How the Severity and Mechanism of Recurrent Laryngeal Nerve Dysfunction during Monitored Thyroidectomy Impact on Postoperative Voice

Intraoperative neuromonitoring can qualify and quantify RLN function during thyroid surgery. This study investigated how the severity and mechanism of RLN dysfunction during monitored thyroid surgery affected postoperative voice. This retrospective study analyzed 1021 patients that received standard...

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Autores principales:	Tzu-Yen Huang, Wing-Hei Viola Yu, Feng-Yu Chiang, Che-Wei Wu, Shih-Chen Fu, An-Shun Tai, Yi-Chu Lin, Hsin-Yi Tseng, Ka-Wo Lee, Sheng-Hsuan Lin
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	recurrent laryngeal nerve (RLN) intraoperative neuromonitoring (IONM) severity and mechanism of RLN dysfunction postoperative voice index of voice and swallowing handicap of thyroidectomy (IVST) Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
Acceso en línea:	https://doaj.org/article/726517fbbc3d49f08539bf848369f381
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spelling	oai:doaj.org-article:726517fbbc3d49f08539bf848369f3812021-11-11T15:29:40ZHow the Severity and Mechanism of Recurrent Laryngeal Nerve Dysfunction during Monitored Thyroidectomy Impact on Postoperative Voice10.3390/cancers132153792072-6694https://doaj.org/article/726517fbbc3d49f08539bf848369f3812021-10-01T00:00:00Zhttps://www.mdpi.com/2072-6694/13/21/5379https://doaj.org/toc/2072-6694Intraoperative neuromonitoring can qualify and quantify RLN function during thyroid surgery. This study investigated how the severity and mechanism of RLN dysfunction during monitored thyroid surgery affected postoperative voice. This retrospective study analyzed 1021 patients that received standardized monitored thyroidectomy. Patients had post-dissection RLN(R2) signal <50%, 50–90% and >90% decrease from pre-dissection RLN(R1) signal were classified into Group A-no/mild, B-moderate, and C-severe RLN dysfunction, respectively. Demographic characteristics, RLN injury mechanisms(mechanical/thermal) and voice analysis parameters were recorded. More patients in the group with higher severity of RLN dysfunction had malignant pathology results (A/B/C = 35%/48%/55%, <i>p</i> = 0.017), received neck dissection (A/B/C = 17%/31%/55%, <i>p</i> < 0.001), had thermal injury (<i>p</i> = 0.006), and had asymmetric vocal fold motion in long-term postoperative periods (A/B/C = 0%/8%/62%, <i>p</i> < 0.001). In postoperative periods, Group C patients had significantly worse voice outcomes in several voice parameters in comparison to Group A/B. Thermal injury was associated with larger voice impairments compared to mechanical injury. This report is the first to discuss the severity and mechanism of RLN dysfunction and postoperative voice in patients who received monitored thyroidectomy. To optimize voice and swallowing outcomes after thyroidectomy, avoiding thermal injury is mandatory, and mechanical injury must be identified early to avoid a more severe dysfunction.Tzu-Yen HuangWing-Hei Viola YuFeng-Yu ChiangChe-Wei WuShih-Chen FuAn-Shun TaiYi-Chu LinHsin-Yi TsengKa-Wo LeeSheng-Hsuan LinMDPI AGarticlerecurrent laryngeal nerve (RLN)intraoperative neuromonitoring (IONM)severity and mechanism of RLN dysfunctionpostoperative voiceindex of voice and swallowing handicap of thyroidectomy (IVST)Neoplasms. Tumors. Oncology. Including cancer and carcinogensRC254-282ENCancers, Vol 13, Iss 5379, p 5379 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	recurrent laryngeal nerve (RLN) intraoperative neuromonitoring (IONM) severity and mechanism of RLN dysfunction postoperative voice index of voice and swallowing handicap of thyroidectomy (IVST) Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
