Nabanita Mandal1, Atish Haldar2, Ranjan Paul3
BACKGROUND
From the last century to modern days, there has been a paradigm shift in the field
of thyroid surgery. Initially what was a dreadful surgery with multi fold serious
complications, now with the advent of modern surgical technique (bipolar to nerve
monitoring & emerging use of microscope), and better knowledge of anatomy, it
has become one of the most frequently performed surgeries worldwide with very
few complications. In spite of all these, postoperative complications like recurrent
laryngeal nerve (RLN) palsy is still mostly feared by surgeons and still is one of the
most frequent complications.
METHODS
This was a prospective nonrandomised controlled trial conducted among 60 study
participants in the Department of Otorhinolaryngology and Head & Neck Surgery,
of a tertiary care centre in West Bengal from July 2016 to June 2018. In this study
two different surgical techniques were applied in two patient groups. In one group
subcapsular dissection of thyroid gland was done without exploration of recurrent
laryngeal nerve course in neck; and in another group, the complete course of the
aforesaid nerve in the neck was explored and preserved. The postoperative
functional status of RLN was assessed by fibreoptic laryngoscopy immediately after
recovery from anaesthesia and in postoperative follow ups. We wanted to compare
the outcome (in terms of functional status of RLN) in these two groups.
RESULTS
3 patients (10 % cases) of nerve palsy were seen among 30 patients of
subcapsular dissection group, whereas only one case (3.3 %) of nerve palsy was
seen amongst 30 cases of complete exploration of recurrent laryngeal nerve.
CONCLUSIONS
Thyroidectomy with meticulous exploration of the recurrent laryngeal nerve was
found to be a superior method as compared to the subcapsular dissection.
