Identification of recurrent laryngeal nerve during thyroidectomy decreases the risk of nerve injury

To determine the effect of Recurrent Laryngeal Nerve [RLN] exposure on the incidence of nerve injury, and compare the injury rate with that when nerve is not exposed during thyroid surgery. This prospective observational study was carried out in department of general surgery, at Liaquat University of Medical and Health Sciences, Jamshoro, from January 2005 to December 2006. A total of 120 patients were included, with 24 males and 96 females [male: female of 1: 4]. Mean age of our patients was 30.85 years [range 14-68 years]. The different surgical procedures, performed on thyroid gland included total thyroidectomy 23, near total thyroidectomy 58, subtotal thyroidectomy 28, and hemi-thyroidectomy 11. The RLN was exposed in 60 patients, in other group of 60 patients thyroidectomy was carried out without exposing RLN, and incidence of nerve injury was compared between two groups. RLN identification decreased the nerve injury incidence from 5% to 1.6%. When recurrent laryngeal nerve is not identified during thyroid surgery the chance to incur damage to RLN is statistically significant [Chi square at 1df 0.000] We believe that RLN identification during thyroidectomy would be the best approach to avoid nerve injury

Thyroidectomy with safe vocal cord functions

To compare the prevalence of vocal cord dysfunctions due to recurrent laryngeal nerve [RLN] injuries in thyroidectomy with and without identification of RLN. A prospective comparative study. The study was conducted in the Department of Surgery, Allied Hospital Faisalabad from October 1[st], 2008 to September 30[th], 2009. With an informed and explained consent, the study was conducted on two groups of patients who had thyroidectomy for the treatment of primary goitre. Patients were distributed on alternate basis irrespective the type of goitre into groups A and B for [thyroidectomy with identification of RLN] and [thyroidectomy with out identification of RLN] respectively. Patients of both groups were compared for the prevalence of post- operative vocal cord dysfunctions in association with recurrent laryngeal nerve injuries. Groups A and B had 52 and 53 patients respectively. Post-thyroidectomy vocal cord functions were remained safe in all the patients of group A. However, 3 [5.66%] patients of group B showed altered vocal cord functions in post operative follow up. Prevalence of RLN injuries in Group A and B remained 0% and 3 [2.97%] respectively. Out of three RLN injuries in group B, 2[1.98%] were transient and 1[0.99%] was permanent. Preservation of vocal cords functions and recurrent laryngeal nerves in thyroidectomy is more likely with the exposure and identification of RLN up to larynx

Post thyroidectomy complications: the Hyderabad experience

Thyroidectomy is a very common surgical procedure worldwide and is performed by surgeons with varied training. The outcome and complication rates are largely dependent on surgeon's skill and experience, the extent of surgery, indication of surgery and number of thyroid surgeries performed at that particular centre. The objective of this study was to determine the frequency of postoperative complications after thyroid surgery in Hyderabad, Pakistan. It was a descriptive study and was carried out at 2 private hospitals including a teaching University Hospital over a period of 3 years from April 2005 to March 2008. All patients with goitre, who underwent any sort of thyroid surgery, were included in this study. Patients' bio-data including name, age sex, clinical status of thyroid, thyroid function tests, ultrasound, fine needle aspiration cytology and operative procedure, findings, post operative complications and histopathology reports were recorded. Data were analysed using SPSS 16.0. The overall postoperative complication rate was 10.7%. Postoperative hypocalcaemia was the most frequent complication observed in 3.5% of all patients followed by recurrent laryngeal nerve [RLN] injury noted in 2.8% patients. The less common complications were bleeding, seroma formation and wound infection. Majority of these complications were associated with total thyroidectomy, male gender, and in patients with age more than 30 years. The commonest post thyroidectomy complication was hypocalcaemia. Male gender, old age, and extensive thyroid surgery were associated with increased complication rate

thyroidectomy safe after identification of recurrent laryngeal nerve - fact or fiction

