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Is It Always the Surgeon?

Matthias Echternach, MD; Christoph Maurer, MD; Thomas Mencke, MD; Martin Schilling, MD; Thomas Verse, MD; Bernhard Richter, MD

Arch Surg. 2009;144(2):149-153.

Hypothesis  Laryngeal dysfunction after thyroidectomy is a common complication. However, few data are available to differentiate whether these complications result from injury to the recurrent nerve or to the vocal folds from intubation.

Setting  University medical center.

Patients  Seven hundred sixty-one patients who underwent surgery to the thyroid gland from 1990 to 2002. Of these patients, 8.4% underwent a revision thyroidectomy.

Intervention  Preoperative and postoperative laryngostroboscopic examination.

Main Outcome Measure  Laryngostroboscopic evaluation of laryngeal complications.

Results  The overall rate of laryngeal complications was 42.0% (320 patients). Complications from an injury to the vocal folds occurred in 31.3% of patients. Weakness or paresis of the recurrent nerve was initially present in 6.6% and was related to the nerves at risk. This rate was higher in revision thyroidectomies than in primary surgical interventions (6.2% vs 11.6%; P = .04). The rate of laryngeal injuries was higher in patients older than 65 years (39.8% vs 30.8%; P = .03).

Conclusions  These data suggest that laryngeal complications after thyroidectomies are primarily caused by injury to the vocal folds from intubation and to a lesser extent by injury to the laryngeal nerve. We recommend documentation of informed consent, especially for patients who use their voice professionally, such as singers, actors, or teachers.

Author Affiliations: Institute for Musicians' Medicine, Freiburg University Medical Center, Freiburg (Drs Echternach and Richter), Department of Anaesthesiology, Rostock University, Rostock (Dr Mencke), Department of Surgery, Saarland University Medical Center, Homburg (Dr Schilling), and Department of Otorhinolaryngology, Asklepios Hospital Harburg, Hamburg (Dr Verse), Germany; and Department of Surgery, Liestal Hospital, Liestal, Switzerland (Dr Maurer).

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Laryngeal Complications After Thyroidectomy—Invited Critique
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Arch Surg. 2009;144(2):153.
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