Recurrent laryngeal nerve palsy after thyroid cancer surgery: a laryngological and surgical problem

Recurrent laryngeal nerve paralysis is one of the most frequent complicatio ns after thyroid surgery due to goiter and cancers. A higher probability of this complication occurs after secondary procedure of the thyroid and in m alignant cases. The symptoms may differ and depend on many factors. General ly, patients need careful ENT and surgical care including diagnosis and tre atment. Four hundred and sixty-six patients who underwent thyroid operation due to cancer were analyzed. The group was composed of 227 papillary carci noma, 87 follicular carcinoma, 51 medullary carcinoma, and 101 anaplastic c arcinoma. Two hundred and fifty-three total thyroidectomies, 82 lobectomies and subtotal second lobe operations, 91 subtotal thyroidectomies, and 40 b iopsies (wedge resections) were performed. In all 426 total and subtotal th yroidectomies an attempt to identify the recurrent laryngeal nerves was car ried out. For 360 patients (77%) the surgical procedure was primary and for 106 patients (23%) the operation was secondary. Preoperative and postopera tive laryngoscopic examinations were performed in all patients. Every patie nt with palsy underwent special laryngological procedures if needed (trache otomy, phoniatric rehabilitation, conservative treatment and surgery in lac k of improvement). The rate of postoperative vocal cord paralysis was 4.7%. The permanent palsy rate was 3.5%. In 1.2% recovery was observed. Of the 4 .7% palsy rate, 3.2% concerned unilateral palsy and 1.5% bilateral patholog y. Using the chi (2) test, no significant differences between the rate of u nilateral and bilateral paralysis and between temporary and permanent paral ysis were found. On the basis of our material and results, identification t he recurrent laryngeal nerves should be mandatory at surgery, thereby avoid ing paralysis. Special laryngological procedures and surgical care from the beginning of paralysis are necessary for patients with vocal cord palsy. I t allows to diagnose and treat patients with quite good results.