Recurrent laryngeal nerve injury during total thyroidectomy

Objective To investigate the mechanism of recurrent laryngeal nerve injury during total thyroidectomy. Methods The clinical data of 36 patients suffering from recurrent laryngeal nerve injury in total thyroidectomy from 2003 to 2014 was analyzed retrospectively. Results 21 cases had temporary recurrent laryngeal nerve injury while 16 cases had permanent injury. The cases of injury included giant thyroid goitre, with variation of recurrent laryngeal nerve, undergoing secondary surgery, with tumor invasion and complicating thyroiditis. During the first surgery, the incidence of temporary recurrent laryngeal nerve injury was 0.43%, and the incidence of permanent damage was 0.27%. The temporary and permanent injury incidence of secondary surgery after initial subtotal thyroidectomy was 4.59% and 4.59%, respectively. For patients with grade 3 thyroid gland, that was 1.81% and 0.30%, respectively and 0.51%, 0.72% respectively in malignant cases. In cases complicating thyroiditis temporary recurrent laryngeal nerve injury occurred in 1.01%. Conclusions There is increased risk of recurrent laryngeal nerve injury in giant goiter cases undergoing secondary operations.Hence it is suggested that initial surgical procedure be hemithyroidectomy or total thyroidectomy Key words: Thyroidectomy; Recurrent laryngeal nerve