The Utility of Evaluating True Vocal Fold Motion Before Thyroid Surgery
description
Transcript of The Utility of Evaluating True Vocal Fold Motion Before Thyroid Surgery
![Page 1: The Utility of Evaluating True Vocal Fold Motion Before Thyroid Surgery](https://reader036.fdocuments.net/reader036/viewer/2022081513/56815a87550346895dc7f854/html5/thumbnails/1.jpg)
The Utility of Evaluating True Vocal Fold Motion Before
Thyroid Surgery
Laryngoscope , February 2006
Farrag, Tarik Y. MD; Samlan, Robin A. MS, MBA; Lin, Frank R. MD; Tufano, R
alph P. MD
From Johns Hopkins University School of Medicine, Department of Otolaryngology–Head & Neck Surgery, Baltimore,
MD.
R1 康焜泰
![Page 2: The Utility of Evaluating True Vocal Fold Motion Before Thyroid Surgery](https://reader036.fdocuments.net/reader036/viewer/2022081513/56815a87550346895dc7f854/html5/thumbnails/2.jpg)
evaluate the utility of screening laryngoscopic examination in evaluating vocal fold (VF) mobility before thyroid surgery.
![Page 3: The Utility of Evaluating True Vocal Fold Motion Before Thyroid Surgery](https://reader036.fdocuments.net/reader036/viewer/2022081513/56815a87550346895dc7f854/html5/thumbnails/3.jpg)
INTRODUCTION
Thyroid pathologic conditions 11% of the general population.
surgical trauma during thyroid operations recurrent laryngeal nerve (RLN) dysfunction vocal fold (VF) motion impairment
![Page 4: The Utility of Evaluating True Vocal Fold Motion Before Thyroid Surgery](https://reader036.fdocuments.net/reader036/viewer/2022081513/56815a87550346895dc7f854/html5/thumbnails/4.jpg)
some researchers : up to 50% of patients with unilateral RLN paralysis may be asymptomatic
Rueger RG. Benign disease of the thyroid gland and vocal cord paraly
sis. Laryngoscope 1974;84:897–907.
![Page 5: The Utility of Evaluating True Vocal Fold Motion Before Thyroid Surgery](https://reader036.fdocuments.net/reader036/viewer/2022081513/56815a87550346895dc7f854/html5/thumbnails/5.jpg)
use of routine VF examination before thyroid surgery ?
This study 1. findings in assessing the benefits of VF
examination as a routine procedure before thyroid surgery
2. evaluate impact on the extent of thyroid surgery.
![Page 6: The Utility of Evaluating True Vocal Fold Motion Before Thyroid Surgery](https://reader036.fdocuments.net/reader036/viewer/2022081513/56815a87550346895dc7f854/html5/thumbnails/6.jpg)
METHODS retrospective study 340 patients : thyroid surgery and have had
VF examination preoperatively from January 1998 to June 2005 114 males : 226 females. Age :18 to 87 years 32.5% (n = 111) indirect mirror laryngoscop
y 67.5% (n = 229) fiberoptic examination or vi
deostroboscopy
![Page 7: The Utility of Evaluating True Vocal Fold Motion Before Thyroid Surgery](https://reader036.fdocuments.net/reader036/viewer/2022081513/56815a87550346895dc7f854/html5/thumbnails/7.jpg)
Two main categories
(based on VF mobility preoperatively 1) with normal VF mobility 2) with VF motion impairment
![Page 8: The Utility of Evaluating True Vocal Fold Motion Before Thyroid Surgery](https://reader036.fdocuments.net/reader036/viewer/2022081513/56815a87550346895dc7f854/html5/thumbnails/8.jpg)
![Page 9: The Utility of Evaluating True Vocal Fold Motion Before Thyroid Surgery](https://reader036.fdocuments.net/reader036/viewer/2022081513/56815a87550346895dc7f854/html5/thumbnails/9.jpg)
Preoperative diagnosis : fine needle aspiration intraoperative condition of RLN history of previous thyroid surgery Reports of final postoperative histopathologi
c examination
![Page 10: The Utility of Evaluating True Vocal Fold Motion Before Thyroid Surgery](https://reader036.fdocuments.net/reader036/viewer/2022081513/56815a87550346895dc7f854/html5/thumbnails/10.jpg)
RESULTS
Category I (normal vocal fold mobility on preoperative examination; 93.5%, n = 318)
90% asymptomatic (n = 285) 10% symptomatic (n = 33) Fiberoptic or videostroboscopy :214 patients
(67%) indirect mirror laryngoscopy :104 patients (3
3%)
![Page 11: The Utility of Evaluating True Vocal Fold Motion Before Thyroid Surgery](https://reader036.fdocuments.net/reader036/viewer/2022081513/56815a87550346895dc7f854/html5/thumbnails/11.jpg)
Category II (vocal fold motion impairment on preoperative examination; 6.5%, n = 22)
seven patients (32%) :asymptomatic without any voice problems (95% confidence interval, 14–55%)
![Page 12: The Utility of Evaluating True Vocal Fold Motion Before Thyroid Surgery](https://reader036.fdocuments.net/reader036/viewer/2022081513/56815a87550346895dc7f854/html5/thumbnails/12.jpg)
Voice Symptoms as a Screening Test for Vocal Fold Mobility
Impairment
Sensitivity was 0.68 (68%)proportion of preoperative thyroid patients with VF motion impairment who were correctly identified as “positive/vocal fold motion impairment” using voice symptoms.
