Is it possible to predict functional recovery of vocal folds palsy? Role of intraoperative neuromonitoring and laryngostroboscopy findings

Background Vocal fold palsy is a common reason for claims after thyroidectomy. We evaluated the prognostic role of intraoperative neuromonitoring and postoperative flexible fiberoptic laryngostroboscopy findings in patients with type I or type II loss of signal, indicating the injury in an exact point of recurrent laryngeal nerve and whether the damage level cannot be determined, respectively. Methods Among 4,526 intraoperative neuromonitoring-assisted thyroidectomies (2021-2024), all cases of loss of signal were prospectively analyzed. Flexible fiberoptic laryngostroboscopy was performed in first, 15th, 45th, and 180th postoperative day for the evaluation of arytenoid motility and arytenoid inward rotation. On the basis of vocal fold motility at postoperative day 180, patients were categorized into a recovery group and nonrecovery group. Predictive factors for vocal fold palsy were assessed using univariable and multivariable analyses. Results Of 104 included patients, 87 (83.6%) patients recovered vocal fold motility within postoperative day 180. After univariable analysis, type I loss of signal (P =.001) and postoperative day 15 arytenoid inward rotation (P =.001) were significantly more frequent in the nonrecovery group, whereas postoperative day 15 arytenoid motility was more frequent in the recovery group (P =.001). Type I loss of signal, absence of arytenoid motility, and presence of arytenoid inward rotation at postoperative day 15 were associated with recovery in 1 case (P =.001), whereas type II loss of signal with presence of arytenoid motility and absence of arytenoid inward rotation related to recovery in all cases (P =.001). Multivariable analysis showed preserved arytenoid motility as a protective factor for persistent vocal fold palsy (P =.010), whereas the presence of arytenoid inward rotation increased the risk of persistent vocal fold palsy (P =.002). Conclusion This study results support the prognostic role of loss of signal type and postoperative day 15 arytenoid features on vocal fold palsy persistence 6 months after surgery. The identification of these parameters may help clinicians to address patients to early management of vocal fold palsy.