Analysis of the risk factors and strategies for recurrent laryngeal nerve paralysis in patients with thyroidectomy

OBJECTIVE To investigate the incidence and risk factors of recurrent laryngeal nerve paralysis in patients after thyroidectomy.METHODS The clinical data of 1902 patients who had consecutively undergone a thyroid operation from 2003 to 2010 were retrospectively analyzed.The potential correlation of the incidence of recurrent laryngeal nerve palsy with division,gender,anesthesiology,thyroid pathology,whether the nerve was identified or not,the number of surgery times and the extent of surgery were evaluated.RESULTS The overall rate of nerve palsy postoperatively was 1.84%.The incidence of recurrent laryngeal nerve palsy were significantly higher in the patients with thyroid malignancy,repeat surgery and who had an extended thyroidectomy comparing with the control groups on univariate analysis(χ 2 =1.096,1.893,1.467,P0.05).In extended thyrodiectomy,exposure of recurrent laryngeal nerve during operation may reduce the risk of nerve injury(χ 2 =1.758,P 0.05).In conservative surgery,the rates of nerve injury were not significantly different in patients with and without identification of the nerve during thyroidectomy(χ 2 =0.638,P0.05).Multivariate analysis showed that repeat surgery and extended thyroidectomy were the independent predictors of recurrent laryngeal nerve injury.CONCLUSION It is safe for smaller benign goiter to leave some remnant tissue without exposure of recurrent laryngeal nerve during the thyroid surgery.Routine exposure of recurrent laryngeal nerve during thyroid surgery is beneficial for extended thyroidectomy.