Department of Otorhinolaryngology Head & Neck Surgery, Guy's and St Thomas Hospital NHS Foundation Trust, 3rd floor Southwark Wing, St Thomas' Street, London, SE1 9RT, UK.
Eur Arch Otorhinolaryngol. 2012 Mar;269(3):983-7. doi: 10.1007/s00405-011-1711-y. Epub 2011 Jul 21.
The association between a pre-operative recurrent laryngeal nerve (RLN) palsy and thyroid disease is usually suggestive of locally advanced malignant thyroid disease by invasion of the nerve. However, the risk of benign thyroid disease causing paralysis to the nerve is extremely rare and has been scarcely reported. The aims of this paper are to analyse the experience of patients presenting with RLN palsy and benign multinodular goitre (MNG), evaluate the mechanisms of pathogenesis and determine if thyroid surgery may be of benefit for these patients. A retrospective review was conducted of five patients presenting to the Otorhinolaryngology Head and Neck Surgery Department at Guy's and St Thomas' NHS Foundation Trust Hospital between 2000 and 2009. All patients were evaluated with fibre-optic laryngoscopy, ultrasound-guided fine needle aspiration cytology and computerised tomography. All patients underwent total or completion thyroidectomy and a handheld nerve stimulator (Xomed-Medtronics Vari-Stim III(®)) was used at the end of the procedure to check the integrity of the RLN. Post-operatively all patients were followed up for at least 12 months with fibre-optic laryngoscopy. Five females with an age range between 32 and 81 years presented with RLN palsy and benign MNG. All patients underwent total or completion thyroidectomies with preservation of the affected nerves. Two patients recovered the function of the nerves. All patients were confirmed to have benign multinodular goitres on histological analysis. RLN palsy in the presence of benign disease is rare. Patients should be carefully evaluated to confirm the palsy and exclude malignant disease prior to surgery. Surgery should be undertaken to remove the MNG, confirm the diagnosis and preserve the affected nerve. There is a significant chance that some of these patients will recover the function of the nerve.
术前喉返神经（RLN）麻痹与甲状腺疾病之间的关联通常提示甲状腺恶性疾病局部侵犯神经。然而，良性甲状腺疾病导致神经麻痹的风险极为罕见，鲜有报道。本文旨在分析 RLN 麻痹伴良性多结节性甲状腺肿（MNG）患者的经验，评估发病机制，并确定甲状腺手术是否对这些患者有益。对 2000 年至 2009 年间在盖伊和圣托马斯国民保健信托基金会医院耳鼻喉头颈外科就诊的 5 例 RLN 麻痹伴良性 MNG 患者进行回顾性分析。所有患者均行纤维喉镜、超声引导下细针穿刺细胞学检查和计算机断层扫描检查。所有患者均行甲状腺全切除术或甲状腺次全切除术，术毕使用手持神经刺激器（Xomed-Medtronics Vari-Stim III(®)）检查 RLN 完整性。所有患者术后均至少随访 12 个月，并行纤维喉镜检查。5 例女性患者年龄 32 至 81 岁，均有 RLN 麻痹伴良性 MNG。所有患者均行甲状腺全切除术或甲状腺次全切除术，保留受影响的神经。2 例患者神经功能恢复。所有患者的组织学分析均证实为良性多结节性甲状腺肿。良性疾病伴 RLN 麻痹罕见。术前应仔细评估以确认麻痹并排除恶性疾病。手术应切除 MNG，明确诊断并保留受累神经。这些患者中有相当一部分有机会恢复神经功能。
