Laryngeal Nerve Palsy

Laryngeal nerve palsy may occur during thyroid surgery as a result of the close relationship of the laryngeal nerves with the thyroid gland and its feeding vessels. It represents the second most common complication of thyroidectomy, accounting for up to 9.8% of cases. Although most patients recover within 6–12 months after surgery (transient nerve palsy), the condition may prove permanent in up to 2.3% of cases. Causes may be related to excessive traction during dissection, crushing, thermal injury, and inadvertent or planned (because of tumor infiltration) transection. Symptoms may range from voice changes (hoarseness, dysphonia) and dysphagia for unilateral injuries to stridor and asphyxia in bilateral palsy, which represent the most fearsome complication of thyroid surgery. Prevention, based on thorough knowledge of the anatomy, adequate training, meticulous surgical dissection, possible use of intraoperative nerve monitoring devices, is mandatory. This chapter discusses all aspects related to applied anatomy, prevention and multidisciplinary treatment of laryngeal nerve palsies.