Aygun Nurcihan, Kostek Mehmet, Unlu Mehmet Taner, Isgor Adnan, Uludag Mehmet
Department of General Surgery, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey.
Department of General Surgery, Sisli Memorial Hospital, Istanbul, Turkey.
Front Surg. 2022 Apr 28;9:867948. doi: 10.3389/fsurg.2022.867948. eCollection 2022.
Despite all the technical developments in thyroidectomy and the use of intraoperative nerve monitorization (IONM), recurrent laryngeal nerve (RLN) paralysis may still occur. We aimed to evaluate the effects of anatomical variations, clinical features, and intervention type on RLN paralysis.
The RLNs identified till the laryngeal entry point, between January 2016 and September 2021 were included in the study. The effects of RLN anatomical features considering the International RLN Anatomical Classification System, intervention and monitoring types on RLN paralysis were evaluated.
A total of 1,412 neck sides of 871 patients (672 F, 199 M) with a mean age of 49.17 + 13.42 years (range, 18-99) were evaluated. Eighty-three nerves (5.9%) including 78 nerves with transient (5.5%) and 5 (0.4%) with permanent vocal cord paralysis (VCP) were detected. The factors that may increase the risk of VCP were evaluated with binary logistic regression analysis. While the secondary thyroidectomy (OR: 2.809, 95%CI: 1.302-6.061, = 0.008) and Berry entrapment of RLN (OR: 2.347, 95%CI: 1.425-3.876, = 0.001) were detected as the independent risk factors for total VCP, the use of intermittent-IONM (OR: 2.217, 95% CI: 1.299-3.788, 0.004), secondary thyroidectomy (OR: 3.257, 95%CI: 1.340-7.937, = 0.009), and nerve branching (OR: 1.739, 95%CI: 1.049-2.882, = 0.032) were detected as independent risk factors for transient VCP.
Preference of continuous-IONM particularly in secondary thyroidectomies would reduce the risk of VCP. Anatomical variations of the RLN cannot be predicted preoperatively. Revealing anatomical features with careful dissection may contribute to risk reduction by minimizing actions causing traction trauma or compression on the nerve.
尽管甲状腺切除术中的所有技术发展以及术中神经监测（IONM）的使用，但喉返神经（RLN）麻痹仍可能发生。我们旨在评估解剖变异、临床特征和干预类型对RLN麻痹的影响。
纳入2016年1月至2021年9月期间识别至喉入口点的RLN。根据国际RLN解剖分类系统评估RLN解剖特征、干预和监测类型对RLN麻痹的影响。
共评估了871例患者（672例女性，199例男性）的1412侧颈部，平均年龄为49.17±13.42岁（范围18 - 99岁）。检测到83条神经（5.9%）出现声带麻痹，其中78条为暂时性麻痹（5.5%），5条为永久性麻痹（0.4%）。采用二元逻辑回归分析评估可能增加声带麻痹风险的因素。二次甲状腺切除术（OR：2.809，95%CI：1.302 - 6.061，P = 0.008）和RLN的Berry卡压（OR：2.347，95%CI：1.425 - 3.876，P = 0.001）被检测为完全声带麻痹的独立危险因素，而间歇性IONM的使用（OR：2.217，95%CI：1.299 - 3.
