Iatrogenic bilateral recurrent laryngeal nerve injury: a retrospective study
DOI:
https://doi.org/10.18203/issn.2454-5929.ijohns20184357Keywords:
Thyroidectomy, Recurrent laryngeal nerve injury, Bilateral abductor paralysis, TracheostomyAbstract
Background: Bilateral recurrent laryngeal nerve injury is mostly iatrogenic following thyroidectomy. Our study aims at defining need for tracheostomy, timing of intervention and best method to achieve permanent treatment in cases of iatrogenic bilateral recurrent laryngeal nerve.
Methods: In past four years we did 34 total thyroidectomy surgeries, all patients were female between 21-65 years of age. Common indications were multi nodular goiter 25 cases, papillary carcinoma thyroid 7 cases and follicular neoplasm 2 cases. 5 patients developed bilateral recurrent laryngeal nerve injury, of which 3 were multi nodular goiter cases and papillary carcinoma thyroid 2 cases.
Results: 5 out of 34 (14.7%) patients developed bilateral recurrent laryngeal nerve injury. 3 patients had complete bilateral abductor paralysis. 1 patient had bilateral abductor paresis and 1 patient had all bilateral recurrent laryngeal nerve and superior laryngeal nerve injury causing combined paralysis of vocal cord. Other 3 patients with bilateral abductor paralysis, 1 patient was not willing for tracheostomy and 2 patients underwent tracheostomy. Of those with tracheostomy, one had partial recovery after one year and tracheostomy was removed. The other patient had coblation arytenoidectomy.
Conclusions: In bilateral recurrent laryngeal nerve injury, Tracheostomy to be done if airway is compromised. Patients with pathological laryngeal electromyographic findings at least two months after the paresis need laryngeal framework surgery. Endoscopic cordotomy is the preferred intervention for long-term management.
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References
Ready AR, Barnes AD. Complications of thyroidectomy. Br J Surg. 1994;81(11):1555-6.
Jatzko GR, Lisborg PH, Müller MG, Wette VM. Recurrent nerve palsy after thyroid operations–principal nerve identification and a literature review. Surgery. 1994;115(2):139-44.
Sosa JA, Bowman HM, Tielsch JM, Powe NR, Gordon TA, Udelsman R. The importance of surgeon experience for clinical and economic outcomes from thyroidectomy. Ann Surg. 1998;228(3):320-30.
Lamadé W, Renz K, Willeke F, Klar E, Herfarth C. Effect of training on the incidence of nerve damage in thyroid surgery. Br J Surg. 1999;86(3):388- 91.
Asgharpour E, Maranillo E, Sañudo J, Pascual-Font A, Rodriguez-Niedenführ M, Valderrama FJ, et al. Recurrent laryngeal nerve landmarks revisited. Head Neck. 2012;34:1240-6.
Dilworth TF. The Nerves of the Human Larynx. J Anat. 1921;56:48-52.
Sañudo JR, Maranillo E, León X, Mirapeix RM, Orús C, Quer M. An anatomical study of anastomoses between the laryngeal nerves. Laryngoscope. 1999;109:983-7.
Björck G, Margolin G, Måbäck GM, Persson JK, Mattsson P, Hydman J. New animal model for assessment of functional laryngeal motor innervation. Ann Otol Rhinol Laryngol. 2012;121:695-9.
Hydman J, Mattsson P. Collateral reinnervation by the superior laryngeal nerve after recurrent laryngeal nerve injury. Muscle Nerve. 2008;38:1280-9.
Wu BL, Sanders I, Mu L, Biller HF. The human communicating nerve. An extension of the external superior laryngeal nerve that innervates the vocal cord. Arch Otolaryngol Head Neck Surg. 1994;120:1321-8.
Maranillo E, León X, Quer M, Orús C, Sañudo JR. Is the external laryngeal nerve an exclusively motor nerve? The cricothyroid connection branch. Laryngoscope. 2003;113:525-9.
Hydman J, Svensson M, Kuylenstierna R, Ohlsson M, Mattsson P. Neuronal survival and glial reactions after recurrent laryngeal nerve resection in the rat. Laryngoscope. 2005;115:619-24.
Blinzinger K, Kreutzberg G. Displacement of synaptic terminals from regenerating motoneurons by microglial cells. Z Zellforsch Mikrosk Anat. 1968;85:145-57.
Randolph GW, Dralle H. International Intraoperative Monitoring Study Group, Electrophysiologic recurrent laryngeal nerve monitoring during thyroid and parathyroid surgery: international standards guideline statement. Laryngoscope. 2011;121(1):1-16.
Dionigi G, Donatini G, Boni L, Rausei S, Rovera F, Tanda ML, et al. Continuous monitoring of the recurrent laryngeal nerve in thyroid surgery: a critical appraisal. Int J Surg. 2013;11(1):44-6.
Jatzko GR, Lisborg PH, Müller MG, Wette VM. Recurrent nerve palsy after thyroid operations–principal nerve identification and a literature review. Surgery. 1994;115(2):139-14.
Kasemsuwaran L, Nubthuenetr SJ. Recurrent laryngeal nerve paresis: a complication of thyroidectomy. Otorhinolaryngology. 1997;26:365-7.
Aytac B, Karamercan A. Recurrent laryngeal nerve injury and preservation in thyroidectomy. Saudi Med J. 2005;26(11):1746-9.