Injury to recurrent laryngeal nerve remains a common complication of thyroid surgery. It is argued whether routine dissection leads to increase risk of palsy or otherwise. To assess recurrent laryngeal nerve injury risk during thyroidectomy with and without routine identification of the recurrent laryngeal nerve during surgery. Department of Surgery, Liaquat University of Medical and Health Sciences, Jamshoro/Hyderabad over 3 years. The frequency of recurrent laryngeal nerve injury following surgery for benign, nontoxic thyroid disease was studied in consecutive patients undergoing hemithyroidectomy, subtotal thyroidectomy or near total thyroidectomy. Patients with benign and non toxic goitre were included in the study while those with toxic goitre and malignancy were excluded. A total of 88 patients were included in the study. They were divided into two groups, group A included patients in whom dissection of recurrent laryngeal nerve was done as standard procedure while in group B, the nerve was not exposed. There were 34 unilateral and 54 bilateral explorations. The mean age of patients in the two groups was almost same, with preponderance of females [M:F ratio 1:17]. The incidence of recurrent laryngeal nerve injury was not significant in both groups [p=0.502], but the incidence of nerve injury in patients who underwent near total thyroidectomy was 17.6% compared to 0.17% in patients who had hemithyroidectomy, indicating that it is not the exploration but the extent of thyroid resection that is a risk factor for recurrent laryngeal nerve injury. Dissection of nerve does not significantly reduce the risk of recurrent laryngeal nerve injury therefore, routine exploration of the nerve during thyroid surgery is not recommended in an expert hand

Surgical evaluation of minimally invasive parathyroidectomy

This study included selected 30 patients with primary hyperparathyroidism [PHPT] due to solitary adenoma after exclusion criteria. All our patients were submitted preoperatively to: estimation of serum calcium level serum parathormone [PTH] level bone survey, neck ultrasonography and technetium 99 sestamibi [Tc99 MIBI] scan. After adequate localization of the parathyroid adenoma, all our patients were treated surgically by excision of the previously adequately localized parathyroid adenoma through a unilateral neck exploration. The unilateral neck exploration [focused technique] for treatment of PHPT due to solitary adenoma can be considered as a good method of treatment of such condition regarding the less surgical morbidity, favourable cosmesis, patient satisfaction, shorter operating time and earlier discharge

brief discussion complications of thyroid surgery at El-Thoura teaching hospital

As every operation, thyroid surgery carries risk to complications, which may transient or permanent Objective of this study was to explore our expereince in thyroidectomy performed for seventy nine patients in General Surgical Departmen of El-Thoura Central Teaching Hospital El-beida, Libya, for a peroid of two years [from May 2003 to April 2005]. Twenty eight [35.4%] patients of them operated by lobo-isthmoectomy, 39 149.4%] sub-total thyroidectomy, 6 [7.6%] near total thyroidectomy, 4 15.1%] total thyroidectomy and the remaining 2 [2. 5%] patients by enculation of simple cyst Post-operatively; reccurent laryngeal nerve [RLN] injury and hypoparathyroidism were transient for a few months and were not common [3.6% and 2.5% respectively]. Wound infection occurred in two [2.5%] cases and hypothyrodism in one [1.3%] case. Severe primary heamorrhage was not developed in our material. Complications of thyroid surgery are fear to patient and surgeon; can be prevented or minimized when the surgery performed under optimal condition by an experienced hand surgeon with meticulous surgical techniques

Carotid triangle approach to control superior thyrovascular pedicle a novel technique to avoid strap muscles cutting during thyroidectomy

