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World Journal of Surgery
Published in: World Journal of Surgery 7/2006

01-07-2006

Sensitivity and Specificity of Intraoperative Recurrent Laryngeal Nerve Stimulation Test for Predicting Vocal Cord Palsy after Thyroid Surgery

Authors: Chisato Tomoda, MD, Yoshihiro Hirokawa, MD, Takashi Uruno, MD, Yuuki Takamura, MD, Yasuhiro Ito, MD, Akihiro Miya, MD, Kaoru Kobayashi, MD, Fumio Matsuzuka, MD, Kanji Kuma, MD, Akira Miyauchi, MD

Published in: World Journal of Surgery | Issue 7/2006

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Abstract

INTRODUCTION

Recurrent laryngeal nerve (RLN) palsy after thyroidectomy, although infrequently encountered, can decrease quality of life. In addition to the hoarseness that occurs with unilateral RLN palsy, bilateral RLN palsy leads to dyspnea and often to life-threatening glottal obstruction. Therefore, intraoperative awareness of the nerve’s status is of great importance. This study examined the sensitivity and specificity of a palpation technique to detect contraction of the posterior cricoarytenoid muscle (PCA) through the posterior hypopharyngeal wall while the RLN was being stimulated with a disposable nerve stimulator during thyroid surgery (the laryngeal palpation test) to predict postoperative RLN deficits.

Methods

A total of 2197 RLNs in 1376 patients were identified to be at risk of injury during thyroidectomy performed between July 2003 and August 2004. Postoperative RLN integrity was assessed using direct laryngoscopy or laryngofiberoscopy to visualize vocal fold mobility.

Results

Altogether, 76 RLNs failed to elicit a PCA contraction in response to nerve stimulation, and 80 cases of temporary vocal cord palsy and 21 cases of permanent vocal cord palsy were recognized on postoperative evaluation. For postoperative vocal cord palsy, the sensitivity and specificity of the laryngeal palpation test were 69.3% and 99.7%, respectively, with a positive predictive value of 92.1% and negative predictive value of 98.5%. For permanent vocal cord palsy, the sensitivity and specificity were 85.7% and 97.3%, respectively, with a positive predictive value of 23.7% and negative predictive value of 99.8%.

Conclusions

The laryngeal palpation test is not a particularly useful method for predicting the level of RLN function after thyroidectomy. All patients must be examined postoperatively by direct laryngoscopy or laryngofiberoscopy to check vocal cord mobility. Even if there is no contraction of the PCA and we detect vocal cord palsy immediately after surgery, vocal cord palsy often recovers within 1 year when visual preservation of RLN is successful.
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Metadata
Title
Sensitivity and Specificity of Intraoperative Recurrent Laryngeal Nerve Stimulation Test for Predicting Vocal Cord Palsy after Thyroid Surgery
Authors
Chisato Tomoda, MD
Yoshihiro Hirokawa, MD
Takashi Uruno, MD
Yuuki Takamura, MD
Yasuhiro Ito, MD
Akihiro Miya, MD
Kaoru Kobayashi, MD
Fumio Matsuzuka, MD
Kanji Kuma, MD
Akira Miyauchi, MD
Publication date
01-07-2006
Publisher
Springer-Verlag
Published in
World Journal of Surgery / Issue 7/2006
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-005-0351-z

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