Sensitivity and Specificity of Intraoperative Recurrent Laryngeal Nerve Stimulation Test for Predicting Vocal Cord Palsy after Thyroid Surgery |
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Authors: | Chisato Tomoda MD Yoshihiro Hirokawa MD Takashi Uruno MD Yuuki Takamura MD Yasuhiro Ito MD Akihiro Miya MD Kaoru Kobayashi MD Fumio Matsuzuka MD Kanji Kuma MD Akira Miyauchi MD |
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Institution: | (1) Kuma Hospital, 8-2-35 Shimoyamate-dori, Chuo-ku Kobe, 650-0011, Japan |
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Abstract: | INTRODUCTION Recurrent laryngeal nerve (RLN) palsy after thyroidectomy, although infrequently encountered, can decrease quality of life.
In addition to the hoarseness that occurs with unilateral RLN palsy, bilateral RLN palsy leads to dyspnea and often to life-threatening
glottal obstruction. Therefore, intraoperative awareness of the nerve’s status is of great importance. This study examined
the sensitivity and specificity of a palpation technique to detect contraction of the posterior cricoarytenoid muscle (PCA)
through the posterior hypopharyngeal wall while the RLN was being stimulated with a disposable nerve stimulator during thyroid
surgery (the laryngeal palpation test) to predict postoperative RLN deficits.
Methods A total of 2197 RLNs in 1376 patients were identified to be at risk of injury during thyroidectomy performed between July
2003 and August 2004. Postoperative RLN integrity was assessed using direct laryngoscopy or laryngofiberoscopy to visualize
vocal fold mobility.
Results Altogether, 76 RLNs failed to elicit a PCA contraction in response to nerve stimulation, and 80 cases of temporary vocal cord
palsy and 21 cases of permanent vocal cord palsy were recognized on postoperative evaluation. For postoperative vocal cord
palsy, the sensitivity and specificity of the laryngeal palpation test were 69.3% and 99.7%, respectively, with a positive
predictive value of 92.1% and negative predictive value of 98.5%. For permanent vocal cord palsy, the sensitivity and specificity
were 85.7% and 97.3%, respectively, with a positive predictive value of 23.7% and negative predictive value of 99.8%.
Conclusions The laryngeal palpation test is not a particularly useful method for predicting the level of RLN function after thyroidectomy.
All patients must be examined postoperatively by direct laryngoscopy or laryngofiberoscopy to check vocal cord mobility. Even
if there is no contraction of the PCA and we detect vocal cord palsy immediately after surgery, vocal cord palsy often recovers
within 1 year when visual preservation of RLN is successful. |
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