spellingShingle	recurrent laryngeal nerve (RLN) intraoperative neuromonitoring (IONM) severity and mechanism of RLN dysfunction postoperative voice index of voice and swallowing handicap of thyroidectomy (IVST) Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282 Tzu-Yen Huang Wing-Hei Viola Yu Feng-Yu Chiang Che-Wei Wu Shih-Chen Fu An-Shun Tai Yi-Chu Lin Hsin-Yi Tseng Ka-Wo Lee Sheng-Hsuan Lin How the Severity and Mechanism of Recurrent Laryngeal Nerve Dysfunction during Monitored Thyroidectomy Impact on Postoperative Voice
description	Intraoperative neuromonitoring can qualify and quantify RLN function during thyroid surgery. This study investigated how the severity and mechanism of RLN dysfunction during monitored thyroid surgery affected postoperative voice. This retrospective study analyzed 1021 patients that received standardized monitored thyroidectomy. Patients had post-dissection RLN(R2) signal <50%, 50–90% and >90% decrease from pre-dissection RLN(R1) signal were classified into Group A-no/mild, B-moderate, and C-severe RLN dysfunction, respectively. Demographic characteristics, RLN injury mechanisms(mechanical/thermal) and voice analysis parameters were recorded. More patients in the group with higher severity of RLN dysfunction had malignant pathology results (A/B/C = 35%/48%/55%, <i>p</i> = 0.017), received neck dissection (A/B/C = 17%/31%/55%, <i>p</i> < 0.001), had thermal injury (<i>p</i> = 0.006), and had asymmetric vocal fold motion in long-term postoperative periods (A/B/C = 0%/8%/62%, <i>p</i> < 0.001). In postoperative periods, Group C patients had significantly worse voice outcomes in several voice parameters in comparison to Group A/B. Thermal injury was associated with larger voice impairments compared to mechanical injury. This report is the first to discuss the severity and mechanism of RLN dysfunction and postoperative voice in patients who received monitored thyroidectomy. To optimize voice and swallowing outcomes after thyroidectomy, avoiding thermal injury is mandatory, and mechanical injury must be identified early to avoid a more severe dysfunction.
format	article
author	Tzu-Yen Huang Wing-Hei Viola Yu Feng-Yu Chiang Che-Wei Wu Shih-Chen Fu An-Shun Tai Yi-Chu Lin Hsin-Yi Tseng Ka-Wo Lee Sheng-Hsuan Lin
author_facet	Tzu-Yen Huang Wing-Hei Viola Yu Feng-Yu Chiang Che-Wei Wu Shih-Chen Fu An-Shun Tai Yi-Chu Lin Hsin-Yi Tseng Ka-Wo Lee Sheng-Hsuan Lin
author_sort	Tzu-Yen Huang
title	How the Severity and Mechanism of Recurrent Laryngeal Nerve Dysfunction during Monitored Thyroidectomy Impact on Postoperative Voice
title_short	How the Severity and Mechanism of Recurrent Laryngeal Nerve Dysfunction during Monitored Thyroidectomy Impact on Postoperative Voice
title_full	How the Severity and Mechanism of Recurrent Laryngeal Nerve Dysfunction during Monitored Thyroidectomy Impact on Postoperative Voice
title_fullStr	How the Severity and Mechanism of Recurrent Laryngeal Nerve Dysfunction during Monitored Thyroidectomy Impact on Postoperative Voice
title_full_unstemmed	How the Severity and Mechanism of Recurrent Laryngeal Nerve Dysfunction during Monitored Thyroidectomy Impact on Postoperative Voice
title_sort	how the severity and mechanism of recurrent laryngeal nerve dysfunction during monitored thyroidectomy impact on postoperative voice
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/726517fbbc3d49f08539bf848369f381
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How the Severity and Mechanism of Recurrent Laryngeal Nerve Dysfunction during Monitored Thyroidectomy Impact on Postoperative Voice

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