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Best Pract Res Clin Endocrinol Metab. 2019 Jun 4. pii: S1521-690X(19)30031-4. doi: 10.1016/j.beem.2019.05.006. [Epub ahead of print]

Surgical management of the compromised recurrent laryngeal nerve in thyroid cancer.

Author information

1
Department of Otolaryngology - Head and Neck Surgery, University of California, San Francisco, San Francisco, CA, USA. Electronic address: Marika.Russell@ucsf.edu.
2
Division of Thyroid and Parathyroid Surgery, Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA. Electronic address: Dipti_Kamani@meei.harvard.edu.
3
Division of Thyroid and Parathyroid Surgery, Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA; Division of Surgical Oncology, Endocrine Surgery Service, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: Gregory_Randolph@meei.harvard.edu.

Abstract

Surgical management of thyroid cancer requires careful consideration of the recurrent laryngeal nerve and its impact on glottic function. Management of the compromised recurrent laryngeal nerve is a complex task, requiring synthesis of multiple elements. The surgeon must have an appreciation for preoperative recurrent laryngeal nerve function, intraoperative anatomic and electromyographic information, disease characteristics, and relevant patient factors. Preoperative clinical evaluation including preoperative laryngoscopy and assessment of recurrent laryngeal nerve risk is essential to formulating a surgical plan and providing appropriate patient counseling. Intraoperative neuromonitoring information has significant implications for surgical management of the injured or invaded recurrent laryngeal nerve and informs strategy with respect to staging of bilateral surgery. Disease characteristics and patient-related factors, including patient preference, must be considered with intraoperative decision-making. Multidisciplinary discussion and patient communication are essential for effective management and successful surgical outcome.

KEYWORDS:

bilateral surgery; neuromonitoring; recurrent laryngeal nerve; thyroid cancer; thyroidectomy; vocal cord paralysis

PMID:
31230919
DOI:
10.1016/j.beem.2019.05.006

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