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

What are the chances that your dad isn't your dad?

Apr 16, 2014

How confident are you that the man you call dad is really your biological father? If you believe some of the most commonly-quoted figures, you could be forgiven for not being very confident at all. But how ...

New technology that is revealing the science of chewing

Apr 15, 2014

CSIRO's 3D mastication modelling, demonstrated for the first time in Melbourne today, is starting to provide researchers with new understanding of how to reduce salt, sugar and fat in food products, as well ...

After skin cancer, removable model replaces real ear

Apr 11, 2014

(HealthDay)—During his 10-year struggle with basal cell carcinoma, Henry Fiorentini emerged minus his right ear, and minus the hearing that goes with it. The good news: Today, the 56-year-old IT programmer ...

Italy scraps ban on donor-assisted reproduction

Apr 09, 2014

Italy's Constitutional Court on Wednesday struck down a Catholic Church-backed ban against assisted reproduction with sperm or egg donors that has forced thousands of sterile couples to seek help abroad.

User comments