Risk Factors for Thyroid Surgery-related Unilateral Vocal Fold Paralysis

Overview

Journal Laryngoscope

Specialty Otorhinolaryngology

Date 2018 Oct 5

PMID 30284255

Citations 5

Authors

Hung-Chun Chen

Yu-Cheng Pei

Tuan-Jen Fang

Affiliations

Soon will be listed here.

Abstract

Objectives/hypothesis: We aimed to identify the risk factors for iatrogenic unilateral vocal fold paralysis (UVFP) caused by thyroid surgery, to allow the identification of patients requiring nerve-protection procedures and monitoring technologies.

Study Design: Retrospective case study in a medical center.

Methods: Patients who underwent thyroid surgery from April 2011 to February 2016 and who were diagnosed with UVFP by laryngoscopy and laryngeal electromyography were included. Patient demographics, types of surgery, and characteristics of the thyroid lesions were analyzed.

Results: Sixty (2.1%) of 2,815 patients who received thyroid surgery developed UVFP. The risk of UVFP was higher in patients over 60 years old (odds ratio, 1.89; 95% confidence interval, 1.01-3.26; P = .01). Involvement of the external branch of superior laryngeal nerve (EBSLN) occurred in 19 (31.7%) of the 60 UVFP patients, and was more likely to occurr in patients with diabetes mellitus (odds ratio, 14.19; 95% confidence interval, 3.80-52.94; P < .001). The incidence of UVFP and involvement of the EBSLN differed among surgery types, and was the highest among patients undergoing total thyroidectomy with neck dissection (TTND) (10/158, 6.3% and 5/158, 3.2%, respectively).

Conclusions: The risk of thyroid surgery-related UVFP is higher in older patients. EBSLN involvement is more likely in patients with diabetes mellitus. TTND is associated with higher risks of UVFP and EBSLN injury than other types of surgery, implying the need of intraoperative nerve monitoring in these high-risk characteristics.

Level Of Evidence: 4 Laryngoscope, 129:275-283, 2019.

Citing Articles

Analysis of Risk Factors for Phonation Disorders after Thyroid Surgery.

Glod M, Marciniak D, Kaliszewski K, Sutkowski K, Rudnicki J, Bolanowski M Biomedicines. 2022; 10(9).

PMID: 36140379 PMC: 9496448. DOI: 10.3390/biomedicines10092280.

Assessment of diagnostic capacity and decision-making based on the 2015 American Thyroid Association ultrasound classification system.

Hurtado-Lopez L, Carrillo-Munoz A, Zaldivar-Ramirez F, Basurto-Kuba E, Monroy-Lozano B World J Methodol. 2022; 12(3):148-163.

PMID: 35721246 PMC: 9157633. DOI: 10.5662/wjm.v12.i3.148.

The effect of intraoperative neuromonitoring on the number of lymph nodes excised and recurrence when applied during neck dissection in cases of papillary thyroid cancer.

Comcali B, Saylam B, Altun Ozdemir B Ann Surg Treat Res. 2022; 102(2):83-89.

PMID: 35198511 PMC: 8831088. DOI: 10.4174/astr.2022.102.2.83.

Effects of Central Neck Dissection on Complications in Differentiated Thyroid Cancer.

Unlu M, Aygun N, Demircioglu Z, Isgor A, Uludag M Sisli Etfal Hastan Tıp Bul. 2021; 55(3):310-317.

PMID: 34712071 PMC: 8526218. DOI: 10.14744/SEMB.2021.80588.

Modified Arytenoid Adduction Operation for the Treatment of Unilateral Vocal Fold Paralysis.

Liu C, Qiu Y, Zhang X, Liu Y, Li G, Huang D ORL J Otorhinolaryngol Relat Spec. 2021; 84(3):205-210.

PMID: 34384083 PMC: 9227680. DOI: 10.1159/000517561.

References

FAABORG-ANDERSEN K, BUCHTHAL F . Action potentials from internal laryngeal muscles during phonation. Nature. 1956; 177(4503):340-1. DOI: 10.1038/177340a0. View

Chiang F, Wang L, Huang Y, Lee K, Kuo W . Recurrent laryngeal nerve palsy after thyroidectomy with routine identification of the recurrent laryngeal nerve. Surgery. 2005; 137(3):342-7. DOI: 10.1016/j.surg.2004.09.008. View

Chen H, Jen Y, Wang C, Lee J, Lin Y . Etiology of vocal cord paralysis. ORL J Otorhinolaryngol Relat Spec. 2007; 69(3):167-71. DOI: 10.1159/000099226. View