Strap muscles division during thyroidectomy is a controversial issue. The role of strap muscles in voice and swallowing functions and the postoperative morbid sequelae after strap muscles cutting are all debatable. So we have been enthused to develop a surgical approach that enables us to avoid such an unnecessary invasiveness, an idea that seems to be in harmony with both surgical orthodoxy and modern surgical trends. To give a precise detailed stepwise description of such proposed procedural surgical approach and its anatomical basis with the assessment of its feasibility and safety. 30 cases 35:60 years, F:M [2:1] presenting to authors hospitals for thyroidectomy from April through October 2009; were selected for lateral approach where we approach the superior thyrovascular pedicle and the middle thyroid vein through the carotid triangle. Eligibility criteria were: Huge goitres, strong taut strap muscles in males, retr opharyngyal, retro-oesophageal or large Zuckerkandl tuberculum and vascular goitres with marked adhesions. Patients with small goitres, recurrent goitres, previous neck irradiation, and malignant goitres were excluded. Intraoperative and postoperative data were gathered for procedural assessment There were no intraoperative morbidity, and the procedure succeeded in all of the study cases with no conversion to strap muscles cutting. RLN was identified in 28 pts and EBSLN in 10. Parahtyroid glands were identified in 27pts. The mean intraoperative blood loss was 70 cc, the mean operative time was 90 minutes, postoperative pain was well tolerated, mean amount of postoperative drainage was 78 cc with a mean duration of 2 days and a mean hospital stay of 3 days. there were no RLN or sympathetic nerve injury but only one developed transient EBSLN injury and 2 developed transient hypoparathyroidism. carotid triangle approach to control the superior thyrovascular pedicle enables us to avoid aggressive surgical handling of strap muscles by cutting or even excessive exhausting muscle retraction and gland manipulation with their possible morbid sequlae. It is an expeditious approach that facilitates surgery without compromising safety, we believe it to be a reasonably straightforward technique to learn and to be an appropriate addition to the armamentarium of endocrine surgeon whenever indicated

Total thyroidectomy in non malignant goitre

Total thyroidectomy is such a procedure where considerable controversy still exists with respect to use for bengin thyroid disease. On other hand reoperation for recurrent disease carries a very significant risk of damage to both the recurrent laryngeal nerves and the parathyroid glands. This study aimed to evaluate the safety and efficacy of total thyroidectomy for Non malignant thyroid disease. In the period between 2000 and 2006, 162 total thyroidectomy for nan malignant goitre were done, 124 females and 38 males with a mean age of 41.5 years, 99. Patients had Bilateral multi nodular goiter, 48patients were Toxic goitre and 15 patients were chronic thyroiditis. Permanent hypoparathyroidism occurred in 1.2%, temporary hypocalcaemia occurred in 8%. Hypocalcaemia was more common after surgery for toxic goitre than surgery for other diseases, permanent unilateral recurrent laryngeal nerve palsy occurred in 1.8%, the rate of post operative hemorrhage was 1.2% and wound infection 1.8%, there was no postoperative mortality. Total thyroidectomy remove the pathologic process completely, lowers local recurrence rates and avoids the risks of reoperation total thyroidectomy is safe and can be carried out with low complication rates

Randomized clinical study of recurrent laryngeal nerve status post thyroidectomy

The objective of this clinical study was to show the risk of recurrent laryngeal nerve injury after thyroidectomy which could be unrecognized without routine laryngoscopy. This is a retrospective randomized study which evaluates vocal cord function before and after thyroidectomy by laryngoscope. Persistent cord palsy for longer than 12 months after the operation was regarded as permanent. From March 2002 through March 2005, At Ain Shams University hospitals, 200 operations upon the Thyroid gland were done [26 males and 174 females] with documented normal cord function at the side of the thyroidectomy. There were 74 unilateral and 126 bilateral procedures, with 326 nerves at risk of injury. Postoperative unilateral cord palsy was documented in 15 patients [7.5%] during routine postoperative vocal cord examination. Twelve patients [6%] developed transient unexpected postoperative unilateral cord paralysis, and three patient had permanent cord paralysis one of them had recognizable nerve damage during the operations for malignant goiter, the other 2 patients one was malignant goiter and the other was recurrent goiter with extensive adhesion. During a median period of 5 months [range, 1-9 months], 12 [80%] of these 15 patients had recovery of vocal cord function with preceding improvement in phonation. The incidence of transient and permanent recurrent nerve palsy was 6% and 1.5% [3.7% and 0.9% of nerves at risk], respectively. There was increase risk of recurrent laryngeal nerve injury after thyroidectomy which could be unrecognized without routine laryngoscopy, and patients have a good potential for recovery. Thyroid surgery for malignant neoplasm and recurrent goiter was associated with an increased risk of permanent recurrent nerve damage

