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Rates of RLN and SLN injury : Data from national quality registries and the literature

Tolley, Neil S.; Chaidas, Konstantinos and Bergenfelz, Anders LU (2016) In The Recurrent and Superior Laryngeal Nerves p.3-16
Abstract

The impact of thyroid surgery on voice is a key performance indicator of surgical quality. This chapter discusses factors that can impact on the incidence of both recurrent and external laryngeal nerve (external branch of superior laryngeal nerve-EBSLN) injury. The literature is reviewed and reported incidence of nerve palsy following thyroid surgery is presented. Particular reference is made to the British and Scandinavian database registries. The present evidence supports that the true injury rate is underreported. Factors that might influence nerve injury are presented in an evidence-based manner. A centrally important dynamic in this area of study is that there is clear positive correlation between the rate of postoperative vocal... (More)

The impact of thyroid surgery on voice is a key performance indicator of surgical quality. This chapter discusses factors that can impact on the incidence of both recurrent and external laryngeal nerve (external branch of superior laryngeal nerve-EBSLN) injury. The literature is reviewed and reported incidence of nerve palsy following thyroid surgery is presented. Particular reference is made to the British and Scandinavian database registries. The present evidence supports that the true injury rate is underreported. Factors that might influence nerve injury are presented in an evidence-based manner. A centrally important dynamic in this area of study is that there is clear positive correlation between the rate of postoperative vocal cord examination and palsy. Overall, 10 % of patients can sustain a temporary laryngeal palsy following thyroidectomy. Permanent voice problems are common and the true incidence of permanent palsy remains unknown. There is little doubt, however, that the literature grossly underestimates its true incidence. Thirty percent of patients with a known vocal palsy may not complain of voice symptoms which again endorses the importance of routine post- operative vocal cord examination. Voice change secondary to EBSLN injury is also common and again the true incidence remains unknown. This situation prevails due to the difficulty of precise diagnosis with extant non- invasive methods of cord examination. The importance of surgical volume to patient outcomes is emphasized. Surgery for cancer particularly when involving nodal dissection has been identified as a significant and higher risk for nerve palsy as have been revision and more extensive thyroid surgery. Similarly, higher rates of nerve injury are reported with retrosternal goitres. The literature is unclear as to whether the side of thyroidectomy is a risk factor or whether certain benign pathology such as Graves' disease confers a higher risk of injury.

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author
organization
publishing date
type
Chapter in Book/Report/Conference proceeding
publication status
published
subject
keywords
Baets database, Ebsln, External laryngeal nerve injury, Recurrent laryngeal nerve injury, Scandinavian quality register, Superior laryngeal nerve
in
The Recurrent and Superior Laryngeal Nerves
pages
14 pages
publisher
Springer International Publishing
external identifiers
  • scopus:85026302223
ISBN
9783319277257
9783319277271
DOI
10.1007/978-3-319-27727-1_1
language
English
LU publication?
yes
id
f21eac54-d9a5-4dd6-988e-eddba3c02cfd
date added to LUP
2017-08-24 16:23:12
date last changed
2017-10-01 05:38:53
@inbook{f21eac54-d9a5-4dd6-988e-eddba3c02cfd,
  abstract     = {<p>The impact of thyroid surgery on voice is a key performance indicator of surgical quality. This chapter discusses factors that can impact on the incidence of both recurrent and external laryngeal nerve (external branch of superior laryngeal nerve-EBSLN) injury. The literature is reviewed and reported incidence of nerve palsy following thyroid surgery is presented. Particular reference is made to the British and Scandinavian database registries. The present evidence supports that the true injury rate is underreported. Factors that might influence nerve injury are presented in an evidence-based manner. A centrally important dynamic in this area of study is that there is clear positive correlation between the rate of postoperative vocal cord examination and palsy. Overall, 10 % of patients can sustain a temporary laryngeal palsy following thyroidectomy. Permanent voice problems are common and the true incidence of permanent palsy remains unknown. There is little doubt, however, that the literature grossly underestimates its true incidence. Thirty percent of patients with a known vocal palsy may not complain of voice symptoms which again endorses the importance of routine post- operative vocal cord examination. Voice change secondary to EBSLN injury is also common and again the true incidence remains unknown. This situation prevails due to the difficulty of precise diagnosis with extant non- invasive methods of cord examination. The importance of surgical volume to patient outcomes is emphasized. Surgery for cancer particularly when involving nodal dissection has been identified as a significant and higher risk for nerve palsy as have been revision and more extensive thyroid surgery. Similarly, higher rates of nerve injury are reported with retrosternal goitres. The literature is unclear as to whether the side of thyroidectomy is a risk factor or whether certain benign pathology such as Graves' disease confers a higher risk of injury.</p>},
  author       = {Tolley, Neil S. and Chaidas, Konstantinos and Bergenfelz, Anders},
  isbn         = {9783319277257},
  keyword      = {Baets database,Ebsln,External laryngeal nerve injury,Recurrent laryngeal nerve injury,Scandinavian quality register,Superior laryngeal nerve},
  language     = {eng},
  month        = {05},
  pages        = {3--16},
  publisher    = {Springer International Publishing},
  series       = {The Recurrent and Superior Laryngeal Nerves},
  title        = {Rates of RLN and SLN injury : Data from national quality registries and the literature},
  url          = {http://dx.doi.org/10.1007/978-3-319-27727-1_1},
  year         = {2016},
}