(0409) Intraoperative Thyroid Cartilage Retraction and Postoperative Vocal Cord Dysfunction

Introduction: Unanticipated injury of the recurrent laryngeal nerve (RLN) during thyroidectomy is one of the most confounding complications with temporary paresis ranging from 1.5-14%. In cases where no perceptible RLN trauma occurred, it is hypothesized that retraction of the thyroid gland may cause traction injury to the RLN. We aim to determine if intraoperative constant retraction of the thyroid cartilage notch counteracts tension on the RLN thus reducing rates of unanticipated postoperative vocal cord (VC) paralysis/paresis.

Methods: Patients who underwent thyroidectomy by a single surgeon at a single academic institution from February 2019 to September 2023 were retrospectively reviewed. Patients who underwent RLN dissection without thyroid cartilage retraction were compared to those with retraction. Thyroid cartilage retraction was performed with a readily available self-retaining, adjustable retractor hooked onto the thyroid cartilage notch with an elastic tension band. VC movement was assessed pre- and 1-week postoperatively with laryngoscopy. Those with preoperative dysfunction, known intraoperative trauma or tumor invasion of the RLN were excluded.

Results: In total, 281 patients were included with 103 (36.7%) undergoing thyroid cartilage retraction with a self-retaining, adjustable retractor. VC paresis/paralysis was noted in 3.52% (9/256) of RLNs without thyroid cartilage retraction compared to 0% (0/162) with thyroid cartilage retraction (p = 0.014). There were no instances of bilateral VC palsy.

Conclusions: This is the first report of intraoperative retraction of the thyroid cartilage notch to reduce tension on the RLN, showing decreased rates of unanticipated postoperative VC paralysis and paresis.