Options to enhance voice quality during and after thyroidectomy

Quality of voice after thyroidectomy remains the main concerns both for surgeons and patients. Injury of the recurrent laryngeal nerve or the external branch of the superior laryngeal nerve may lead to serious voice alteration and dysphonia. On the other hand, patients may complain of voice problems without direct injury to the nerve, which may be considered as a post-thyroidectomy syndrome. Regarding nerve injury during thyroidectomy, intraoperative neuromonitoring is helpful to identify, preserve and prognosticate the nerve function. In cases when the nerve is sacrificed (or resected), reinnervation may help to improve postoperative vocal function. If postoperative vocal fold paralysis is identified, early identification and management is mandatory. Injection laryngoplasty and laryngeal framework surgery may be required as appropriate. Early rehabilitation and voice therapy has demonstrated better post-thyroidectomy vocal outcomes. Feasibility of innovative strategies of managing nerve injury include nerve guiding conduit, bioengineering scaffold, neurostimulation and cell/gene therapy. In this review article, up-to-date options to enhance post-thyroidectomy vocal outcomes will be summarized.