Is it possible to predict functional recovery of vocal folds palsy? Role of intraoperative neuromonitoring and laryngostroboscopy findings.

IF 2.7 2区医学 Q1 SURGERY

Surgery Pub Date : 2025-10-08 DOI:10.1016/j.surg.2025.109712

Pierpaolo Gallucci, Priscilla Francesca Procopio, Francesco Pennestrì, Luca Revelli, Annamaria D'Amore, Annamaria Martullo, Giuseppe Marincola, Maria Raffaella Marchese, Lucia D'Alatri, Carmela De Crea, Marco Raffaelli

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引用次数: 0

Abstract

Background: Vocal fold palsy is a common reason for claims after thyroidectomy. We evaluated the prognostic role of intraoperative neuromonitoring and postoperative flexible fiberoptic laryngostroboscopy findings in patients with type I or type II loss of signal, indicating the injury in an exact point of recurrent laryngeal nerve and whether the damage level cannot be determined, respectively.

Methods: Among 4,526 intraoperative neuromonitoring-assisted thyroidectomies (2021-2024), all cases of loss of signal were prospectively analyzed. Flexible fiberoptic laryngostroboscopy was performed in first, 15th, 45th, and 180th postoperative day for the evaluation of arytenoid motility and arytenoid inward rotation. On the basis of vocal fold motility at postoperative day 180, patients were categorized into a recovery group and nonrecovery group. Predictive factors for vocal fold palsy were assessed using univariable and multivariable analyses.

Results: Of 104 included patients, 87 (83.6%) patients recovered vocal fold motility within postoperative day 180. After univariable analysis, type I loss of signal (P = .001) and postoperative day 15 arytenoid inward rotation (P = .001) were significantly more frequent in the nonrecovery group, whereas postoperative day 15 arytenoid motility was more frequent in the recovery group (P = .001). Type I loss of signal, absence of arytenoid motility, and presence of arytenoid inward rotation at postoperative day 15 were associated with recovery in 1 case (P = .001), whereas type II loss of signal with presence of arytenoid motility and absence of arytenoid inward rotation related to recovery in all cases (P = .001). Multivariable analysis showed preserved arytenoid motility as a protective factor for persistent vocal fold palsy (P = .010), whereas the presence of arytenoid inward rotation increased the risk of persistent vocal fold palsy (P = .002).

Conclusion: This study results support the prognostic role of loss of signal type and postoperative day 15 arytenoid features on vocal fold palsy persistence 6 months after surgery. The identification of these parameters may help clinicians to address patients to early management of vocal fold palsy.

查看原文本刊更多论文

是否有可能预测声带麻痹的功能恢复？术中神经监测和喉频闪检查结果的作用。

背景：声带麻痹是甲状腺切除术后索赔的常见原因。我们评估了术中神经监测和术后柔性纤维喉频响镜检查结果在I型或II型信号丧失患者中的预后作用，分别表明喉返神经的确切损伤点和损伤程度是否无法确定。方法：对术中神经监测辅助甲状腺切除术4526例（2021-2024）患者的信号丢失情况进行前瞻性分析。术后第1天、第15天、第45天和第180天行柔性纤维喉频颤镜检查，评估杓状体运动和杓状体向内旋转。根据术后180天声带运动情况将患者分为恢复组和不恢复组。使用单变量和多变量分析评估声带麻痹的预测因素。结果：104例患者中，87例（83.6%）患者术后180天内声带运动恢复。单变量分析后，I型信号丧失（P = .001）和术后第15天杓骨向内旋转（P = .001）在未恢复组明显更频繁，而术后第15天恢复组杓骨运动更频繁（P = .001）。术后第15天，I型信号丧失、类杓运动缺失和类杓内旋存在与1例恢复相关（P = 0.001），而II型信号丧失、类杓运动存在和类杓内旋缺失与所有病例的恢复相关（P = 0.001）。多变量分析显示，保留的杓状体运动是持续性声带麻痹的保护因素（P = 0.010），而杓状体向内旋转的存在增加了持续性声带麻痹的风险（P = 0.002）。结论：本研究结果支持信号类型的丧失和术后第15天的类鼻窦特征对术后持续6个月的声带麻痹的预后作用。这些参数的识别可以帮助临床医生解决声带麻痹患者的早期处理。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Surgery 医学-外科

CiteScore

5.40

自引率

5.30%

发文量

687

审稿时长

64 days

期刊介绍： For 66 years, Surgery has published practical, authoritative information about procedures, clinical advances, and major trends shaping general surgery. Each issue features original scientific contributions and clinical reports. Peer-reviewed articles cover topics in oncology, trauma, gastrointestinal, vascular, and transplantation surgery. The journal also publishes papers from the meetings of its sponsoring societies, the Society of University Surgeons, the Central Surgical Association, and the American Association of Endocrine Surgeons.