TY - JOUR
T1 - Risk factors for thyroid surgery–related unilateral vocal fold paralysis
AU - Chen, Hung Chun
AU - Pei, Yu Cheng
AU - Fang, Tuan Jen
N1 - Publisher Copyright:
© The Authors. The Laryngoscope published by Wiley Periodicals, Inc. on behalf of The American Laryngological, Rhinological and Otological Society, Inc.
PY - 2019/1
Y1 - 2019/1
N2 - Objectives/Hypothesis: We aimed to identify the risk factors for iatrogenic unilateral vocal fold paralysis (UVFP) caused by thyroid surgery, to allow the identification of patients requiring nerve-protection procedures and monitoring technologies. Study Design: Retrospective case study in a medical center. Methods: Patients who underwent thyroid surgery from April 2011 to February 2016 and who were diagnosed with UVFP by laryngoscopy and laryngeal electromyography were included. Patient demographics, types of surgery, and characteristics of the thyroid lesions were analyzed. Results: Sixty (2.1%) of 2,815 patients who received thyroid surgery developed UVFP. The risk of UVFP was higher in patients over 60 years old (odds ratio, 1.89; 95% confidence interval, 1.01-3.26; P =.01). Involvement of the external branch of superior laryngeal nerve (EBSLN) occurred in 19 (31.7%) of the 60 UVFP patients, and was more likely to occurr in patients with diabetes mellitus (odds ratio, 14.19; 95% confidence interval, 3.80-52.94; P <.001). The incidence of UVFP and involvement of the EBSLN differed among surgery types, and was the highest among patients undergoing total thyroidectomy with neck dissection (TTND) (10/158, 6.3% and 5/158, 3.2%, respectively). Conclusions: The risk of thyroid surgery–related UVFP is higher in older patients. EBSLN involvement is more likely in patients with diabetes mellitus. TTND is associated with higher risks of UVFP and EBSLN injury than other types of surgery, implying the need of intraoperative nerve monitoring in these high-risk characteristics. Level of Evidence: 4 Laryngoscope, 129:275–283, 2019.
AB - Objectives/Hypothesis: We aimed to identify the risk factors for iatrogenic unilateral vocal fold paralysis (UVFP) caused by thyroid surgery, to allow the identification of patients requiring nerve-protection procedures and monitoring technologies. Study Design: Retrospective case study in a medical center. Methods: Patients who underwent thyroid surgery from April 2011 to February 2016 and who were diagnosed with UVFP by laryngoscopy and laryngeal electromyography were included. Patient demographics, types of surgery, and characteristics of the thyroid lesions were analyzed. Results: Sixty (2.1%) of 2,815 patients who received thyroid surgery developed UVFP. The risk of UVFP was higher in patients over 60 years old (odds ratio, 1.89; 95% confidence interval, 1.01-3.26; P =.01). Involvement of the external branch of superior laryngeal nerve (EBSLN) occurred in 19 (31.7%) of the 60 UVFP patients, and was more likely to occurr in patients with diabetes mellitus (odds ratio, 14.19; 95% confidence interval, 3.80-52.94; P <.001). The incidence of UVFP and involvement of the EBSLN differed among surgery types, and was the highest among patients undergoing total thyroidectomy with neck dissection (TTND) (10/158, 6.3% and 5/158, 3.2%, respectively). Conclusions: The risk of thyroid surgery–related UVFP is higher in older patients. EBSLN involvement is more likely in patients with diabetes mellitus. TTND is associated with higher risks of UVFP and EBSLN injury than other types of surgery, implying the need of intraoperative nerve monitoring in these high-risk characteristics. Level of Evidence: 4 Laryngoscope, 129:275–283, 2019.
KW - Unilateral vocal fold paralysis
KW - external branch of superior laryngeal nerve
KW - intraoperative nerve monitoring
KW - laryngeal electromyography
KW - thyroid surgery
UR - http://www.scopus.com/inward/record.url?scp=85054330990&partnerID=8YFLogxK
U2 - 10.1002/lary.27336
DO - 10.1002/lary.27336
M3 - 文章
C2 - 30284255
AN - SCOPUS:85054330990
SN - 0023-852X
VL - 129
SP - 275
EP - 283
JO - Laryngoscope
JF - Laryngoscope
IS - 1
ER -