Recurrent nerve damage following thyroid surgery: What can I do?

Objectives: Bilateral recurrent nerve damage still represents one of the main complications following thyroid surgery, even though the nerve intraoperative monitoring has allowed the decrease of this injury. This observational retrospective study aims to define the onset modalities and the recovery time of different clinical conditions that may occurs after thyroidectomy.

Methods: From a total of 1417 patients who underwent total thyroidectomy for benign tumors between 2017 and 2022 in ENT Unit of University of Campania "L. Vanvitelli," this study involved 30 patients with bilateral vocal folds motility deficit. These patients (28 F, 2 M), aged from 24 to 78 years old (average age 51.7), presented a bilateral vocal fold motility deficit. Five patients of the study developed an acute respiratory failure upon the awakening that required a nasotracheal prolonged safe extubation. The other 25 patients underwent 9 months diagnostic and therapeutic process, which started approximately 30 days after thyroid surgery.

Results: Indeed, there are several outcomes of these complications, like functional laryngeal defects, which are mainly related to respiratory and phonatory activities. These clinical manifestations can evolve in different ways within a context of a wide range of possibilities, from the spontaneous bilateral or monolateral recovery to the necessity of a functional or surgical restoration.

Conclusion: This study allowed the acquisition of useful information about prognostic indications and an adequate therapeutic process, based on the specific clinical characteristics.