Recurrent laryngeal nerve paralysis in patients with papillary thyroid carcinomas: evaluation and management of resulting vocal dysfunction

Abstract 

Background

Recurrent laryngeal nerve paralysis (RLNP) occurs in patients with thyroid malignancy. This study prospectively evaluated vocal function and management outcomes of patients with papillary thyroid carcinomas (PTCs) and RLNP.

Methods

Of 319 PTC patients, 256 underwent total thyroidectomy with or without neck dissection, 42 underwent lobectomy, and 21 underwent reoperation for recurrent cancers. All patients underwent laryngoscopy and vocal function measurements before and after surgery. Patients with RLNP and poor vocal function underwent voice surgery.

Results

Temporary and permanent RLNP rates were 2.8% and .9% at nerve-at-risk–based analysis, respectively. Of 28 patients with tumor invasion of RLN, 14 had preoperative RLNP, with 9 of 14 showing voice changes. RLNP was detected in 9 of 291 (3.1%) patients without documented nerve injury; 8 recovered. Nine of 15 patients with RLN section had poor vocal function, which improved in 8 patients after medialization of the unilateral vocal fold.

Conclusions

Patients with PTC may have vocal dysfunction from cancer or surgery-related RLNP. Vocal evaluation and management may help improve their vocal function, thus enhancing their quality of life.

Keywords: Papillary thyroid carcinoma, Thyroid surgery, Recurrent laryngeal nerve, Paralysis, Voice management