RECURRENT NERVE PALSY AFTER THYROID OPERATIONS - PRINCIPAL NERVE IDENTIFICATION AND A LITERATURE-REVIEW

Background. Recurrent laryngeal nerve paralysis is one of the most fre quent and serious complications after thyroid operation. The routine d issection and demonstration of the recurrent nerve remain controversia l. In a retrospective study in an endemic region, patients operated on with principal nerve identification were investigated for vocal paral ysis. Methods. Eight hundred and three consecutive goiter operations w ere analyzed. Because six patients had undergone isthmusectomies only, the recurrent laryngeal nerves were at risk in 797 operations. For 73 6 patients the surgical procedure was primary for benign disease, for 40 patients the operation for thyroid cancer. All patients underwent p reoperative and postoperative laryngoscopic examination of the vocal c ords by an ear, nose, and throat specialist. Results. Rate of primary postoperative vocal cord paralysis was 3.6%, and the permanent palsy r ate was 0.5% with a recurrent laryngeal nerve recovery rate of 86%. In a literature survey, reports with identification of the recurrent ner ve had significantly lower primary and permanent palsy rates when comp ared with reports without obligatory identification of the nerve (p < 0.01). Conclusions. Our results and those of reports in the literature indicate that recurrent nerve paralysis is a less frequent complicati on when the nerve is identified.