Diagnostic and prognostic role of laryngeal electromyography in vocal fold immobility

Laryngeal electromyography [EMG] was carried out for twenty patients with vocal fold immobility [VCI], diagnosed with indirect laryngoscopy. They were followed up for six months. A control group often subjects was included. The specificity of EMG in detecting VFI was 100%, and sensitivity 80%. Thirteen patients [65%] with abnormal EMG had a lesion of recurrent and superior laryngeal nerves and 3 [15%] had recurrent laryngeal nerve lesion alone. A significant statistical difference was found between EMG of patients and controls regarding all parameters. In cricothyroid, EMG was normal in 7 [35%], signs of reinnervation in 1 [5%], chronic neuropathy in 8 [40%] and denervation in 4 [20%]. EMG of thyroarytenoid was normal in 4 [20%], reinnervation in 3 [15%], chronic neuropathy in 9 [45%] and denervation in 4 [20%]. After six months 4 patients [20%] had full recovery, while 16 patients [80%] had persistent VFI. EMG of thyroarytenoid and cricothyroid showed no significant statistical difference between resolved cases and controls. There was a significant statistical difference between patients with resolved and those with persistent VFI as regards spontaneous activity, recruitment and interference patterns, but no significant statistical difference between the two groups regards MUAPs morphology. The positive predictive value of laryngeal EMG was 93.7%, and negative predictive value was 75%. The sensitivity of EMG in predicting recovery was 93.7%, and specificity 75%. Laryngeal electromyography is a useful adjunct to the diagnosis and prognosis of VFI. It provides information about the site and duration of lesion and differentiates fixation from paralysis. It is helpful in predicting recovery of vocal fold motion after laryngeal nerve injury

Effect of near-total thyroidectomy on thyroid orbitopathy due to toxic goiter

The relative merit of operation in the treatment of Graves' ophthalmopathy as well as the extent of surgical resection is still a matter of debate. This work aimed at reporting the assessment of the impact of near-total thyroidectomy on the course of ophthalmopathy including exophthalmos. A total of 20 patients, with thyrotoxic goiters suffering from mild to moderate exophthalmos were enrolled onto this prospective study. Preoperative evaluation of ophthalmopathy was accomplished through the NOSPECS classification, MRI scanning for measuring the extraocular muscle diameters and measurement of the exophthalmos using Hertel's exophthalmometer. Six months postoperatively, ophthalmopathy including exophthalmos was re-evaluated using the same parameters mentioned before. Clinical activity evaluation, exophthalmometry and extraocular muscles measurement by MRI revealed that the majority of the cases experienced improvement of their ophthalmopathy [65%]. This improvement was statistically significant In addition, no major postoperative complications were observed. However, the study, unlike a number of reported retrospective ones, failed to specify any statistically significant prognostic factors affecting the course of ophthalmopathy possibly due to the limited number of cases in general In addition, all of the cases were of relatively young age and thyrotoxic, and the majority were females and non-smoking. Beside the fact that near-total thyroidectomy adds the advantages of total thyroidectomy [no recurrence] to those of subtotal thy-roidectomy [low incidence of temporary and permanent hypoparathyroidism], it has a significant positive impact on thyroid-associated orbitopathy