Chaudhary IA, Samiullah MR, Masood R, Majrooh MA, Mallhi AA. Recurrent laryngeal nerve injury: an experience with 310 thyroidectomies. J Ayub Med Coll Abbottabad. 2007;19(3):46-50.
Zakaria HM, Awad NAA, Kreedes ASA, Al-Mulhim AMA, Al-Sharway MA, Hadi MA, et al. Recurrent Laryngeal Nerve Injury in Thyroid. Surg Oman Med J. 2011;26(1):34-8.
Hillel AD, Benninger M, Blitzer A, Crumley R, Flint P, Kashima HK, et al. Evaluation and management of bilateral vocal cord im¬mobility. Otolaryngol Head Neck Surg. 1999;121(6):760-5.
Myssiorek D. Recurrent laryngeal nerve paralysis: anatomy and etiology. Otolaryngol Clin North Am. 2004;37(1):25-44.
Francis DO, Pearce EC, Ni S, Garrett CG, Penson DF. Epidemiology of vocal fold paralyses after total thyroidectomy for well-differentiated thyroid cancer in a Medicare population. Otolaryngol Head Neck Surg 2014;150:548-57.
Wang CC, Chang MH, De Virgilio A, Jiang RS, Lai HC, Wang CP, et al. Laryngeal electromyography and prognosis of unilateral vocal fold paralysis-A long-term prospective study. Laryngoscope. Laryngoscope. 2015;125(4):898-903.
Volk GF, Hagen R, Pototschnig C, Friedrich G, Nawka T, Arens C, et al. Laryngeal electromyography: a proposal for guidelines of the European Laryngological Society. Eur Arch Otorhinolaryngol. 2012;269:2227-45.
Mattsson P, Björck G, Remahl S, Bäckdahl M, Hamberger B, Hydman J, et al. Nimodipine and microsurgery induced recovery of the vocal cord after recurrent laryngeal nerve resection. Laryngoscope 2005;115:1863-5.
Rosen CA, Smith L, Young V, Krishna P, Muldoon MF, Munin MC. Prospective investigation of nimodipine for acute vocal fold paralysis. Muscle Nerve. 2014;50:114-8.
Sridharan SS, Rosen CA, Smith LJ, Young VN, Munin MC. Timing of nimodipine therapy for the treatment of vocal fold paralysis. Laryngoscope. 2015;125:186-90.
Li Y, Garrett G, Zealear D. Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, TN, USA Review Current Treatment Options for Bilateral Vocal Fold Paralysis: A State-of-the-Art. Rev Clin Exp Otorhinol. 2017;10(3):203-12.
Thornell WC. A new intralaryngeal approach in arytenoidectomy in bilateral abductor paralysis of the vocal cords; report of three clinical situations. Arch Otolaryngol. 1949;50(5):634-9.
Ossoff RH, Karlan MS, Sisson GA. Endoscopic laser arytenoidecto¬my Lasers Surg Med. 1983;2(4):293-9.
Crumley RL. Endoscopic laser medial arytenoidectomy for airway management in bilateral laryngeal paralysis Ann Otol Rhinol Laryngol. 1993;102(2):81-4.
Googe B, Nida A, Schweinfurth J. Coblator arytenoidectomy in the treatment of bilateral vocal cord paralysis. Case Rep Otolaryngol. 2015;2015:487280.
Sapundzhiev N, Lichtenberger G, Eckel HE, Friedrich G, Zenev I, Toohill RJ, et al. Surgery of adult bilateral vocal fold paralysis in adduction: history and trends. Eur Arch Otorhinolaryngol. 2008;265(12):1501-14.
Dennis DP, Kashima H. Carbon dioxide laser posterior cordectomy for treatment of bilateral vocal cord paralysis Ann Otol Rhinol Laryngol. 1989;98(12):930-4.
Szakacs L, Sztano B, Matievics V, Bere Z, Bach A, Castellanos PF, et al. A comparison between transoral glottis-widening techniques for bilateral vocal fold immobility Laryngoscope. 2015;125(11):2522-9.
Damrose EJ. Suture laterofixation of the vocal fold for bilateral vocal fold immobility. Curr Opin Otolaryngol Head Neck Surg. 2011;19(6):416-21.
Marina MB, Marie JP, Birchall MA. Laryngeal reinnervation for bilateral vocal fold paralysis Curr Opin Otolaryngol Head Neck Surg. 2011;19(6):434-8.
Li M, Chen S, Zheng H, Chen D, Zhu M, Wang W, et al. Reinnervation of bilateral posterior cricoarytenoid muscles using the left phrenic nerve in patients with bilateral vocal fold paralysis PLoS One. 2013;8(10):e77233.
Zealear DL, Rainey CL, Herzon GD, Netterville JL, Ossoff RH. Electrical pacing of the paralyzed human larynx Ann Otol Rhinol Laryngol. 1996;105(9):689-93.
Shiotani A, Saito K, Araki K, Moro K, Watabe K. Gene therapy for laryngeal paralysis Ann Otol Rhinol Laryngol. 2007;116(2):115-22.
Irja BT, Yoshie S, Ikeda M, Imaizumi M, Nakamura R, Otsuki K, et al. Potential of laryngeal muscle regeneration using induced plu¬ripotent stem cell-derived skeletal muscle cells. Acta Otolaryngol. 2016;136(4):391-6.
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