Hydrodissection of Recurrent Laryngeal Nerve: Case Series

Thyroid surgery is one of the most frequently performed surgical procedures. Recurrent laryngeal nerve (RLN) injury is the most annoying complication of thyroid surgery. According to literature 0.5-5% and 1-30% of patients is reported to have permanent or temporary RLN injury after the surgery, respectively.

RLN innervates all intrinsic muscles of larynx with the exception of cricothyroid muscle. Injury of RLN causes vocal cord paralysis. Unilateral RLN injury causes hoarseness, but when RLNs are bilaterally damaged aspiration during swallowing or life threatening dyspnea can occur according to severity of glottal narrowing.

Hydrodissection is described in laparoscopic cholecystectomy, cataract surgery, carpal tunnel syndrome treatment where meticulous dissection must be carried out as mentioned above. This technique helps exploring anatomical landmarks by gentle dissection without giving harm to tissues. In thyroid surgery hydrodissection is performed to dissect foamy planes and increase visualization of RLN by high velocity stream of warm saline. Despite being used extensively in routine clinical practice to our best knowledge no report evaluating hydrodissection in thyroid surgery exists in the literature up to date.

In this study, investigators aimed to assess the incidence of RLN damage observed in our series by hydrodissection of RLN during thyroid surgery.

To prevent RLN damage, a good knowledge of anatomy and surgeon's experience are crucial. Routine visualization of RLN along tracheoesophageal sulcus, following the course of RLN near suspensory ligament of berry ligament until entering the larynx is recommended to avoid RLN injury. But still some surgeons declare that visualization of RLN is not possible in all operations. Therefore staying close to thyroid capsule during thyroidectomy is considered to be a good surgical practice to preserve the nerve.