A prospective study evaluating the feasibility and accuracy of very early postoperative translaryngeal ultrasonography in the assessment of vocal cord function after neck surgery

• Published in: Surgery 2021-01, Vol.169 (1), p.191-196
• Main Authors: Fung, Matrix Man Him, Lang, Brian Hung-Hin
• Format: Article
• Language: English
• Subjects: Aged; Early Diagnosis; Endosonography - methods; Endosonography - statistics & numerical data; Feasibility Studies; Female; Humans; Laryngoscopy - statistics & numerical data; Male; Middle Aged; Parathyroidectomy - adverse effects; Postoperative Complications - diagnosis; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Prospective Studies; Recurrent Laryngeal Nerve Injuries - diagnosis; Recurrent Laryngeal Nerve Injuries - epidemiology; Recurrent Laryngeal Nerve Injuries - etiology; Thyroidectomy - adverse effects; Time Factors; Vocal Cord Paralysis - diagnosis; Vocal Cord Paralysis - epidemiology; Vocal Cord Paralysis - etiology; Vocal Cords - diagnostic imaging; Vocal Cords - innervation
• ISSN: 0039-6060; 1532-7361
• DOI: 10.1016/j.surg.2020.03.025

Early recognition of postoperative vocal cord palsy enhances postoperative care. Translaryngeal ultrasonography can assess vocal cord function accurately and noninvasively, but it is unclear whether it is feasible or accurate when done immediately after extubation in the recovery room owing to possible interference from laryngeal swelling. This study assessed the feasibility and accuracy of translaryngeal ultrasonography in this setting. Consecutive patients undergoing neck operations were subjected to translaryngeal ultrasonography and flexible direct laryngoscopy 1 day before and day 7 after thyroidectomy and parathyroidectomy. Translaryngeal ultrasonography was performed early in the recovery room immediately after extubation in the operating room. A standardized assessment protocol was used. Patient parameters were compared between those with assessable and unassessable vocal cords. Sixty-five patients (91 recurrent laryngeal nerves-at-risk) were analyzed after excluding 2 male patients who failed preoperative translaryngeal ultrasonography. Fifty-six patients underwent thyroidectomy and 9 parathyroidectomy. The median age (range) was 57 (46–69); 44 (68%) were women. Sixty-one patients (94%) had assessable bilateral vocal cords on translaryngeal ultrasonography in the recovery room. Translaryngeal ultrasonography in the recovery room findings corresponded completely with day-7 findings on direct laryngoscopy. Long operative time was associated with nonassessable vocal cords on translaryngeal ultrasonography in the recovery room (P = .026). Very early postoperative translaryngeal ultrasonography in the recovery room after neck surgery is highly feasible and accurate. Long operative time may hinder the use of translaryngeal ultrasonography in the recovery room.