Reasons and preventions for damage of recurrent laryngeal nerve in thyroid surgery

Objective To investigate the reasons and the preventive measures of recurrent laryngeal nerve (RLN) injury during operations in patients with thyroid neoplasm.Methods The clinic data of 1 174 cases of thyroid neoplasm in a single unit (department of breast and thyroid surgery center,Union hospital,Tongji medical college,Huazhong university of science and technology) from June 2003 to August 2006 were surveyed retrospectively.The relationships of 41 cases postoperative RLN injury between type of operation,routine identification and unidentification of the RLN during the operation were analyzed.Results Transient RLN injury in primary,second time and over two times operation were 2.1%,3.8%and 9.5% respectively.Permanent RLN injury in primary,second time and over two times operation were 1.0%,1.5% and 4.8% respectively.Routine identification and no identification RLN inducing transient RLN injury were 2.3% and 2.5% respectively,whereas permanent RLN injury were 0.2%and 2.3% respectively.Conclusion Operations for thyroid cancer and reoperation for thyroid diseases demonstrate higher RLN injury rates significantly.Routine nerve exposure remain crucial to the minimization of permanent RLN injury.And the way always cause temporary RLN injury immediately postoperation which can complete recovery with expectant treatment as long as RLN was anatomically intact.Once RLN injury without certain cause was made,an operation should be performed as early as possible to recovering the function of RLN.