Severity of Recurrent Laryngeal Nerve Injuries in Thyroid Surgery

Gianlorenzo Dionigi, Che Wei Wu, Hoon Yub Kim, Stefano Rausei, Luigi Boni, Feng Yu Chiang

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

Background: Few studies in the literature have reported recovery data for different types of recurrent laryngeal nerve injuries (RLNIs). This study is the first attempt to classify RLNIs and rank them by severity. Methods: This prospective clinical study analyzed 281 RLNIs in which a true loss of signal was identified by intraoperative neuromonitoring (IONM), and vocal cord palsy (VCP) was confirmed by a postoperative laryngoscope. For each injury type, the prevalence of VCP, the time of VCP recovery, and physical changes on nerves were analyzed. Additionally, different RLNI types were experimentally induced in a porcine model to compare morphological change. Results: The overall VCP rate in at-risk patients/nerves was 8.9/4.6 %, respectively. The distribution of RLNI types, in order of frequency, was traction (71 %), thermal (17 %), compression (4.2 %), clamping (3.4 %), ligature entrapment (1.6 %), suction (1.4 %), and nerve transection (1.4 %). Complete recovery from VCP was documented in 91 % of RLNIs. Recovery time was significantly faster in the traction group compared to the other groups (p < 0.001). The rates of temporary and permanent VCP were 98.6 and 1.4 % for traction lesion, 72 and 28 % for thermal injury, 100 and 0 % for compression injury, 50 and 50 % for clamping injury, 100 and 0 % for ligature entrapment, 100 and 0 % for suction injury, and 0 and 100 % for nerve transection, respectively. Physical changes were noted in 14 % of RLNIs in which 56 % of VCP was permanent. However, among the remaining 86 % IONM-detectable RLNIs without physical changes, only 1.2 % of VCP was permanent. A porcine model of traction lesion showed only distorted outer nerve structure, whereas the thermal lesion showed severe damage in the inner endoneurium. Conclusions: Different RNLIs induce different morphological alterations and have different recovery outcomes. Permanent VCP is rare in lesions that are visually undetectable but detectable by IONM. By enabling early detection of RLNI and prediction of outcome, IONM can help clinicians plan intra- and postoperative treatment.

Original languageEnglish
Pages (from-to)1373-1381
Number of pages9
JournalWorld Journal of Surgery
Volume40
Issue number6
DOIs
Publication statusPublished - 2016 Jun 1

Fingerprint

Recurrent Laryngeal Nerve Injuries
Vocal Cord Paralysis
Thyroid Gland
Traction
Wounds and Injuries
Hot Temperature
Suction
Constriction
Ligation
Swine
Laryngoscopes
Peripheral Nerves
Prospective Studies

ASJC Scopus subject areas

  • Surgery

Cite this

Severity of Recurrent Laryngeal Nerve Injuries in Thyroid Surgery. / Dionigi, Gianlorenzo; Wu, Che Wei; Kim, Hoon Yub; Rausei, Stefano; Boni, Luigi; Chiang, Feng Yu.

In: World Journal of Surgery, Vol. 40, No. 6, 01.06.2016, p. 1373-1381.

Research output: Contribution to journalArticle

Dionigi, G, Wu, CW, Kim, HY, Rausei, S, Boni, L & Chiang, FY 2016, 'Severity of Recurrent Laryngeal Nerve Injuries in Thyroid Surgery', World Journal of Surgery, vol. 40, no. 6, pp. 1373-1381. https://doi.org/10.1007/s00268-016-3415-3
Dionigi, Gianlorenzo ; Wu, Che Wei ; Kim, Hoon Yub ; Rausei, Stefano ; Boni, Luigi ; Chiang, Feng Yu. / Severity of Recurrent Laryngeal Nerve Injuries in Thyroid Surgery. In: World Journal of Surgery. 2016 ; Vol. 40, No. 6. pp. 1373-1381.
@article{85e05f671f024bae9cb7b972774f95bf,
title = "Severity of Recurrent Laryngeal Nerve Injuries in Thyroid Surgery",
abstract = "Background: Few studies in the literature have reported recovery data for different types of recurrent laryngeal nerve injuries (RLNIs). This study is the first attempt to classify RLNIs and rank them by severity. Methods: This prospective clinical study analyzed 281 RLNIs in which a true loss of signal was identified by intraoperative neuromonitoring (IONM), and vocal cord palsy (VCP) was confirmed by a postoperative laryngoscope. For each injury type, the prevalence of VCP, the time of VCP recovery, and physical changes on nerves were analyzed. Additionally, different RLNI types were experimentally induced in a porcine model to compare morphological change. Results: The overall VCP rate in at-risk patients/nerves was 8.9/4.6 {\%}, respectively. The distribution of RLNI types, in order of frequency, was traction (71 {\%}), thermal (17 {\%}), compression (4.2 {\%}), clamping (3.4 {\%}), ligature entrapment (1.6 {\%}), suction (1.4 {\%}), and nerve transection (1.4 {\%}). Complete recovery from VCP was documented in 91 {\%} of RLNIs. Recovery time was significantly faster in the traction group compared to the other groups (p < 0.001). The rates of temporary and permanent VCP were 98.6 and 1.4 {\%} for traction lesion, 72 and 28 {\%} for thermal injury, 100 and 0 {\%} for compression injury, 50 and 50 {\%} for clamping injury, 100 and 0 {\%} for ligature entrapment, 100 and 0 {\%} for suction injury, and 0 and 100 {\%} for nerve transection, respectively. Physical changes were noted in 14 {\%} of RLNIs in which 56 {\%} of VCP was permanent. However, among the remaining 86 {\%} IONM-detectable RLNIs without physical changes, only 1.2 {\%} of VCP was permanent. A porcine model of traction lesion showed only distorted outer nerve structure, whereas the thermal lesion showed severe damage in the inner endoneurium. Conclusions: Different RNLIs induce different morphological alterations and have different recovery outcomes. Permanent VCP is rare in lesions that are visually undetectable but detectable by IONM. By enabling early detection of RLNI and prediction of outcome, IONM can help clinicians plan intra- and postoperative treatment.",
author = "Gianlorenzo Dionigi and Wu, {Che Wei} and Kim, {Hoon Yub} and Stefano Rausei and Luigi Boni and Chiang, {Feng Yu}",
year = "2016",
month = "6",
day = "1",
doi = "10.1007/s00268-016-3415-3",
language = "English",
volume = "40",
pages = "1373--1381",
journal = "World Journal of Surgery",
issn = "0364-2313",
publisher = "Springer New York",
number = "6",

