Loss of Neural Signal in Thyroid and Parathyroid Surgery

Injury to the recurrent laryngeal nerve (RLN) remains a serious and not uncommon complication in thyroid and parathyroid surgery. When laryngeal nerve monitoring is utilized and loss of signal (LOS) occurs, it is important to distinguish between true LOS and equipment malfunction. When LOS has been verified to occur, postoperative flexible laryngoscopy may be undertaken to confirm the presumed true vocal fold (TVF) dysfunction. If dysfunction occurs, and is unilateral, management in the outpatient setting is appropriate. When the dysfunction is projected to be temporary, supportive measures are usually all that is necessary. In the event of LOS in planned bilateral surgery, a number of options are available, including staging the operation to reduce the potential for bilateral RLN injury. Because bilateral laryngeal dysfunction may sometimes result in the need for an artificial airway, particular care is exercised to avoid this condition. When bilateral dysfunction occurs, steroid administration, conservative management, and even inpatient observation may be appropriate.