THE INCIDENCE OF RECURRENT LARYNGEAL NERV E LESIONS AFTER THYROID-GLAND SURGERY - A RETROSPECTIVE ANALYSIS

We investigated the incidence of the recurrent laryngeal nerve (RLN) p alsy after thyroid gland surgery in 725 cases. The incidence was corre lated to the different diseases of the thyroid gland, to the operative procedure (subtotal resection, lobectomy, thyroidectomy), to the intr aoperative exploration of the nerve and to the surgeons' state of trai ning. RLN palsy was found in 7.6 per cent (4.8 per cent nerve at risk) five days after surgery. A permanent RLN damage was defined as a pers isting paralysis of the vocal cord six months after surgery. Permanent nerve damage occurred in 2.1 per cent for euthyroid nodular goitre, f or recurrent goitre in 11.7 per cent and for thyroid carcinoma in 10.1 per cent. There was a statistically significant difference between th e number of RLN pareses occurring after nerve exposure with 4.2 per ce nt and that occurring after non-exposure with 1.1 per cent for subtota l lobectomy. 67.7 per cent of these pareses at day five were transient . The RLN palsy rate for Senior House Officers was 6.7 per cent but th ere where none for registrars and consultants. Conclusions: The RLN da mage five days after thyroid gland surgery is mainly caused by the gre at number of recurrent goitre and thyroid cancer (16.1 per cent), the rate of procedures performed by younger surgeons and the near total re section of euthyroid goitre. The exposure of RLN is important for the training to manage thyroid gland surgery.