checking vocal cords after thyroid surgery

[Russell Coupland]

I have an old-fashioned surgeon who likes me to check the patient's vocal cords after thyroid and parathyroid surgery to look for recurrent laryngeal nerve palsy. Despite having done this list for many years, I am yet to find a consistently successful way fo doing this.

The techniques that I use are:
1. Pull the ETT while the patient is deeply anesthetized and look using direct laryngoscopy.
2. Insert laryngoscope as the patient emerges, and when they are ready to extubate, pull ETT while looking at cords.
3. replace ETT with LMA while patient is deep and check crods with a fibreoptic bronchoscope.

None of these works all the time, and I am too often reassuring my surgeon despite NOT having had a good look at the cords.

Any other suggestions?

[Igor Bulatov]

Any reason not to use an LMA for  para/thyroid surgery with fiberoptic scope attached to the camera with monitor visible to the surgeon.Scope could be inserted via regular bronchoscopy side port with  patient spontaneously breathing.Any damage to recurrent nerve vould be visible to you and surgeon immediately.

[princessnicole03]

Thyroid surgery is frequently used to treat thyroid cancer and is sometimes the preferred approach to dealing with goiter, nodules or an overactive thyroid. That is why it is require to check the vocal cords after thyroid surgery.



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International medical insurance

[jafo1964]

Checking vocal cords after thyroid surgery was a routine
Its usefulness and validity are under question now

Cord injuries seen immediately after sugery may be transient neuropraxia due to edema around nerve during surgery. These can change dramatically
Also the same edema induced neuropraxia related cord dysfunction have been known to occur as late as 24 hours after checking them post-surgically and finding them to be normal

The more important factor seems to be that laryngoscopy during recovery may produce 2 things

1. Hypertension due to sympathetic stimulation that can increase reactionary and secondary haemorrhage and hence risk of post-op heamatoma and airway compromise
2. Layrngoscopy may induce laryngospasm in a patient not fully recovered from the residual effect of anesthetics


So what is recommended instead

Ensure adequate recovery
Adequately suction oropharynx
Deflate cuff
Demonstrate " Breathing around the ETT
Extubate over AEC
IF stridor is seen reintubate and leave ETT in situ

If no stridor seen after extubation
Ask patient to phonate
If phonation is OK patient should do OK
If phonation is absent no need to reintubate but oral feeding not to be started until ENT clearance

All cases of suspected cord problem can be referred to ENT for adequate evaluation using videolaryngoscopy and further management

with regs

[Dr. Mian]

I agree more or less with jafo although I think that may even be excessive and would put most of the emphasis on phonation (classically saying EEEE); as a patient who is able to do that would have almost no chance of either recurrent laryngeal nerve palsy.