Risk for recurrent laryngeal nerve injury after thyroidectomy

This study was conducted to assess the risk of recurrent laryngeal nerve palsy [RLNP] in different types of thyroidectomy with identification of the nerve during operation and its relation to different thyroid diseases. One hundred eighty seven patients were included in this study, 69 men and 118 women, Patients classified into four groups according to the underlying disease benign thyroid disease [n=56], Graves' disease [n=21], thyroid carcinoma [n=73], and recurrent goiter [n=37]. Of recurrent group 7 had recurrent Graves' disease, 10 had thyroid cancer, and 20 had recurrent nodular goiter. Total thyroidectomy was done in 85 patients, near total in 45, subtotal thyroidectomy in 30 and lobectomy in 27 patients. Temporary and permanent RLNP rates were analyzed for patients groups, 7 patients develop RLNP postoperatively [3.74%], recovery of nerve function was documented for 6 patients [85.7%]. recovery from temporary RLNP ranged from 5 days to 2 months [mean 27 days]. Overall incidence of temporary and permanent RLNP was 3.74% and 0.53% respectively. The rates of temporary/permanent RLNP were 0.0%, 0.0% for benign thyroid disease, 4.1%, 0.0% for thyroid cancer, 4.76%, 0.0% for Graves' disease, 5.4%, 2.7% for recurrent goiter. Surgery for thyroid cancer, Graves' disease, and recurrent goiter were associated with significantly higher RLNP rates. Temporary RLN palsy rate was not affected by the type of operation, while permanent vocal cord palsy occurred in total thyroidectomy and this attributed to recurrence more than to the type of operation. Identification of the nerve during operation does not affect the rate of RLNP

Vocal fold immobility after thyroidectomy with intraoperative recurrent laryngeal nerve monitoring

CONTEXT AND OBJECTIVE: Intraoperative nerve monitoring has emerged as a valuable tool to facilitate recurrent laryngeal nerve identification during thyroid surgery, thereby avoiding its injury. The aim was to evaluate vocal fold mobility in patients who underwent thyroidectomy with intraoperative nerve monitoring. DESIGN AND SETTING: Cohort formed by a consecutive series of patients, at a tertiary cancer hospital. METHODS: The subjects were patients who underwent thyroidectomy using intraoperative laryngeal nerve monitoring, between November 2003 and January 2006. Descriptive analysis of the results and comparison with a similar group of patients who did not undergo nerve monitoring were performed. RESULTS: A total of 104 patients were studied. Total thyroidectomy was performed on 65 patients. Vocal fold immobility (total or partial) was detected in 12 patients (6.8 percent of the nerves at risk) at the first postoperative evaluation. Only six (3.4 percent of the nerves at risk) continued to present vocal fold immobility three months after surgery. Our previous series with 100 similar patients without intraoperative nerve monitoring revealed that 12 patients (7.5 percent) presented vocal fold immobility at the early examination, and just 5 (3.1 percent) maintained this immobility three months after surgery, without significant difference between the two series. CONCLUSION: In this series, the use of intraoperative nerve monitoring did not decrease the rate of vocal fold immobility.

CONTEXTO E OBJETIVO: A monitorização intra-operatória de nervos surgiu como uma ferramenta valiosa para facilitar a identificação do nervo laríngeo recorrente durante a cirurgia de tireóide, evitando a sua lesão. O objetivo foi avaliar a mobilidade das pregas vocais em pacientes submetidos a tireoidectomia com monitorização intra-operatória do nervo laríngeo recorrente. TIPO E LOCAL DO ESTUDO: Coorte de uma série consecutiva de pacientes em um hospital terciário de tratamento de câncer. MÉTODOS: Pacientes foram submetidos à cirurgia de tireóide usando a monitorização intra-operatória do nervo laríngeo recorrente, entre novembro de 2003 e janeiro de 2006. Uma análise descritiva dos resultados e uma comparação com um grupo similar de pacientes que não foram submetidos a monitorização dos nervos foram realizadas. RESULTADOS: Um total de 104 pacientes foi estudado. Tireoidectomia total realizada em 65 pacientes. Imobilidade de pregas vocais (parcial ou total) foi detectada em 12 pacientes (6.8 por cento dos nervos sob risco) na primeira avaliação pós-operatória. Apenas 6 (3.4 por cento dos nervos sob risco) permaneceram com imobilidade de prega vocal três meses após a cirurgia. Nossa série prévia com 100 pacientes similares sem a monitorização intra-operatória revelou que 12 pacientes (7.5 por cento) apresentaram imobilidade de prega vocal na avaliação precoce, e apenas 5 (3.1 por cento) mantiveram a imobilidade três meses após a cirurgia, sem diferença significativa entre as séries. CONCLUSÃO: Nesta série, o uso da monitorização intra-operatória do nervo laríngeo recorrente não diminuiu a taxa de imobilidade de prega vocal.

