Dastagir Waheed, Akhter Munir, Wasim Ahmad, Afaq Ali


Background: Thyroidectomy is one of the most complicated surgeries because of damage to recurrent laryngeal nerve. The objective of the study was to determine the frequency of recurrent laryngeal injury in thyroidectomy surgery.
Material &Methods: This record based, cross sectional study was conducted in the department of general surgery, Gomal Medical College, D.I.Khan, from 2008 to 2014. Sample size of the study was 104, selected through consecutive sampling technique. Patients who underwent thyroid surgery for thyroid disease were included. Indirect laryngoscopy was performed preoperatively and was repeated postoperatively for all patients. Demographic variables were gender, age in years, age groups. Research variables were type of surgery, technique, type of goiter. Histological diagnosis with dysphonia or vocal cord paralysis greater than 06 months duration was termed as permanent RLN injury while less as temporary injury.
Results: Out of tatal 104 patients 84 (81%) were females and 20 (19%) were male. Indications for surgery were multinodular goiter in 62 cases, solitary nodule in 18, hyperthyroidism in 17, thyroid carcinoma in 2 and recurrent goiter in 5 cases. Bilateral subtotal thyroidectomy was performed in 71 cases (68%), unilateral subtotal thyroidectomy in 13 (12%), unilateral total thyroidectomy in 6 (6%), bilateral total thyroidectomy in 6 (6%), nodule excision in 3 (3%) and completion thyroidectomy for recurrent goiter in 5(5%) cases.
Conclusion: Frequency of RLN injury was almost 5% as whole in thyroid surgery but rate was more in complicated cases like thyroid carcinoma, recurrent goiter and hyperthyroid goiter because of altered anatomy.


Recurrent Laryngeal Nerve; Thyroidectomy; Goiter.

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Hermann M, Alk G, Roka R, Glaser K, Freissmuth M. Laryngeal Recurrent Nerve Injury in Surgery for Benign Thyroid Diseases. Ann. Surg. 2002; 235:261-8.

Ready AR, Barnes AD. Complications of thyroidectomy. Br J Surg 1994;1:1555-6.

Shindo ML. Considerations in surgery of the thyroid gland. Otolaryngol Clin North Am 1996; 26:629-35.

Kaplan EL. Thyroid and parathyroid. In: Schwartz SI, Shires GT, Spencer FC, editors. Principles of Surgery. International ed. New York: McGraw Hill; 1994.p.1611-80.

Aytac B, AhmetKaramercan A. Recurrent laryngeal nerve injury and preservation in thyroidectomy. Saudi Med J 2005;26:1746-9.

Jiang Y, Gao B, Zhang X, Zhao J, Chen J, Zhang S, et al. Prevention and treatment of recurrent laryngeal nerve injury in thyroid surgery, Int J Clin Exp Med 2014;7:101-7.

Edis AJ. Complications of thyroid and parathyroid surgery. Surg Clin North Am 1979; 59: 83-92.

Falk SA. Complications of thyroid surgery: Hypothyroidism and hyperthyroidism. In: Falk SA, editor. Thyroid Disease. New York: Raven Press; 1991.p.621-4.

Sanders LE, Rossi RL, Cady B. Surgical complications and their management. In: Cady B, Ross RL, editors. Surgery of the thyroid and parathyroid glands. Philadelphia: WB Saunders Company; 1991.p.326-33.

Sturniolo G, D’Alia C, Tonante A, Gagliano E, Taranto F, Schiano MGL. The recurrent laryngeal nerve related to thyroid surgery. Am J Surg 1999; 177:485-8.

Caldarelli DD. Complications of thyroid surgery: Non Metabolic complications. In: Falk SA, editor. Thyroid Disease. New York: Raven Press; 1991. p. 599-608.

Flynn MB, Lyons KJ, Tarter JW, Ragsdale TL. Local complications after surgical resection for thyroid carcinoma. Am J Surg 1994;168:404-7.

Jatzko GR, Lisborg PH, Müller MG, Wette VM. Recurrent nerve palsy after thyroid operations: Principal nerve identification and the literature review. Surg 1994;115:139-44.

Al-Salamah SM, Khalid K, Bismar HA. Incidence of differentiated cancer in nodular goiter. Saudi Med J 2002;23:947-52.

Bergamaschi R, Beceuarn G, Ronceray J, Arnaud JP. Morbidity of thyroid surgery. Am J Surg 1998; 176:71-5.

Zakaria H M, Awad N A A, Kreedes ASA, Al-mulhim AMA, Al-Sharway MA, Hadi MA, et al. Recurrent Laryngeal Nerve Injury in Thyroid Surgery. Oman Med J 2011; 26:34-8.

Aytac B, Karamercan A. Recurrent laryngeal nerve injury and preservation in thyroidectomy. Saudi Med J 2005;26:1746-9

Tocchi A, Lepre L, Costa G, Liotta G, Mazzoni G, Maggidini F. The role of identification of the recurrent laryngeal nerve in thyroid surgery. G Chir 1996;17:279-82.


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