Recurrent Laryngeal Nerve Palsy Following Thyroid Surgery: A Retrospective Analysis of 100 Cases

Abstract

Introduction: Recurrent laryngeal nerve paralysis is one of the most feared complications of thyroid surgery due to its functional repercussions on phonation, respiration, and patients quality of life. Despite advances in surgical techniques and improved anatomical knowledge, the risk of nerve injury persists. The objective of this study was to assess the frequency of recurrent laryngeal nerve palsy after thyroid surgery and to identify factors that may influence its occurrence.

Materials and Methods: This was a retrospective study conducted in the ENT head and neck surgery department in 20 august hospitals involving 100 patients operated for thyroid pathology. Demographic, clinical, surgical, and outcome data were collected from medical records and direct patient interviews. All patients underwent laryngeal assessment by nasofibroscopy, allowing analysis of vocal cord mobility at rest and during phonation. Data were analyzed using SPSS software.

Results: The study population was predominantly female (84%) with a mean age of 50 years. Total thyroidectomy was the most frequently performed procedure (80% of cases). Histopathological examination revealed benign pathology in 55% of cases and malignant pathology in 45% of cases, predominantly papillary carcinoma. Vocal cord paralysis was observed in 8% of patients. Involvement was predominantly right-sided (75%) and remained asymptomatic in nearly half of cases. Postoperative dysphonia was the main clinical symptom. Analysis of associated factors showed a higher frequency in patients with malignant pathology and in procedures performed in a training context.

Discussion: Recurrent laryngeal nerve palsy remains a significant complication of thyroid surgery, with variable incidence in the literature. In our series, the observed rate remains comparable to that reported in several international studies. The occurrence of this complication depends on multiple factors, including the extent of surgery, the nature of the thyroid pathology, and surgeon experience. Systematic identification of the recurrent laryngeal nerve and mastery of surgical technique are essential elements for reducing the risk of nerve injury.