Nerve identification technique during thyroid removal associated with fewer complications

During thyroidectomy (surgery to remove the thyroid gland), the technique surgeons use to identify an important nerve appears to make a difference in terms of complications such as impairment of the parathyroid glands (which make a hormone that controls calcium levels), according to a report published Online First today by Archives of Otolaryngology–Head and Neck Surgery.

According to background information in the article, thyroidectomy is a common operation, but it can be associated with serious complications: paralysis of the recurrent laryngeal (RLN, a nerve that transmits motor function and sensation to the larynx, or voice box) and hypoparathyroidism (caused by injury to the ). Unintentional damage to the RLN by this surgery is reported to cause nerve paralysis in one percent to two percent of cases. Extensive searching for the RLN during surgery may cause temporary or permanent hypoparathyroidism. The authors note two methods of identifying the RLN: one approach locates the nerve where it enters the larynx (superior-inferior direction), and the other approach locates the nerve in the trachea-esophageal groove, and traces it in the superior direction (inferior-superior direction).

Bayram Veyseller, M.D., from Bezmialem Vakif University, Istanbul, Turkey, and colleagues conducted a study to compare both techniques. They studied patients undergoing partial or total thyroidectomy between January 2006 and August 2009. In 67 patients, the superior-inferior RLN identification technique was used, and in 128 patients, the inferior-superior method was used, according to the attending surgeon's preference. Researchers evaluated patients' vocal cord function and blood calcium levels on the first day after the surgery. Follow-up was conducted every three months until patients' calcium levels improved, for an average of 26 months. If at the one-year mark blood were still low (a sign of hypoparathyroidism) or RLN paralysis did not improve, the conditions were considered permanent.

Permanent paralysis of the RLN occurred in two patients in the inferior-superior group, and none in the other group. Hypoparathyroidism among the superior-inferior group patients was temporary in four and permanent in none; among the inferior-superior group patients, 14 experienced temporary hyperthyroidism and four experienced permanent hypoparathyroidism. Overall, significantly fewer complications were found in terms of RLN paralysis and hypoparathyroidism in the superior-inferior group.

"Significantly lower rates of RLN and hypoparathyroidism were observed in thyroidectomies using a superior-inferior approach," the authors concluded. They added that more studies should be conducted to corroborate these results.

More information: Arch Otolaryngol Head Neck Surg. Published August 15, 2011. doi:10.1001/archoto.2011.134

add to favorites email to friend print save as pdf

Related Stories

Recommended for you

Medtronic spends $350M on another European deal

15 hours ago

U.S. medical device maker Medtronic is building stronger ties to Europe, a couple months after announcing a $42.9 billion acquisition that involves moving its main executive offices across the Atlantic, where it can get a ...

Mind over matter for people with disabilities

Aug 26, 2014

People with serious physical disabilities are unable to do the everyday things that most of us take for granted despite having the will – and the brainpower – to do so. This is changing thanks to European ...

Ukraine's former world's tallest man dies

Aug 25, 2014

Ukraine's tallest man, who briefly held the world record but gave it up to live as a recluse, has died due to complications from the condition that saw him never stop growing, local media reported Monday.

User comments