Strategies to prevent bilateral vocal fold paralysis in thyroid surgery

Thyroid surgery carries the risk of bilateral vocal fold paralysis (VFP), which can lead to airway compromise and necessitate intervention. Despite surgical advancements, 45% of patients experience permanent paralysis, with a 30% risk of tracheotomy. Bilateral VFP can compromise the airway, presenting with noisy breathing and voice changes. Hemi-thyroidectomy carries a lower VFP risk than total thyroidectomy. IONM aids RLN preservation but hasn't consistently lowered VFP rates. Continuous IONM benefits RLN preservation but its effect on VFP rates is debated. Staged surgery post-ipsilateral nerve injury may reduce bilateral VFP risk. Preventing bilateral VFP in thyroid surgery is of paramount importance. Utilizing routine IONM and implementing staged surgery following ipsilateral nerve injury could potentially reduce the incidence of bilateral VFP. However, additional research is warranted to establish the most effective management strategies for optimizing patient outcomes in thyroid surgery.