Recurrent Laryngeal Nerve Injury With Versus Without Nerve Identification In Different Thyroidectomy Procedures

Abstract

Background: The world health organization estimates that worldwide 2 billion people still have iodine deficiency Objectives: Is to make comparison between the effect of identification of recurrent laryngeal nerve (RLN) and non-identification of the nerve on incidence of recurrent laryngeal nerve injury (RLNI) in different thyroidectomy procedures.

Type of the study: cross –sectional study.

Methods: 132 patients with goiters underwent thyroidectomy .Identification of RLN visually by exposure were done for agroup of them and non-identification of the nerves for the other group. The outcomes of RLNI in the two groupsanalyzed statistically for the effect of Identification of RLN on decreasing the incidence of the nerveinjury .The benefits of identification of RLN evaluated in each procedure ofthyroidectomy which were total thyroidectomy (TT), near totalthyroidectomy (NTT), and subtotal thyroidectomy (STT).Patients were followed up monthly for 6 months by indirect laryngoscopy for mobility of the vocal cords.

Results: 132 patients underwent thyroidectomy,258 RLNswere at risk, 124 nerves were  identified and134 nerves were  not identified,1 RLN was injured in identified group, and  8 RLN were injured in non-identified group. The pvalue was (0.0393) which was significant. TT were performed for 56 patients (42.4%) and total hemi thyroidectomy(THT)  for 6patients(4.5%), there were 118 RLNs at risk, 64RLNs were identified and 54 RLNs were not identified.1RLN was injured in identified group, and 7RLNs were injured in non-identifiedgroup, the pvalue was(0.023)which was significant.NTT procedure were performed for 38 patients(28.8%) , 76 RLNs were at risk. 30 RLNswere identified and none of themwas injured, 46 RLNswere not identified, 1 RLN was injured the p value was(1)which was not significant.STT were performed for 32patients(24.4%),64 RLNs were at risk. 30 RLNs were  identified  and 34 RLNs not identified,there was no nerve injury in both groups .

Conclusions: identification of RLN decrease incidence of RLNI in TT, while there was no significant increase of RLNI in NTT and STT when the nerve was not identified