Reducing the rate of recurrent nerve paralysis by routine exposure of the nerves in thyroid gland operations

UNLABELLED: The retrospective and comparative analysis of 734 benign operations of the thyroid gland during the years 1979-1993 without preparation and 1.022 operations between 1994 and 1996 with routine preparation of the recurrent laryngeal nerve shows a decrease of the permanent palsy rate from 5.99% to 0.88%. In 1996 0.48% pareses (2 cases in 410 operations) were seen. OPERATIVE TECHNIQUE: Before ligature of the blood-vessels at the hilum and before dorsal mobilisation of the thyroid lobe first the inferior thyroid artery and then the recurrent laryngeal nerve are identified which is located distally of the artery at the esophago-tracheal sulcus and is prepared until its entry in the larynx. RECOMMENDATION: We advice routine recurrent laryngeal nerve preparation in any operation of the thyroid gland. However, absolutely necessary is the identification of the nerve in the following situations: 1. Hemithyroidectomy, 2. Exstirpation of dorsal nodules of the hilum, 3. Morbus Basedow, 4. Reoperations, 5. Carcinomas.