Surgery Trauma Surgery in the Neck

Thyroid Factor

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Thyroid Surgery

The close anatomical relationship of both the recurrent and superior laryngeal nerves with the blood vessels supplying the thyroid gland represents a well-recognized challenge to surgeons. Vocal fold paralysis does not result only from nerve section but also from nerve manipulation, sometimes minor; a paralyzed vocal fold has surprised many an experienced thyroid surgeon who is certain that nerve has been left intact.

In recent series, the number of patients experiencing temporary vocal fold dysfunction following thyroidectomy varies from 1.0 to 5.1%, and permanent paralysis from o to 5.8%, with most series reporting less than 3%, and in some cases less than 1% (Table 3.7). If this is judged as a percentage of nerves at risk rather than patients, a common means of tabulating this complication, the incidence may be up to 50% lower depending on the proportion of patients undergoing total thyroidectomy. Principal vari-

Table 3.5. Surgical causes of unilateral vocal fold paralysis. A CSS anterior cervical spine surgery



Surgical Cause (%)

Number Thyroid and of Cases parathyroid

ACSS Carotid

Other cervical



Thoracic and mediastinal



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