Delayed-onset vocal cord palsy after thyroidectomy occurring despite normal initial post-operative endoscopy.

Autor: Ren T; Monash University Endocrine Surgery Unit, Alfred Hospital, Melbourne, Victoria, Australia., Manning S; Monash University Endocrine Surgery Unit, Alfred Hospital, Melbourne, Victoria, Australia., Lee JC; Monash University Endocrine Surgery Unit, Alfred Hospital, Melbourne, Victoria, Australia.; Department of Surgery, Central Clinical School, Monash University, Melbourne, Victoria, Australia., Serpell J; Monash University Endocrine Surgery Unit, Alfred Hospital, Melbourne, Victoria, Australia.; Department of Surgery, Central Clinical School, Monash University, Melbourne, Victoria, Australia.
Jazyk: angličtina
Zdroj: ANZ journal of surgery [ANZ J Surg] 2024 Oct; Vol. 94 (10), pp. 1794-1799. Date of Electronic Publication: 2024 Oct 07.
DOI: 10.1111/ans.19235
Abstrakt: Background: Recurrent laryngeal nerve (RLN) injury is a known complication of thyroidectomy. Most cases manifest immediately and are promptly recognized. Rarely, some patients experience delayed-onset vocal cord palsy. This can occur despite normal findings on intra-operative nerve monitoring and initial post-operative endoscopy. This can cause considerable distress for patients, and its incidence and prognosis should be recognized.
Methodology: We report seven patients experiencing delayed-onset RLN palsy (RLNP) after thyroidectomy. All had normal findings on pre-operative flexible nasoendoscopy (FNE), intra-operative nerve monitoring at conclusion of surgery, and initial post-operative FNE. All diagnoses of RLNP were confirmed on endoscopy. Serial FNE examinations were performed to evaluate recovery.
Results: Of seven patients (43% male, median age 65 years), the median timing of delayed-onset RLNP was 12 (range 9-35) days. RLNP was diagnosed on the unilateral side of surgery in six out of seven patients (86%). All received conservative management, including referral to voice therapy. All seven patients recovered vocal cord function after a median duration of 24 weeks (range 8-52 weeks), and six within ~6 months (28 weeks). The incidence of this complication was 0.1% (among 6607 thyroidectomies).
Conclusion: We report the first Australian series of delayed-onset vocal cord palsy after thyroidectomy. We explore its prognosis, discussing different pathophysiological mechanisms and the timeframe for recovery compared to most other RLN injuries. This may assist recognition of a rare complication, reassure patients, and facilitate early intervention to improve a patient's quality of life.
(© 2024 The Author(s). ANZ Journal of Surgery published by John Wiley & Sons Australia, Ltd on behalf of Royal Australasian College of Surgeons.)
Databáze: MEDLINE
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