Recurrent laryngeal nerve(RLN) damage during total thyroidectomy is rare and estimated to occur in upto 14% of cases. Damage to RLN may be unilateral or bilateral. Bilateral RLN injury results in dysfunction of both vocal cords ;which remain in midline during inspiration. After extubation ,biphasic stridor ,respiratory distress and aphonia occurs due to unopposed adduction of vocal cords and closure of glottic aperture necessitating immediate intervention and emergency intubation or tracheostomy. Deliberate intraoperative identification and preservation of the recurrent laryngeal nerve minimizes the risk of injury. Post operative visualization of vocal cord movements should also be performed as patients may be asymptomatic at first .Laryngeal electromyography EMG may be useful to distinguish vocal cord paralysis from injury to the cricoarytenoid joint secondary to intubation, and it may yield prognostic information. We report a case of post extubation stridor following total thyroidectomy probably due to accidental bilateral RLN damage and the management of the same after tracheal extubation
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