Completion thyroidectomy: Relation of timing with complications

To assess the association of timing with complications following completion thyroidectomy. Prospective, quasi-experimental clinical trial from June 2002 to March 2007. Surgical Unit-2, Jinnah Postgraduate Medical Centre [JPMC], Karachi. A total of 114 patients who underwent completion thyroidectomy. The patients were divided into two groups viz. Group-I [n = 76] where completion thyroidectomy was performed between 10 days and three months and Group-II [n = 38] where completion thyroidectomy was carried out beyond this time. Transient hypocalcaemia was seen in two cases of Group-I and one case of Group-IL while transient recurrent laryngeal nerve paresis was seen in two patients, one in each group. However, there was no statistically significant difference in the outcome between Group-I and IL in terms of complications. Timing does not influence the complication rate after completion thyroidectomy

Voice dysfunction following thyroidectomy

Voice dysfunction after thyroidectomy is not rare, and is generally reported in terms of recurrent laryngeal nerve [RLN] or superior laryngeal nerve [SLN] injuries. However, voice dysfunction can occur without laryngeal nerves injuries. Prompt recognition of causes of dysphonia is essential so that relevant therapeutic decision allows early management. The aim is to analyze voice change after thyroidectomy for patients with normal pre-operative voice. The study included 30 patients who had developed voice change within 6 months after thyroidectomy. They were subjected to voice evaluation, indirect laryngoscopy, videostroboscopy and electromyography [EMG]. It was found that dysphonia after thyroid surgery was caused by neurogenic causes [RLN and SLN injuries] in 23 patients [76.7%], non-neurogenic causes in 5 patients [16.7%] and combined causes in 2 patients [6.6%]. EMG studies revealed complete denervation in 6 patients [20] and incomplete denervation [paresis] in 19 patients [63.3%]. Post-thyroidectomy dysphonias are not rare. Injuries of the RLN constitute the main cause. Non-neurogenic injury is another contributing factor. Diagnosis is essential for early management through videostroboscopy and EMG which is specific to differentiate between neurogenic and traumatic injuries and to detect complete or incomplete denervation

value of recurrent laryngeal nerve identification and stimulation by usig intraoperative disposable nerve stimulator during thyoid operation

Recurrent laryngeal nerve [RLN] iatrogenic injury is one of the most serious complications in thyroid surgery. Paralysis of vocal cords can repesents a srious complication inducing, when bilateral, serious functional sequelae such as phonatory, respiratory and psychological problems that limit working capacities and social relationships of patients. This work is to study the importance of searching, identification and exposure of the RLN surgically and confirming this by using a disposable nerve stimulator to avoid its injury.Design: prospective study. Patients and Records of forty patients who underwent thyroidectomy by the authers at several Hospitals were reviewed for RLN paralysis between January2001 and December 2003. Intraoperative determination of RLN function was evaluated with a disposable nerve stimulator [Xomed, Jacksonville, Florida] set at 0.5 milliamper [mA]. Without the use of neuromuscular blockade during anesthesia, RLN function was assessed by palpating of the cricoarytenoid joint and posterior cricoaryteniod muscle while the stimulus was applied directly to nerve after identificantion. Postoperative, assessment of RLN integrity was determined by using flexible nasolaryngoscopy 7 days after the procedure to visualize the vocal cord mobility. RLNs were identified and stimulated intraoperatively in all patients. Concerning the postoperative results, flexible nasolaryngoscopy was utilized in all patients one week after the procedure. All patients had bilateral mobile vocal cords after the first week postoperatively. Conclusions: The authors concluded that iatrogenic injury to the RLN or to its branches could be avoided by searching, identifying, and exposing the nerve itself and by following its course with care. In addition, using intraoperative disposable nerve stimulator is very helpful in confirming the location and function of the RLN

