ISPUB.COM The Internet Journal of Surgery Volume 20 Number 1 1 of 4 Incidence Of Recurrent Laryngeal Nerve Palsy With And Without Nerve Identification During Thyroid Surgery V Yagnik, M Mehta Citation V Yagnik, M Mehta. Incidence Of Recurrent Laryngeal Nerve Palsy With And Without Nerve Identification During Thyroid Surgery. The Internet Journal of Surgery. 2008 Volume 20 Number 1. Abstract Background: Recurrent laryngeal nerve paralysis is one of the most frequent and serious complications after thyroid operation. Routine dissection and demonstration of the recurrent nerve remain controversial. To know the risk of damage of the recurrent laryngeal nerve, a prospective study was done randomly in 50 patients.Material and method: Fifty consecutive patients underwent thyroidectomy. Only patients with normal vocal cords were included in the study. Patients were allocated to two groups randomly, in group (a) the nerve was not identified and in group (b) the nerve was identified.Results: There were 29 unilateral and 21 bilateral operations performed, with 71 nerves at risk. Out of these 50 operations, 4 patients in the group without nerve identification developed nerve palsy (16%) but the percentage of nerves injured was 2.84%.Conclusions: Careful dissection of the nerve during surgery essentially eliminates the risk of nerve injury during surgery. INTRODUCTION Recurrent laryngeal nerve paralysis is one of the most frequent and serious complications after thyroid operation. Routine dissection and demonstration of the recurrent nerve remain controversial. The most important aspect of an effective and safe surgical approach is a vast knowledge of surgical anatomy and pathophysiology in combination with meticulous handling and dissection of tissue. There is an inverse relationship between the number of thyroid surgeries performed and complication rate. This complication rate can be minimized in surgical novices by accurate anatomical knowledge and meticulous surgical technique .As with all surgical techniques, since Hippocrates, both sides of the coin are to be evaluated; here also an attempt is made to evaluate the complication rates and their consequences, if the recurrent laryngeal nerve is identified during surgery. Permanent nerve palsy is cited in the literature to occur in 0% to 2.1%, with an average of approximately 0.5% to 1%. Temporary palsy varies from 2.9% to over 10%. The right- sided nerve is at higher risk due to its wide anatomical variation as compared to the left one. Aims and objective of study. 1) To assess the risk of damage of the recurrent laryngeal nerve during thyroidectomy. 2) To know the merits of one technique over the other and thus to reduce morbidity by coming up with a better technique with lesser morbidity. METHOD In a prospective study, 50 patients who underwent thyroid surgeries for various thyroid pathologies from January 2002 to October 2004 were analysed for RLN palsy at MP Shah Medical College, Jamnagar. Surgeries were performed by surgeons qualified in doing thyroid surgery. All patients were subjected to pre-operative indirect laryngoscopy (IDL) to asses the status of the vocal cords. Only patients with normal vocal cords were included in the study. Patients with evidence of pre-existing RLN palsy were rejected. The patients were allocated randomly in 2 groups (a) surgery performed without tracing the nerve (b) surgery performed with tracing the nerve. All patients were subjected to thyroidectomy under GA with endotracheal intubation. RLN was identified by standard surgical technique, traced and due care taken to avoid damage in group (b) .Suspected nerve injuries were documented during the operations. Immediate post-operative direct laryngoscopy was performed by a surgeon with the help of an anesthesiologist for the assessment of vocal cords. Unilateral post-operative RLN palsy was defined as a paralyzed vocal cord with loss of movement from the midline. Patients with nerve palsy were followed by a general surgeon and ENT surgeon until full recovery. Follow-up IDL was done on the 5 th post-operative day, and at the end of the 1st and 3rd month. The palsy was considered permanent if it persist for 6 months.