A case of bilateral recurrent laryngeal nerve palsy after thyroid surgery under intraoperative nerve monitoring

: A 66-year-old woman suffering from Basedow disease had total thyroidectomy under intraoperative monitoring (IOM) of recurrent laryngeal nerve (RLN) using Medtronic Xomed Nerve Integrity Monitor-2 (Medotronic, Mineapolice, Minesota, USA). IOM indicated a positive signal for her right RLN while the signal for her left RLN disappeared during the operation. During the surgery, surgeons identified her left RLN which was anatomically intact. During the attempted extubation of the endotracheal tube, the patient experienced severe dyspnea resulting in re-intubation. Fiber-optic examination revealed bilateral vocal cord immobility. On POD3, dysfunction of her vocal cord continued, therefore, she had tracheotomy With long-term follow up, her vocal cord function returned to normal on POD37 and tracheotomy tube was removed. In conclusion, positive signals of IOM are not always correlated with proper function of vocal cord. Therefore, respiratory condition should be carefully observed during postoperative period.