One of the most important problems that may occur in thyroid surgery is the problems in voice (speech) that may occur due to injury or damage to the nerves going to the vocal cords.
“These problems; It can be temporary or permanent.”
While temporary problems resolve within a few weeks to a few months, permanent problems continue for life.
There are two nerves adjacent to the thyroid. The main problem that develops due to upper nerve damage (called SLSE for short) is that the voice gets tired while talking and the inability to produce high-pitched sounds. While this problem can be noticed more in individuals who use their voices professionally (such as voice artists, teachers), it causes less of a problem in other individuals. For these reasons, it is often not possible to give an exact rate as there are some difficulties in determining the rate of occurrence of this nerve-related problem.
As a result of damage to the second nerve, the lower nerve (called RLN for short), problems ranging from mild hoarseness to insufficient voice may occur. This problem, unlike any damage that may occur in the upper nerve, can be easily detected by direct examination of the vocal cords after surgery.
The most important approach to prevent damage to the thyroid-related nerves is to visualize and protect these nerves during a careful surgical technique. Visualizing and protecting the upper nerves requires a little more effort because the upper nerves have a different course. In recent years, a technique called nerve monitoring, which allows both upper and lower nerves to be controlled with special devices during surgery, has come into use.
Nerve monitoring technique
Monitoring of lower nerves: In a significant portion of patients given general anesthesia, a tube is placed in the patient's windpipe after the patient sleeps (endotracheal tube) to ensure controlled breathing during the surgery. The tubes used in patients undergoing nerve monitoring technique are slightly different from standard tubes and there is a sensor wire (electrode) in the part corresponding to the vocal cords (vocal cords).
This wire inside the tube detects the movement of the vocal cords. It converts this into sound and a graphical image on a screen.
During the surgery, when the lower nerve going to the vocal cords is stimulated (a special stimulating probe) and if the nerve is intact, the vocal cords move and this movement is visual, as mentioned before. It is reflected on the screen and can be heard as sound. In other words, if the surgeon receives a visual or audio response as a result of stimulation of the nerve, he can conclude that the nerve is healthy. Thus, by stimulating the nerve at various stages of the surgery, it is possible to detect whether there is a problem during the surgery and to predict whether the patient will encounter a voice problem after the surgery while the patient is still asleep on the operating table.
Monitoring of the upper nerves: As with the lower nerves, the upper nerves are stimulated during the surgery to determine whether there is any damage to the nerve. For this purpose, when the nerve is stimulated, it is observed whether there is a contraction in a muscle operated by this nerve and located in the immediate vicinity of the thyroid. If a contraction is detected in the muscle, it is concluded that there is no injury or damage to the nerve. In addition, before the vessels in the region are ligated and cut, the formation that is planned to be ligated and cut is stimulated with the probe in order to protect the nerve that runs close to these vessels from damage. If there is no contraction in the relevant muscle, this formation can be easily cut.
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