Bilateral Vocal Cord Palsy After Thyroid Surgery: What to Expect?

Bilateral Vocal Cord Palsy After Thyroid Surgery: What to Expect?

Purpose: This study aimed to evaluate the natural course of structurally intact bilateral recurrent laryngeal nerve (RLN) injury leading to bilateral vocal cord palsy (VCP) and assess the frequency of the need for tracheostomy following thyroid surgery. Methods: This was a single-institution retrospective review of patients who developed bilateral VCP following open or endoscopic total thyroidectomy between 2003 and 2021. Results: Thirty-four of the 9,066 patients had bilateral RLN injury. Twenty-one patients with structurally intact RLN injuries were included in the study (0.23%): 14 with bilateral vocal cord (VC) paralysis (66.7%) and seven with bilateral VC paresis (33.3%). All patients underwent a total thyroidectomy with central lymph node dissection. The incidence was higher in female patients (66.7%) in their 5th and 6th decade. Final diagnoses included papillary thyroid cancer (52.4%), papillary thyroid microcancer (42.9%), and multinodular goiter (4.8%). The cause of RLN injury was idiopathic in most cases; however, some cases were due to tumor invasion, traction, thermal injury, and traumatic endotracheal intubation. Tracheostomy was required in four patients (19.05%) with bilateral VC paralysis. Complete recovery of the VCs occurred in nine patients (42.9%). In most cases, VC mobility improved within six months. Conclusion: Bilateral VCP caused by structurally intact bilateral RLN injury following thyroid surgery was transient, with a high possibility of complete recovery. The period of VC mobility recovery ranges from one day to nine months, and a mandatory tracheostomy may not be needed unless there is a definite sign of airway obstruction.