Prospective evaluation of vocal cord function with intra-operative nerve identification in total thyroidectomy patients.

Kumaran, M P (2013) Prospective evaluation of vocal cord function with intra-operative nerve identification in total thyroidectomy patients. Masters thesis, Madras Medical College, Chennai.


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The recurrent laryngeal nerve and the external branch of the superior laryngeal nerve are at risk of injury during total thyroidectomy. This may result in change of voice post-operatively. The recurrent laryngeal nerve is at particular risk due to its proximity to the inferior thyroid artery and the ligament of Berry. Injury to the recurrent laryngeal nerve may result in dreaded complications like stridor, loss of voice sometimes necessitating tracheostomy as a life saving procedure. One’s voice is one of the integral aspects of one’s identity. Change of voice, to any degree, is not acceptable regardless of whether one is dependent on voice for one’s profession. Post operative voice change is a major concern for the patients undergoing total thyroidectomy as well as for surgeons performing the surgery. This could be mild or it may be severe. While it is often transient, it could be permanent as well. In order to analyze voice change after surgery, an objective method of assessment of the patient’s voice is necessary, which depends on reliable and accurate feedback from the patients. This necessitates a questionnaire, which can be administered to the patients in question. In this respect, compliance of the patients can be ensured with a simple and relatively short questionnaire, which is easy to understand. In addition, the questionnaire should be so constructed as to enable objective assessment of severity of the symptoms. This can be achieved by permitting the patients to grade each voice-related symptom on a simple scale on the basis of severity. Validation of the questionnaire affords credibility to this method of assessment. In the present study, the incidence of transient vocal cord palsy after total thyroidectomy, as evidenced by videolaryngoscopy, was 21%. In about two-thirds of patients, the vocal cords recovered within 6 months of surgery, so that the incidence of permanent vocal cord palsy was 7.6%. With regards to the validated voice assessment score, the score on the 5th post-operative day was invariably higher than that pre-operatively. Vocal cord palsy was associated with a higher score post-operatively. Further, in those patients who had vocal cord palsy and high voice assessment scores on the 5th post-operative day, persistently high scores on the 180th postoperative day and permanent vocal cord palsy were likely. Voice assessment scoring is a reliable, noninvasive method of assessment of vocal cord function, vocal cord palsy and pattern of recovery after thyroidectomy.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Prospective evaluation; vocal cord function; intra-operative nerve identification; total thyroidectomy patients.
Subjects: MEDICAL > Endocrine Surgery
Depositing User: Kambaraman B
Date Deposited: 23 Jun 2017 06:41
Last Modified: 23 Jun 2017 07:26

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