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
...branches of RLN and SLNFrom Randolph GW, ed. Su...
Relationship of RLN and SLN to thyroid lobe and tracheoesphageal groove
...ationship of RLN and SLN to thyroid lob...
Variations of nonrecurrent recurrent laryngeal nerve
...nrecurrent recurrent laryngeal nerve...
Diagnosis
...gnosis...
...ey Action State...
...reoperative Management
...VOICE ASSESSMENT:The surgeon should document...
...LARYNGEAL ASSESSMENT OF THE IMPAIRE...
...PERATIVE LARYNGEAL ASSESSMENT OF THE NON...
...N ON VOICE OUTCOMES:The clinician should educ...
...ON WITH ANESTHESIOLOGIST:The surgeon shoul...
...le 1. Preoperative Voice Assessment ChartHaving tr...
...ssion Points for the Surgeon/Patient EducatorHa...
...Preoperative Factors that May Be Associated wi...
Treatment
...eatment...
Key Action Stat...
...FYING RLN:The surgeon should identify...
...ION OF SLN:The surgeon should take steps to pres...
...AOPERATIVE EMG MONITORING:The surgeon...
...RATIVE CORTICOSTEROIDS:No recommendation c...
...ERATIVE VOICE ASSESSMENT:The surgeon s...
...ERATIVE LARYNGEAL EXAMINATION:Clinicians shoul...
...ARYNGOLOGY REFERRAL:The clinician should ref...
...OICE REHABILITATION:Clinicians sho...
Table 4. Causes of Thyroidectomy-related Dysphonia
...e 4. Causes of Thyroidectomy-related D...
Table 5. Discussion Points for a Patient Who Has Voice Changes After Thyroidectomy
...cussion Points for a Patient Who Has Voice...