Fazila Hashmi, Faisal Ghani Siddiqui, Abdul Sattar Memon.
Is thyroidectomy safe after identification of recurrent laryngeal nerve – fact or fiction.
Pak J Med Res Jan ;49(4):131-3.

Background: 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. Objectives: To assess recurrent laryngeal nerve injury risk during thyroidectomy with and without routine identification of the recurrent laryngeal nerve during surgery. Settings and study design: Department of Surgery, Liaquat University of Medical & Health Sciences, Jamshoro/Hyderabad over 3 years. Patients and Methods: 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. Results: 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. Conclusions: 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.

PakMediNet -Pakistan's largest Database of Pakistani Medical Journals - http://www.pakmedinet.com