Publication:

Identification of recurrent laryngeal nerve: a dilemma in thyroid surgery

Background Surgery of the thyroid gland is one of the most common surgical procedures performed. Recurrent laryngeal nerve injury is the most dreaded complication of thyroid surgery. Hence reducing intraoperative injury is of utmost importance. Routine dissection and identification of the recurrent nerve remain controversial.

Methods This study consists of 70 patients who underwent thyroid surgery. This study was conducted at our institute during the period of 2 years (2018-2020). Patients were evaluated and operated. Patients with thyroid diseases and normal vocal cords were allocated to two groups randomly; in group A the nerve was identified and in group B the nerve was not identified.

Results Most of the patients participating in the study were in the age group of 33-42 years. Male to female disease ratio was 0.13:1. In our study out of 70 patients who underwent thyroid surgery, 18 (25.71%) patients suffered from recurrent laryngeal nerve palsy. Amongst those 18 patients, 2 palsies (5.71%) were in Group A and 16 palsies (45.71%) were in Group B. Recurrent laryngeal nerve most commonly lied posterior to the inferior thyroid artery on both right (65.38%) as well as left side (45.45%). Most commonly injured recurrent laryngeal nerve was the right sided recurrent laryngeal nerve (77.77%).

Conclusions Careful dissection of nerve during thyroid surgery eliminates the risk of recurrent laryngeal nerve injury. A thorough knowledge of thyroid gland, recurrent laryngeal nerve and its anatomical relations and variations is of utmost importance in preserving the recurrent laryngeal nerve in thyroid surgery.