Risk Factors For Transient Vocal Cord Palsy After Thyroidectomy
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RISK FACTORS FOR TRANSIENT VOCAL CORD PALSY AFTER THYROIDECTOMY
INTRODUCTION
Vocal cord palsy is a dreaded complication of thyroidectomy.
It produces a disturbing postoperative hoarseness that can become permanent.
Lahey proposed the routine identification of the inferior or recurrent laryngeal nerve(ILN) to avoid its injury during thyroidectomy, unintentional division of the nerve causing permanent vocal cord paralysis has become uncommon .
Transient ILN palsy still represents a common complication of thyroidectomy after an extracapsular resection, when dissection of the distal portion of the ILN is carried out.
Exact pathology of transient ILN palsy- unknown.
Prevalence of transient ILN palsy after initial thyroidectomy- stressed the importance of assessing vocal cord status within 2 weeks after thyroidectomy.
S YMPTOMS
Transient and permanent vocal cord dysfunction may produce the same symptoms
Dysphonia
Risk of aspiration
Dyspnoea
Stridor
R ISK
FACTORS FOR VOCAL CORD PALSY
Technical factors during surgery
Direct injury-mechanic or electric
Other factors-stretching, perineural devascularization, compression by haematoma
Anatomical variations of the ILN
Extralaryngeal branching of the ILN
S URGICAL T ECHNIQUE
Conventional midline approach
Careful dissection of upper pole
The lower pole vessel clipped or ligated
The ITA identified & search for ILN done
P OSTOPERATIVE FINDINGS
When VCD identified
Weekly followup upto 8 weeks
Then at 4 week interval
All paretic & all but one paralytic cords recovered fully after 61 days
CONCLUSION
Branched ILNs suffer more surgical injuries and are twice as likely to be associated with Vocal Cord Dysfunction.
T HANK YOU
INTRODUCTION
Vocal cord palsy is a dreaded complication of thyroidectomy.
It produces a disturbing postoperative hoarseness that can become permanent.
Lahey proposed the routine identification of the inferior or recurrent laryngeal nerve(ILN) to avoid its injury during thyroidectomy, unintentional division of the nerve causing permanent vocal cord paralysis has become uncommon .
Transient ILN palsy still represents a common complication of thyroidectomy after an extracapsular resection, when dissection of the distal portion of the ILN is carried out.
Exact pathology of transient ILN palsy- unknown.
Prevalence of transient ILN palsy after initial thyroidectomy- stressed the importance of assessing vocal cord status within 2 weeks after thyroidectomy.
S YMPTOMS
Transient and permanent vocal cord dysfunction may produce the same symptoms
Dysphonia
Risk of aspiration
Dyspnoea
Stridor
R ISK
FACTORS FOR VOCAL CORD PALSY
Technical factors during surgery
Direct injury-mechanic or electric
Other factors-stretching, perineural devascularization, compression by haematoma
Anatomical variations of the ILN
Extralaryngeal branching of the ILN
S URGICAL T ECHNIQUE
Conventional midline approach
Careful dissection of upper pole
The lower pole vessel clipped or ligated
The ITA identified & search for ILN done
P OSTOPERATIVE FINDINGS
When VCD identified
Weekly followup upto 8 weeks
Then at 4 week interval
All paretic & all but one paralytic cords recovered fully after 61 days
CONCLUSION
Branched ILNs suffer more surgical injuries and are twice as likely to be associated with Vocal Cord Dysfunction.
T HANK YOU
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