Roh J, Park J, Park C . Total thyroidectomy plus neck dissection in differentiated papillary thyroid carcinoma patients: pattern of nodal metastasis, morbidity, recurrence, and postoperative levels of serum parathyroid hormone. Ann Surg. 2007; 245(4):604-10. PMC: 1877043. DOI: 10.1097/01.sla.0000250451.59685.67. View

Swibel Rosenthal L, Benninger M, Deeb R . Vocal fold immobility: a longitudinal analysis of etiology over 20 years. Laryngoscope. 2007; 117(10):1864-70. DOI: 10.1097/MLG.0b013e3180de4d49. View

Sancho J, Pascual-Damieta M, Pereira J, Carrera M, Fontane J, Sitges-Serra A . Risk factors for transient vocal cord palsy after thyroidectomy. Br J Surg. 2008; 95(8):961-7. DOI: 10.1002/bjs.6173. View

Roh J, Yoon Y, Park C . Recurrent laryngeal nerve paralysis in patients with papillary thyroid carcinomas: evaluation and management of resulting vocal dysfunction. Am J Surg. 2008; 197(4):459-65. DOI: 10.1016/j.amjsurg.2008.04.017. View

Alimoglu O, Akdag M, Kaya B, Eryilmaz R, Okan I, Coskun A . Recurrent laryngeal nerve palsy after thyroid surgery. Int Surg. 2009; 93(5):257-60. View

Statham M, Rosen C, Nandedkar S, Munin M . Quantitative laryngeal electromyography: turns and amplitude analysis. Laryngoscope. 2010; 120(10):2036-41. DOI: 10.1002/lary.21046. View

10.

Higgins T, Gupta R, Ketcham A, Sataloff R, Wadsworth J, Sinacori J . Recurrent laryngeal nerve monitoring versus identification alone on post-thyroidectomy true vocal fold palsy: a meta-analysis. Laryngoscope. 2011; 121(5):1009-17. DOI: 10.1002/lary.21578. View

11.

Takano S, Nito T, Tamaruya N, Kimura M, Tayama N . Single institutional analysis of trends over 45 years in etiology of vocal fold paralysis. Auris Nasus Larynx. 2012; 39(6):597-600. DOI: 10.1016/j.anl.2012.02.001. View

12.

Gremillion G, Fatakia A, Dornelles A, Amedee R . Intraoperative recurrent laryngeal nerve monitoring in thyroid surgery: is it worth the cost?. Ochsner J. 2012; 12(4):363-6. PMC: 3527866. View

13.

Pei Y, Fang T, Li H, Wong A . Cricothyroid muscle dysfunction impairs vocal fold vibration in unilateral vocal fold paralysis. Laryngoscope. 2013; 124(1):201-6. DOI: 10.1002/lary.24229. View

14.

Ahn D, Sohn J, Park J . Surgical complications and recurrence after central neck dissection in cN0 papillary thyroid carcinoma. Auris Nasus Larynx. 2013; 41(1):63-8. DOI: 10.1016/j.anl.2013.06.002. View

15.

Landerholm K, Wasner A, Jarhult J . Incidence and risk factors for injuries to the recurrent laryngeal nerve during neck surgery in the moderate-volume setting. Langenbecks Arch Surg. 2014; 399(4):509-15. DOI: 10.1007/s00423-013-1154-6. View

16.

Pisanu A, Porceddu G, Podda M, Cois A, Uccheddu A . Systematic review with meta-analysis of studies comparing intraoperative neuromonitoring of recurrent laryngeal nerves versus visualization alone during thyroidectomy. J Surg Res. 2014; 188(1):152-61. DOI: 10.1016/j.jss.2013.12.022. View

17.

Enomoto K, Uchino S, Watanabe S, Enomoto Y, Noguchi S . Recurrent laryngeal nerve palsy during surgery for benign thyroid diseases: risk factors and outcome analysis. Surgery. 2014; 155(3):522-8. DOI: 10.1016/j.surg.2013.11.005. View

18.

Fang T, Pei Y, Li H, Wong A, Chiang H . Glottal gap as an early predictor for permanent laryngoplasty in unilateral vocal fold paralysis. Laryngoscope. 2014; 124(9):2125-30. DOI: 10.1002/lary.24689. View

19.

Spataro E, Grindler D, Paniello R . Etiology and Time to Presentation of Unilateral Vocal Fold Paralysis. Otolaryngol Head Neck Surg. 2014; 151(2):286-93. DOI: 10.1177/0194599814531733. View

20.

Serpell J, Lee J, Yeung M, Grodski S, Johnson W, Bailey M . Differential recurrent laryngeal nerve palsy rates after thyroidectomy. Surgery. 2014; 156(5):1157-66. DOI: 10.1016/j.surg.2014.07.018. View