Management of bilateral recurrent laryngeal nerve paresis after thyroidectomy.

Abstract

Bilateral recurrent laryngeal nerve (RLN) injury is rare for benign thyroid lesions (0.2%). After extubation-stridor, respiratory distress, aphonia occurs due to the closure of the glottic aperture necessitating immediate intervention and emergency intubation or tracheostomy. Intra-operative identification and preservation of the RLN minimizes the risk of injury. It is customary to expect RLN problems after thyroid surgery especially if malignancy, big thyroid, distorted anatomical problems and difficult airway that can lead to intubation trauma. Soon after extubating, it is essential to the anesthetist to check the vocal cord movements on phonation and oropharyngeal reflexes competency. But this case is specially mentioned to convey the message that in spite of absence of above mentioned predisposing factors for complications and good recovery profile specific to thyroid, there can be unanticipated airway compromise that if not attended to immediately may cost patient's life. This is a case of postextubation stridor following subtotal thyroidectomy due to bilateral RLN damage and its management.

• Authors: Anitha Sanapala, Male Nagaraju, Lella Nageswara Rao, Koteswar Nalluri
• Journal: Anesthesia, essays and researches (Anesth Essays Res) 2015 May-Aug Vol. 9 Issue 2 Pg. 251-3 ISSN: 0259-1162 [Print] India
• PMID: 26417137 (Publication Type: Case Reports)