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- Title
Is There Any Reliable Predictor of Functional Recovery Following Post-thyroidectomy Vocal Fold Paralysis?
- Authors
Revelli, Luca; Gallucci, Pierpaolo; Marchese, Maria Raffaella; Voloudakis, Nikolaos; Di Lorenzo, Sofia; Montuori, Claudio; D'Alatri, Lucia; Pennestri, Francesco; De Crea, Carmela; Raffaelli, Marco
- Abstract
Background: Predicting definitive outcomes of post-thyroidectomy vocal fold paralysis (VFP) is challenging. We aimed to identify reliable predictors based on intraoperative neuromonitoring (IONM) and flexible fiberoptic laryngostroboscopy (FFL) findings. Methods: Among 1172 thyroid operations performed from April to December 2021, all patients who exhibited vocal fold paralysis (VFP) at post-operative laryngoscopy were included. IONM data, including type of loss of signal (LOS), were collected. Patients underwent FFL, with arytenoid motility assessment, at 15, 45 and 120 days post-operatively. Patients were divided into two groups: those who recovered vocal fold motility (VFM) by the 120th post-operative day (recovery group) and those who did not (non-recovery group). Results: Fifty-nine VFP cases (5.0% of total patients) met the inclusion criteria. Eight patients were lost at follow-up and were excluded. Overall, 9 patients were included in the non-recovery group (0.8% of total patients) and 42 in the recovery group. Among various predictive factors, only arytenoid fixation (AF) at the 15th post-operative day and Type I LOS were significant predictors for no VFM recovery (p = 0.007, RR = 9.739, CI:1.3–72.3 and p = 0.001, RR = 9.25, CI:2.2–39.3 for AF and Type I injury, respectively). The combination of type of LOS and arytenoid motility at the 15th post-op day yielded satisfactory predictive values for the progression of transient VFP to permanent. Conclusions: Arytenoid motility at the 15th post-op day and type II LOS are associated with recovery of VFM. Type of LOS and FFL could be included in the follow-up protocols of patients with VFP to reliably predict clinical outcomes.
- Subjects
VOCAL cords; THYROIDECTOMY; PARALYSIS
- Publication
World Journal of Surgery, 2023, Vol 47, Issue 2, p429
- ISSN
0364-2313
- Publication type
Article
- DOI
10.1007/s00268-022-06765-w