Incidence Of Recurrent Laryngeal Nerve (RLN) Palsy In Patients Undergoing Thyroid Surgery

Abstract

Introduction: Thyroid surgery is among the most common neck surgeries performed worldwide. Injury to the recurrent laryngeal nerve (RLN) remains one of its most significant complications, leading to vocal cord paresis or paralysis. The most reliable way to preserve RLN integrity is to visually identify the nerve during all thyroid and parathyroid surgeries.

Objective: To determine the incidence of RLN palsy in patients undergoing thyroid surgery.

Methods: This prospective longitudinal observational study was conducted at the Department of Otolaryngology–Head & Neck Surgery, BSMMU Hospital, from July 2023 to August 2024. All patients provided informed consent and were counseled regarding the type of surgery (hemithyroidectomy, total thyroidectomy, or completion thyroidectomy) and potential complications, with special emphasis on RLN palsy. Preoperative and postoperative vocal cord assessments were performed using flexible laryngoscopy. Patients with RLN palsy were managed conservatively and followed up for six months to determine recovery status.

Results: Among 78 thyroid surgeries, 8 patients (10.25%) developed RLN palsy (5 right-sided, 3 left-sided). Seven patients (8.97%) recovered within 4 weeks, while one male patient (1.28%) developed permanent palsy. RLN injury was more common in total and completion thyroidectomy compared to hemithyroidectomy.

Conclusion: RLN injury during thyroid surgery is not uncommon. Most cases are temporary and resolve with conservative management. Careful dissection, full visualization of the RLN, and preservation of its blood supply are crucial to reducing the risk of nerve injury.