Modification of anaesthetic technique for thyroidectomy with preservation of external laryngeal nerve to aid electrical stimulation

the external branch of the superior laryngeal nerve is a branch of the vagus nerve that innervates the cricothyroid muscle. Contraction of the cricothyroid muscle tenses and elongates the vocal cords, so that its function is of vital importance in certain professionals who need a high pitched voice. The incidence of injury to this nerve during thyroid surgery is as high as 28% in all cases. Patients and forty patients undergoing thyroid surgery were enrolled in this study. An intraoperative electrical nerve simulator was used for nerve identification along with a modified anaesthetic technique. The choice of muscle relaxant used was based on a review of the literature in order to determine which relaxant has no delayed effect. preservation of this nerve was successful in this study in all 40 patients who underwent thyroidectomy or other thyroid surgery. Using this method, none of the patients participating in this study showed anaeshetic complications, voice changes or cord abnormalities in the postoperative period. having had a 100% success rate to identify the nerve and preserve it, it is recommended that this method be used for every thyroidectomy, especially for huge goiters, and certainly for actors, professional lecturers and singers

Paralisia de prega vocal esquerda secundária à lesäo do nervo laríngeo recorrente após cirurgia de ligadura do canal arterial: relato de caso / Paralysis of the left vocal cord secondary to left recurrent nerve lesion following surgery for ligation of the arterial canal: case report

Justificativa e objetivos - Embora as disfonias pós-operatórias sejam freqüentemente associadas a complicações da intubaçäo e extubaçäo traqueal, outras causas podem estar envolvidas, inclusive cirúrgicas. O objetivo deste artigo é relatar um caso de disfonia no pós-operatório tardio, decorrente de paralisia de prega vocal esquerda, devido à lesäo do nervo laríngeo recorrente esquerdo, durante cirurgia de ligadura do canal arterial. Relato do caso - Paciente do sexo feminino, 6 anos, estado físico ASA II, peso 18.800 g. submetida à cirurgia para ligadura do canal arterial. Recebeu como medicaçäo pré-anestésica, midazolam (0,8 mg.kgðû), 60 minutos antes da cirurgia. A sevoflurano, alfentanil e pancurônio. A dissecçäo do canal arterial foi realizada com dificuldade. No 4º dia do pós-operatório apresentou disfonia persistente. A videolaringoscopia mostrou paralisia de prega vocal esquerda e pequena fenda paramediana. Conclusões - Pela sua íntima relaçäo com o canal arterial, o nervo laríngeo recorrente esquerdo pode ser lesado, durante a cirurgia corretiva, principalmente quando existem dificuldades na dissecçäo e ligadura do canal arterial. Diferentemente das disfonias decorrentes da intubaçäo e extubaçäo traqueal, surgem mais tardiamente e permanecem por longos períodos, podendo inclusive serem irreversíveis

use of laryngeal mask airway with fiberoptic laryngoscope and swivel adaptor for continuous monitoring of recurrent laryngeal nerve during thyroid surgery

Recurrent laryngeal nerve injury is the most important complication of thyroid surgery. Correct identification of the nerve during the surgical procedure is essential to avoid its damage. Was to evaluate the effectiveness and safety of using the laryngeal mask airway and fiberoptic laryngoscopy for direct monitoring of the true vocal cord after stimulation of the recurrent laryngeal nerve. We performed thyroidectomy on twenty seven patients of ASA physical status I and II. Patients with esophageal reflux, hiatus hernia, body weight more than 20% of the ideal or history of asthma were excluded, The technique of laryngeal mask airway anesthesia with swivel adaptor and fiberoptic laryngoscope was used to monitor the recurrent laryngeal nerve. The incidence of postoperative recurrent laryngeal nerve dysfunction was zero. Also there was no case of laryngeal spasm or aspiration. There were two cases of mild coughing/gagging. Hemodynamic response did not show any, clinical significance. The combination of laryngeal mask airway with fiberoptic laryngoscope and swivel adaptor is a safe technique for airway management during thyroidectomy and provides advantage in term of preservation of recurrent laryngeal nerve