Specificity was 0.9 (90%); this is the proportion of preoperative thyroid patients with normal VF mobility who were correctly identified as “negative/no motion impairment” using voice symptoms
![Page 13: The Utility of Evaluating True Vocal Fold Motion Before Thyroid Surgery](https://reader036.fdocuments.net/reader036/viewer/2022081513/56815a87550346895dc7f854/html5/thumbnails/13.jpg)
Voice Symptoms as a Screening Test for Vocal Fold Mobility
Impairment Positive predictive value (PPV) was 0.31
(31%); this is the proportion of preoperative thyroid patients with positive voice symptoms who actually had VF motion impairment.
Negative predictive value (NPV) was 0.98 (98%); this is the proportion of preoperative thyroid patients with no voice symptoms who did not have VF motion impairment.
![Page 14: The Utility of Evaluating True Vocal Fold Motion Before Thyroid Surgery](https://reader036.fdocuments.net/reader036/viewer/2022081513/56815a87550346895dc7f854/html5/thumbnails/14.jpg)
In category II, 59% (n = 13) malignancy on histopathologic
examination 62% (n = 8) of these malignant cases demo
nstrated papillary thyroid carcinoma (PTC)
![Page 15: The Utility of Evaluating True Vocal Fold Motion Before Thyroid Surgery](https://reader036.fdocuments.net/reader036/viewer/2022081513/56815a87550346895dc7f854/html5/thumbnails/15.jpg)
7 patients :asymptomatic +VF motion impairment
5 benign disease on their histopathology reports.
15 patients: symptomatic + VF motion impairment
11 patients had malignant disease
![Page 16: The Utility of Evaluating True Vocal Fold Motion Before Thyroid Surgery](https://reader036.fdocuments.net/reader036/viewer/2022081513/56815a87550346895dc7f854/html5/thumbnails/16.jpg)
presence of VF motion impairment plus positive symptoms is strongly suggestive, but not conclusive, of malignancy (P = .07)
![Page 17: The Utility of Evaluating True Vocal Fold Motion Before Thyroid Surgery](https://reader036.fdocuments.net/reader036/viewer/2022081513/56815a87550346895dc7f854/html5/thumbnails/17.jpg)
differs significantly from the hypothesis that VF motion impairment will only be seen ipsilateral to the thyroid lesion
![Page 18: The Utility of Evaluating True Vocal Fold Motion Before Thyroid Surgery](https://reader036.fdocuments.net/reader036/viewer/2022081513/56815a87550346895dc7f854/html5/thumbnails/18.jpg)
DISCUSSION
recommend vocal fold examination as a routine preoperative investigation for all patients undergoing thyroid surgery.
1. high incidence of asymptomatic VF motion impairment (32%)
2. some patients (10%) with normal VF mobility had positive voice symptoms.
![Page 19: The Utility of Evaluating True Vocal Fold Motion Before Thyroid Surgery](https://reader036.fdocuments.net/reader036/viewer/2022081513/56815a87550346895dc7f854/html5/thumbnails/19.jpg)
1.asymptomatic + preoperative VF motion impairment
majority : slowly progressive benign 2. some cases VF motion impairment co
ntralateral to the side of the thyroid lesion possibility that RLN paralysis independe
nt of the existing thyroid pathology Further diagnostic studies would be ne
eded to explain this possibility
![Page 20: The Utility of Evaluating True Vocal Fold Motion Before Thyroid Surgery](https://reader036.fdocuments.net/reader036/viewer/2022081513/56815a87550346895dc7f854/html5/thumbnails/20.jpg)
Documenting asymptomatic VF motion impairment preoperatively may provide the surgeon medicolegal protection
Proper preoperative counseling is important, and with preoperative VF evaluation
easier to clearly inform patients about their disease process
explain the risks of thyroid surgery to the RLNs and the resultant functional impairment that comes with injury
![Page 21: The Utility of Evaluating True Vocal Fold Motion Before Thyroid Surgery](https://reader036.fdocuments.net/reader036/viewer/2022081513/56815a87550346895dc7f854/html5/thumbnails/21.jpg)
CONCLUSION
status of VF mobility is essential information that should be known to both the patient and surgeon before thyroid surgery.