Improving Voice Outcomes After Thyroid Surgery
Key Points
Key Points
- Voice disturbance may be identified at least temporarily in up to 80% of patients after thyroid surgery.
- About 1 in 10 patients experience temporary laryngeal nerve injury after surgery, with longer lasting voice problems in ≤1 in 25.
- The most common site of neural injury is the distal recurrent laryngeal nerve (RLN), which can be nonrecurrent in 0.5%-0.7% of cases (See figures below).
- The other nerves of major interest, and frequently less directly addressed during thyroid surgery, are the bilateral superior laryngeal nerves (SLN), injury to which can impair the ability to change pitch and reduce voice projection.
- Another less common surgical cause for post-thyroidectomy voice change may be cervical strap muscle injury.
- Nonsurgical causes may include laryngeal irritation, edema, or injury from airway management.
Course and branches of RLN and SLN
...ourse and branches of RLN and SLNFrom...
Relationship of RLN and SLN to thyroid lobe and tracheoesphageal groove
...of RLN and SLN to thyroid lobe and tracheoesp...
Variations of nonrecurrent recurrent laryngeal nerve
...iations of nonrecurrent recurrent...
Diagnosis
...gnosis...
...ey Action Statem...
Preoperative Mana...
...INE VOICE ASSESSMENT:The surgeon should do...
PREOPERATIVE LARYNGEAL ASSESSMENT OF THE IMPAIRED...
...E LARYNGEAL ASSESSMENT OF THE NONIMP...
...NT EDUCATION ON VOICE OUTCOMES:The cl...
...WITH ANESTHESIOLOGIST:The surgeon should inform t...
...able 1. Preoperative Voice Assessment ChartHav...
...able 2. Discussion Points for the Surgeon/Pa...
...ative Factors that May Be Associated with E...
Treatment
...atment...
...ction Statement...
...RLN:The surgeon should identify the RLN(s) during...
...ROTECTION OF SLN:The surgeon should take...
...VE EMG MONITORING:The surgeon or a designe...
...TIVE CORTICOSTEROIDS:No recommendation can be ma...
...VE VOICE ASSESSMENT:The surgeon should doc...
...TOPERATIVE LARYNGEAL EXAMINATION:Clinicians shoul...
...TOLARYNGOLOGY REFERRAL:The clinician should r...
...ILITATION:Clinicians should counsel pat...
Table 4. Causes of Thyroidectomy-related Dysphonia
...s of Thyroidectomy-related DysphoniaHavin...
Table 5. Discussion Points for a Patient Who Has Voice Changes After Thyroidectomy
...sion Points for a Patient Who Has Vo...