RISK-FACTORS AND FOLLOW-UP OF RECURRENT L ARYNGEAL NERVE PALSY AFTER THYROID-GLAND SURGERY - RESULTS OF A RETROSPECTIVE TRIAL OF 1556 PATIENTS

Patients and methods: Risk factors of recurrent laryngeal nerve (RLN) palsy after thyroid gland surgery were evaluated retrospectively in 15 56 patients who were submitted to an operation because of a benign thy roid disease. Recurrences were also excluded. Results: RLN palsy occur red in 6.6 %. In relation to the nerves at risk the incidence of prima ry postoperative nerve damages was 4.3 %. After a long-term follow-up of in total 18 months the incidence of permanent nerve palsy was 1.6 % (related to the nerves at risk: 1.1 %) as 75.5 % of the paralyses wer e transient in an average of 6.2 months. Substernal goitres especially when sternotomy became necessary, the ligature of the inferior laryng eal artery, serious perioperative complications and total lobectomy in comparison to subtotal resection were important risk factors for prim ary postoperative RLN palsy (p<0,05 resp. p<0,01). The ligature of the inferior laryngeal artery and the extension of resection were indeed significant risk factors also for permanent nerve damages, but the oth er factors had no influence on the risk of permanent RLN palsy. Howeve r the non-exposure of RLN in subtotal lobectomy was significantly asso ciated (p<0.01) with permanent, but not with transient nerve palsy. Co nclusion: The exposure of the RLN is one of the most important procedu res during thyroid surgery and particular also during subtotal lobecto my to reduce the rate of permanent RLN damages.