STUDY ON THE EFFECT OF RECURRENT LARYNGEAL NERVE IDENTIFICATION TECHNIQUE IN THYROIDECTOMY ON RECURRENT LARYNGEAL NERVE PARALYSIS AND HYPOPARATHYROIDISM

DR.K.VIJAY BABU; DR.S.NARESHKUMAR

Volume : V, Issue : X, October - 2016

STUDY ON THE EFFECT OF RECURRENT LARYNGEAL NERVE IDENTIFICATION TECHNIQUE IN THYROIDECTOMY ON RECURRENT LARYNGEAL NERVE PARALYSIS AND HYPOPARATHYROIDISM

Dr. K. Vijay Babu, Dr. S. Nareshkumar

Abstract :

AIMS AND OBJECTIVES 1. To study the correlation between the technique of recurrent laryngeal nerve identification i.e superiorinferior OR inferior–superior during thyroidectomy and post operative RLN paralysis. 2. To study the incidence of hypoparathyroidism in relation to the technique of identification of RLN . 3. To study the predictive value of i–PTH in predicting the hypocalcemia in post operative period following total thyroidectomy. MATERIAL AND METHODS This is a prospective study, including all patients who underwent thyroid surgery in the Department of General Surgery & ENT in Gandhi Hospital, Secunderabad and in Government ENT Hospital, Koti from July 2012 to October 2012. The study included 96 patients who underwent surgery for thyroid disorders between July 2012 and October 2012. Patients with multinodular goiter, uninodular goiter, thyroid cancer, thyroiditis, and recurrent goiter were included in the study. RESULTS Thisis a prospectivestudy, including all the patients who underwentsurgery forthyroid disordersfrom July 2012 to October 2012. The cases were taken from the Department of General Surgery & ENT , Gandhi Hospital and Government ENT Hospital, Koti. The patients were separated in to 2 groups according to the RLN identification technique. The first group included thyroidectomies performed in a superior– inferior direction by fixing the nerve where it enters into the larynx, followed by superior pedicle ligation. Thesecond group included thyroidectomies performed in an inferior–superior direction , following inferior pedicleligation and determination of the nerve in the tracheoesophageal groove. Post operative RLN paralysis was observed in 2 patients. None of the patients developed post op hemorrhage or wound infection. Hypocalcemia was observed in 4 patients out of 12 operated cases. Out of these patients in 3 cases total serum calcium level was lower than 8.0mg/dl In the group of patients with hypocalcemia the average level if i–PTH 1 hr after surgery was 12.33pg/ml. average level of serum calcium after 24 hr was 7.53 mg/dl CONCLUSION 1. Different techniques are followed by different surgeons for identification of recurrent laryngeal nerve during thyroidectomy. The superior–inferior technique has least incidence of RLN injury (nil in our study). Hence superior–inferior technique is recommended for identification of RLN during thyroidectomy. 2. The Superior – Inferior technique for identification of RLN prevents post op hypoparathyroidism.