Surgical management of the compromised recurrent laryngeal nerve in thyroid cancer

Best Pract Res Clin Endocrinol Metab. 2019 Aug;33(4):101282. doi: 10.1016/j.beem.2019.05.006. Epub 2019 Jun 4.


Surgical management of thyroid cancer requires careful consideration of the recurrent laryngeal nerve and its impact on glottic function. Management of the compromised recurrent laryngeal nerve is a complex task, requiring synthesis of multiple elements. The surgeon must have an appreciation for preoperative recurrent laryngeal nerve function, intraoperative anatomic and electromyographic information, disease characteristics, and relevant patient factors. Preoperative clinical evaluation including preoperative laryngoscopy and assessment of recurrent laryngeal nerve risk is essential to formulating a surgical plan and providing appropriate patient counseling. Intraoperative neuromonitoring information has significant implications for surgical management of the injured or invaded recurrent laryngeal nerve and informs strategy with respect to staging of bilateral surgery. Disease characteristics and patient-related factors, including patient preference, must be considered with intraoperative decision-making. Multidisciplinary discussion and patient communication are essential for effective management and successful surgical outcome.

Keywords: bilateral surgery; neuromonitoring; recurrent laryngeal nerve; thyroid cancer; thyroidectomy; vocal cord paralysis.

Publication types

  • Review

MeSH terms

  • Humans
  • Laryngeal Nerve Injuries / epidemiology
  • Laryngeal Nerve Injuries / etiology*
  • Laryngeal Nerve Injuries / prevention & control
  • Postoperative Complications / epidemiology
  • Postoperative Complications / etiology*
  • Postoperative Complications / prevention & control
  • Thyroid Neoplasms / surgery*
  • Thyroidectomy / adverse effects
  • Thyroidectomy / methods*
  • Vocal Cord Paralysis / epidemiology
  • Vocal Cord Paralysis / etiology*
  • Vocal Cord Paralysis / prevention & control