Frequency of Recurrent Laryngeal Nerve Palsy with Routine Nerve Identification in Benign Thyroid Surgeries

Background: Goiter is a global health issue. A small goiter with normal thyroid function tests does not require treatment. The size of a large euthyroid goiter may be reduced by thyroxine suppressive therapy. The study aimed to determine the frequency of recurrent laryngeal nerve (RLN) injury through routine visual identification during thyroidectomy and to provide a foundation for developing advanced identification methods. Methods: This cross-sectional survey was conducted at the General Surgery Department of Fauji Foundation Rawalpindi from July 2022 to June 2023. The study included 241 patients with benign thyroid disorders requiring thyroidectomy. Non-probability consecutive technique was used for sampling. All patients underwent fiber-optic direct laryngoscopy (FODL) before surgery to assess the preoperative RLN status. Patients showing improvement on follow-up laryngoscopy were classified as having transient recurrent laryngeal nerve palsy, while those with persistent abnormal vocal cord mobility even after 6 months were classified as having permanent RLN palsy. Data was analyzed using SPSS version 25. Qualitative and quantitative variables were expressed as percentages/frequencies and mean±SD. Effect modifiers were controlled by stratification and p value <0.05 considered as significant. Results: The average age of the patients was 50.67±9.06 years. There were 73 (30.29%) males and 168 (69.71%) females. After 24 hours post-surgery, the RLN injury rate in endoscopic thyroidectomy was 1.2%. At 3 months, the injury rate increased to 3.7%, and after 6 months, it was 2.1%. Stratification analysis reflected that among all the study confounders, statistically significant association (p<0.05) for was noted for size of goiter only. Conclusion: In this study, RLNP during thyroidectomy was identified in 1.2% of patients after 24 hours, 3.7% at 3 months, and 2.1% after 6 months. This comprehensive analysis of RLN injury can inform discussions during informed consent and assist surgeons in identifying candidates at higher risk for injury.