Technology introduction and experience sharing of transcutaneous laryngeal ultrasonography in vocal cord evaluation before and after thyroidectomy

摘要

Vocal cord palsy is one of the major complications after thyroid and parathyroid surgeries. It is not only an important procedure related complication, but also a major contributor to medicolegal litigation in thyroid surgery. Flexible laryngoscopic examination has been the gold standard in assessing the function of the vocal cords and recurrent laryngeal nerve before and after thyroid and parathyroid surgeries. So information on the patient's preoperative and postoperative vocal cord status is considered essential. However, its routine application in the perioperative period remains controversial, because preoperative vocal cord palsy is rare, a great majority of patients (particularly those with no voice symptoms or previous neck operations) are subjected to unnecessary laryngeal examination. Furthermore, laryngoscopy causes patient discomfort and that could potentially lead to poor patient compliance to the procedure. Transcutaneous laryngeal ultrasonography (TLUSG) has been shown recently to be a promising, noninvasive tool in vocal cord examination. Apart from its relative noninvasiveness, it adds very little extra cost, because it can be performed as part of the preoperative examination of the thyroid gland and its regional lymph nodes, and it takes as little as a few minutes. Therefore, it is becoming more popular among clinicians treating thyroid and parathayroid diseases. TLUSG remains a relatively new and evolving imaging technique in vocal cord assessment. Using US to evaluate vocal cord movement is not new. However, its clinical utility has so far been limited by a paucity of evidence regarding its validity and reliability. At present, there is rare hospital to carry out this technique in China, and just one literature report in Chinese. The aim of this paper was to introduction this technique as a screening tool for assessment of vocal cord movement in patients before and after undergoing thyroid and parathyroid surgery.