}

TY - JOUR

T1 - Severity of Recurrent Laryngeal Nerve Injuries in Thyroid Surgery

AU - Dionigi, Gianlorenzo

AU - Wu, Che Wei

AU - Kim, Hoon Yub

AU - Rausei, Stefano

AU - Boni, Luigi

AU - Chiang, Feng Yu

PY - 2016/6/1

Y1 - 2016/6/1

N2 - Background: Few studies in the literature have reported recovery data for different types of recurrent laryngeal nerve injuries (RLNIs). This study is the first attempt to classify RLNIs and rank them by severity. Methods: This prospective clinical study analyzed 281 RLNIs in which a true loss of signal was identified by intraoperative neuromonitoring (IONM), and vocal cord palsy (VCP) was confirmed by a postoperative laryngoscope. For each injury type, the prevalence of VCP, the time of VCP recovery, and physical changes on nerves were analyzed. Additionally, different RLNI types were experimentally induced in a porcine model to compare morphological change. Results: The overall VCP rate in at-risk patients/nerves was 8.9/4.6 %, respectively. The distribution of RLNI types, in order of frequency, was traction (71 %), thermal (17 %), compression (4.2 %), clamping (3.4 %), ligature entrapment (1.6 %), suction (1.4 %), and nerve transection (1.4 %). Complete recovery from VCP was documented in 91 % of RLNIs. Recovery time was significantly faster in the traction group compared to the other groups (p < 0.001). The rates of temporary and permanent VCP were 98.6 and 1.4 % for traction lesion, 72 and 28 % for thermal injury, 100 and 0 % for compression injury, 50 and 50 % for clamping injury, 100 and 0 % for ligature entrapment, 100 and 0 % for suction injury, and 0 and 100 % for nerve transection, respectively. Physical changes were noted in 14 % of RLNIs in which 56 % of VCP was permanent. However, among the remaining 86 % IONM-detectable RLNIs without physical changes, only 1.2 % of VCP was permanent. A porcine model of traction lesion showed only distorted outer nerve structure, whereas the thermal lesion showed severe damage in the inner endoneurium. Conclusions: Different RNLIs induce different morphological alterations and have different recovery outcomes. Permanent VCP is rare in lesions that are visually undetectable but detectable by IONM. By enabling early detection of RLNI and prediction of outcome, IONM can help clinicians plan intra- and postoperative treatment.

AB - Background: Few studies in the literature have reported recovery data for different types of recurrent laryngeal nerve injuries (RLNIs). This study is the first attempt to classify RLNIs and rank them by severity. Methods: This prospective clinical study analyzed 281 RLNIs in which a true loss of signal was identified by intraoperative neuromonitoring (IONM), and vocal cord palsy (VCP) was confirmed by a postoperative laryngoscope. For each injury type, the prevalence of VCP, the time of VCP recovery, and physical changes on nerves were analyzed. Additionally, different RLNI types were experimentally induced in a porcine model to compare morphological change. Results: The overall VCP rate in at-risk patients/nerves was 8.9/4.6 %, respectively. The distribution of RLNI types, in order of frequency, was traction (71 %), thermal (17 %), compression (4.2 %), clamping (3.4 %), ligature entrapment (1.6 %), suction (1.4 %), and nerve transection (1.4 %). Complete recovery from VCP was documented in 91 % of RLNIs. Recovery time was significantly faster in the traction group compared to the other groups (p < 0.001). The rates of temporary and permanent VCP were 98.6 and 1.4 % for traction lesion, 72 and 28 % for thermal injury, 100 and 0 % for compression injury, 50 and 50 % for clamping injury, 100 and 0 % for ligature entrapment, 100 and 0 % for suction injury, and 0 and 100 % for nerve transection, respectively. Physical changes were noted in 14 % of RLNIs in which 56 % of VCP was permanent. However, among the remaining 86 % IONM-detectable RLNIs without physical changes, only 1.2 % of VCP was permanent. A porcine model of traction lesion showed only distorted outer nerve structure, whereas the thermal lesion showed severe damage in the inner endoneurium. Conclusions: Different RNLIs induce different morphological alterations and have different recovery outcomes. Permanent VCP is rare in lesions that are visually undetectable but detectable by IONM. By enabling early detection of RLNI and prediction of outcome, IONM can help clinicians plan intra- and postoperative treatment.

UR - http://www.scopus.com/inward/record.url?scp=84955566442&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84955566442&partnerID=8YFLogxK

U2 - 10.1007/s00268-016-3415-3

DO - 10.1007/s00268-016-3415-3

M3 - Article

C2 - 26817650

AN - SCOPUS:84955566442

VL - 40

SP - 1373

EP - 1381

JO - World Journal of Surgery

JF - World Journal of Surgery

SN - 0364-2313

IS - 6

ER -