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Nerve identification technique may play role in complications after thyroidectomy
Veyseller B. Arch Otolaryngol Head Neck Surg. 2011;doi:10.1001/archoto.2011.134.
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The approach used for locating the recurrent laryngeal nerve during thyroidectomy appears to affect the rate of complications, such as hypoparathyroidism, experienced after the operation, recent data indicate.
Although thyroidectomy is a common procedure, the surgery is associated with serious complications, including parathyroid gland damage and recurrent laryngeal nerve paralysis — problems that may result from extensive searching for the nerve, according to an article published online today.
Bayram Veyseller, MD, of Bezmialem Vakif University in Istanbul, and colleagues compared the frequency of complications among 195 patients who underwent two different methods of recurrent laryngeal nerve identification during thyroidectomy for goiter between 2006 and 2009. One technique locates the nerve where it enters the larynx (superior-inferior direction) while the other technique locates the nerve in the tracheoesophageal groove (inferior-superior direction). The chosen method was dependent on the surgeon’s preference, the researchers said, and follow-up occurred every 3 months for a mean of 26 months.
The researchers found no cases of recurrent laryngeal nerve paralysis, four cases of temporary hypoparathyroidism and no cases of permanent hypoparathyroidism among the 67 patients in the superior-inferior group. In contrast, among the 128 patients in the inferior-superior group, there were two cases of unilateral recurrent laryngeal nerve paralysis, 14 cases of temporary hypoparathyroidism and four cases of permanent hypoparathyroidism.
“Significantly lower rates of [recurrent laryngeal nerve] paralysis and hypoparathyroidism were observed in thyroidectomies using a superior-inferior approach,” the researchers wrote. “In conclusion, the superior-inferior approach is a safer technique in terms of avoiding complications.”
They noted, however, that larger studies involving more cases are needed.
Disclosure: The researchers report no relevant financial disclosures.
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