral recurrent laryngeal nerve (RLN) palsy. From January 1, 2004 to January 30, 2011, 29 consecutive patients underwent immediate revision after total thyroidectomy.
Cohort comprised 29 patients, 2 males and 27 females, aged 23 to 76 years (median 52 years). Identification of the type and extent of injury of every branch was reported in the protocol, reconstruction was performed whenever possible.
A complete trans section of the nerve or of one of its branches was found in 14 and 5 nerves, respectively. In three patients the nerve was completely or partially transected on both sides.
Seven anatomically intact nerves were injured by loaded ligature, in one case there was a sign of thermal damage, four nerves showed sign of excessive manipulation (thinning of the nerve trunk). Primary end-to-end anastomosis was performed in seven completely transected RLN and four transected anterior branches of RLN.
None of the reconstructed nerve trunks or its branches regained function, however, good muscle tone was observed. 23 out of 38 intact nerves (61%) regained function, and normal vocal-cord mobility on the both sides was restored only in four patients. In all cases with regained vocal-cord mobility the functional recovery occurred within 3 months from the primary surgery.
In conclusion, immediate revision after thyroidectomy can help to precise the type of the RLN damage that is a predictor of functional recovery and one of major factors influencing future therapeutic steps.