CASE OF THE MONTH

 

PRESENTED BY

THE THYROID SURGERY CENTER OF TEXAS, P.A.

1927 Lohmans Crossing Road, Suite 201, Austin, TX 78734

www.thyroidcancer.com

512-608-9595; Fax-512-608-9833

 

You Have Some Nerve!!!

 

Probably the first concern that pops into the mind of physicians when they hear the word “thyroidectomy” is the risk of damage to the nerves that go to the voice box. There are two main laryngeal nerves, the superior laryngeal nerve, which has an internal branch and an external branch, and the recurrent laryngeal nerve, which controls movement of the vocal cords. The recurrent nerve also has some sensory branches, but it is the hoarseness due to vocal cord dysfunction from recurrent nerve injury that most catches our attention. 

The rate of permanent vocal cord paralysis is low, but in some instances it has been reported as high as 1-3%, or even higher. This is not an acceptable statistic to us, as we believe the nerve injury rate should approach zero if the procedure is done correctly. In teaching thyroidectomy to surgery residents, I have emphasized that the nerve should always be identified before any cutting goes on, and the nerve should be kept in sight throughout the procedure. As a young surgeon, it simply occurred to me that if I didn’t cut anything before finding and preserving the nerve, nerve injury would be avoided. I was correct.

There is some biotech equipment available today that can be used for what is called “intraoperative nerve monitoring”, and it is said that this may reduce the likelihood of nerve injury. This approach is probably a good one if referral of the patient to a more senior colleague is not possible. Still others would say that if you do not know where the nerve is, you should not be doing the operation. I won’t get into that debate, and my office will simply continue to use our nerve identification technique that has produced near perfect results in our office since 1949, through many, many thousands of thyroid operations. 

On the next page are some photos of recurrent laryngeal nerves. They are all under direct visualization throughout the procedure. I hope you find this interesting.

 

 

 

 

“…Thyroid surgery…it’s all we do…”