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KMID : 1202020090020020128
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Journal of Korean Thyroid Association
2009 Volume.2 No. 2 p.128 ~ p.134
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Iatrogenic Injury of Recurrent Laryngeal Nerve during Thyroid Surgery
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Han Young-Jin
Lee Kang-Dae
Kim Sung-Won
Kim Woo-Sung
Cha Young-Woo
Lee Jae-Hoon
Kang Dae-Hyoung
Park Hyo-Sang
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Abstract
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Background and Objectives : Iatrogenic injury of recurrent laryngeal nerve (RLN) remains as one of the most serious concerns in thyroid surgery. This study was aimed to analyze the mechanisms and potential risk factors of iatrogenic injury of RLN during thyroid surgery.
Materials and Methods :Retrospective study of 7 patients with permanent vocal cord palsy and 15 patients with temporary vocal cord palsy among the 1,010 cases of thyroidectomy performed at our institution by a single surgeon from April 1998 through July 2008 was conducted. Medical records of these patients were reviewed to identify the mechanisms and potential risk factors of iatrogenic injury of RLN.
Results:The causes of permanent RLN injury were 3 transections, 3 ligations, 1 unrecognized injury. The causes of temporary RLN injury were 1 transection, 1 forcipressure and 13 unrecognized injuries. Anatomic risk factors were bifurcated RLN (4 cases), thin diameter of the nerve (4 cases) and reoperation (1 case). Tumor factors were malignant (14 cases) and large-sized tumor (5 cases). Surgeon factors were poor surgeon’s experience (1 case) and excessive blunt dissection at Berry’s ligament (1 case) and incomplete hemostasis (1 case).
Conclusion:Risk factors of iatrogenic RLN injury include anatomic, tumor and surgeon factors, the risk may rise when these factors are accompanied with each other. Thorough evaluation of the risk factors and surgical technique considering the factors may be helpful to prevent injury of the RLN.
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KEYWORD
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Thyroidectomy, Recurrent laryngeal nerve, Vocal cord palsy
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