Observational Assessment of Recurrent Laryngeal Nerve Dysfunction and Postoperative Complications Following Thyroidectomy with Intraoperative Nerve Monitoring

Abstract

Background: Recurrent laryngeal nerve dysfunction remains an important complication of thyroidectomy because it may lead to voice change, aspiration, ineffective cough, or airway compromise. Intraoperative nerve monitoring provides real-time functional assessment of the recurrent laryngeal nerve and may assist in identifying patients at risk of postoperative nerve dysfunction.

Aim: To assess recurrent laryngeal nerve dysfunction and postoperative complications following thyroidectomy performed with intraoperative nerve monitoring.

Material and Methods: This prospective observational study included 64 patients undergoing thyroidectomy at a tertiary care hospital. Demographic characteristics, thyroid pathology, type of surgery, intraoperative nerve-monitoring signals, postoperative recurrent laryngeal nerve function, and surgical complications were recorded. Postoperative complications included hypocalcaemia, neck haematoma, seroma, wound infection, respiratory distress, and need for re-exploration. Data were analysed using SPSS version 23.0, and a p-value <0.05 was considered statistically significant.

Results: The mean age was 46.78±12.64 years, and 78.13% of patients were female. Multinodular goitre was the most common diagnosis (43.75%), while total thyroidectomy was performed in 53.13%. Abnormal intraoperative nerve-monitoring signals were observed in 8 patients (12.50%). Postoperative recurrent laryngeal nerve dysfunction occurred in 6 patients (9.38%), including 5 of 8 patients (62.50%) with abnormal signals compared with 1 of 56 patients (1.79%) with normal signals (p<0.001). Reoperative surgery (p=0.009) and retrosternal extension (p=0.044) were significantly associated with RLN dysfunction. Overall hypocalcaemia occurred in 20.31%, with significantly higher occurrence after total, near-total, or completion thyroidectomy (p=0.013).

Conclusion: Intraoperative nerve monitoring was useful for functional assessment of the recurrent laryngeal nerve and abnormal signals were strongly associated with postoperative dysfunction. Reoperative surgery and retrosternal extension increased the risk of RLN dysfunction, while hypocalcaemia remained the most frequent postoperative complication.