The utility of surgeon performed transcutaneous laryngeal ultrasound for the assessment of vocal cords in post-thyroidectomy patients
DOI:
https://doi.org/10.18203/2349-2902.isj20184615Keywords:
Surgeon performed ultrasound, Thyroidectomy, Video laryngoscopy, Vocal cord palsyAbstract
Background: Post-thyroidectomy vocal cord palsy is a significant procedure associated complication and a notable contributor for medico-legal litigation. The standard technique for vocal cord evaluation and the most commonly used tool is direct laryngoscopy. Endocrine surgeons generally address the patients to otolaryngologist for laryngoscopy, leading to extra expense and time loss. Laryngoscopy causes patient annoyance and could potentially contribute to poor patient compliance. Ultrasonography is a non-invasive technique that is regularly used by endocrine surgeons to examine the thyroid region.
Methods: A prospective study conducted on patients who underwent thyroidectomy between September 2016 and August 2017 at endocrine surgery department in a tertiary care institute (South India), Surgeon performed ultrasound (SPU) and Video laryngoscopy (VDL) was performed before and after elective thyroidectomy.
Results: 155 patients who consented were categorized in the study, 2 of the patients included in the study had preoperative vocal cord palsy and 12 of them had unilateral postoperative vocal cord palsy detected using VDL. In general, the postoperative vocal cord palsy rate was 6.45%. Postoperative SPU was ineffective in assessing vocal cords in 16(10.32%) of patients. SPU had a sensitivity of 83.33% and negative predictive value of 97.90%, for the visualization of vocal cords in the postoperative period.
Conclusions: SPU is convenient and non-invasive technique which could provide our speciality with cheap yet powerful diagnostic tool for vocal cord assessment in post-thyroidectomy patients and can potentially decrease the requirement of difficult and cumbersome VDL.
References
Randolph GW, Kamani D. The importance of preoperative laryngoscopy in patients undergoing thyroidectomy: voice, vocal cord function, and the preoperative detection of invasive thyroid malignancy. Surg. 2006;139(3):357-62.
Ozbas S, Kocak S, Aydintug S, Cakmak A, Demirkiran MA, Wishart GC. Comparison of the complications of subtotal, near total and total thyroidectomy in the surgical management of multiple goiter. Endocr J. 2005;52(2):199-205.
Sugitani I, Fujimoto Y. Symptomatic versus asymptomatic papillary thyroid microcarcinoma: a retrospective analysis of surgical outcome and prognostic factors. Endocr J. 1999;46(1):209-16.
Shaha AR. Routine laryngoscopy in thyroid surgery: a valuable adjunct. Surg. 2007;142(6):865-66.
Paul BC, Rafii B, Achlatis S, Amin MR, Branski RC. Morbidity and patient perception of flexible laryngoscopy. Ann Otol Rhinol Laryngol. 2012;121(11):708-13.
Lang BH, Lee GC, Ng CP, Wong KP, Wan KY, Lo CY. Evaluating the morbidity and efficacy of reoperative surgery in the central compartment for persistent/recurrent papillary thyroid carcinoma. World J Surg. 2013;37(12):2853-59.
Dionigi G, Boni L, Rovera F, Rausei S, Castelnuovo P, Dionigi R. Postoperative laryngoscopy in thyroid surgery: proper timing to detect recurrent laryngeal nerve injury. Langenbecks Arch Surg. 2010;395(4):327-31.
Borel F, Delemazure AS, Espitalier F, Spiers A, Mirallie E. Transcutaneous ultrasonography in early postoperative diagnosis of vocal cord palsy after total thyroidectomy. World J Surg. 2016;40(3):665-71.
Sidhu S, Stanton R, Shahidi S, Chu J, Chew S, Campbell P. Initial experience of vocal cord evaluation using grey-scale, real-time, B-mode ultrasound. ANZ J Surg. 2001;71(12):737-9.
Dedecjus M, Adamczewski Z, Brzezinski J, Lewinski A. Real-time, high-resolution ultrasonography of the vocal folds-a prospective pilot study in patients before and after thyroidectomy. Langenbecks Arch Surg. 2010;395(7):859-64.
Wong KP, Lang BH, Ng SH, Cheung CY, Chan CT, Lo CY. A prospective, assessor blind evaluation of surgeon-performed transcutaneous laryngeal ultrasonography in vocal cord examination before and after thyroidectomy. Surg. 2013;154(6):1158-65.
Cheng SP, Lee JJ, Liu TP, Lee KS, Liu CL. Preoperative ultrasonography assessment of vocal cord movement during thyroid and parathyroid surgery. World J Surg. 2012;36(10):2509-15.
Sabaretnam M, Ramakanth P, Abraham DT, Paul MJ. Preoperative ultrasonography assessment of vocal cord movement during thyroid and parathyroid surgery. World J Surg. 2013;37(7):1740.
Wang CP, Chen TC, Yang TL, Chen CN, Lin CF, Lou PJ, et al. Transcutaneous ultrasound for evaluation of vocal fold movement in patients with thyroid disease. Eur J Radiol. 2012;81(3):e288-91.
Rubin AD, Sataloff RT. Vocal fold paresis and paralysis: what the thyroid surgeon should know. Surg Oncol Clin N Am. 2008;17(1):175-96.
Ooi LL. B-mode real-time ultrasound assessment of vocal cord function in recurrent laryngeal nerve palsy. Ann Acad Med Singapore. 1992;21(2):214-6.
Hu Q, Zhu SY, Luo F, Gao Y, Yang XY. High-frequency sonographic measurements of true and false vocal cords. J Ultrasound Med. 2010;29(7):1023-30.
Fukuhara T, Donishi R, Matsuda E, Koyama S, Fujiwara K, Takeuchi H. A novel lateral approach to the assessment of vocal cord movement by ultrasonography. World J Surg. 2018;42(1):130-6.