Predictive Factors for Recurrent Laryngeal Nerve Palsy after Thyroid Surgery
Keywords:
Recurrent Laryngeal Nerve (RLN) palsy, Thyroidectomy complications, Papillary thyroid carcinoma, Nerve identification, Reoperation risk factorsAbstract
Background: Recurrent laryngeal nerve (RLN) palsy is a frequent complication of thyroid surgery, often leading to significant morbidity. Routine visual identification of the RLN through meticulous dissection remains the most effective method to prevent nerve injury. This study aims to identify key predictive factors for RLN palsy following thyroidectomy.
Methods: Conducted at the Department of Otolaryngology-Head & Neck Surgery, Bangladesh Medical University, this study included 39 patients aged 20–60 years with thyroid swelling. All underwent ultrasound and fine-needle aspiration cytology (FNAC). Data analysis was performed using SPSS v.26, with results expressed as frequencies and percentages. The Fisher's Exact test assessed statistical significance, with a p-value <0.05 deemed significant.
Results: Of the participants, 5 cases (12.82%) developed RLN palsy, while 6 (15.38%) developed hypothyroidism, and 2 (5.13%) had wound infections. Among the RLN palsy cases, 3 (7.69%) were temporary, and 2 (5.13%) were permanent. Pathologically, 4 of the RLN palsy cases (7.69%) had papillary thyroid carcinoma, and 1 (2.56%) was a colloid goiter, a non-neoplastic condition. Factors associated with RLN palsy included central neck dissection (2 cases; 5.13%), lateral neck dissection, non-tracing of the RLN (3 cases; 7.69%), and reoperation (3 cases; 7.69%).
Conclusion: RLN palsy remains a significant postoperative risk in thyroid surgery, especially in cases involving malignancy, neck dissections, reoperations, or failure to trace the nerve. Identifying these factors can help improve surgical strategies and reduce nerve injury rates.
Bangladesh J Otorhinolaryngol 2026; 32(1): 39-47
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