Iatrogenic bilateral recurrent laryngeal nerve injury: a retrospective study

P. Thamizharasan, R. Madanagopal


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.


Thyroidectomy, Recurrent laryngeal nerve injury, Bilateral abductor paralysis, Tracheostomy

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