Preoperative and postoperative laryngoscopy in thyroid surgery

The absence of preoperative or postoperative voice change does not exclude RLN palsy; conversely, preoperative or postoperative hoarseness does not exclusively indicate RLN injury. Knowledge of preoperative vocal cord function is important to patient counselling for postoperative complications. It is also essential for the management of cases with thyroid carcinoma infiltrating the RLN since it facilitates preoperative recognition of disease extent, preoperative investigation planning and appropriate operative strategy. The value of routine preoperative and postoperative laryngoscopy in all patients undergoing thyroid surgery, however, is debatable in the literature. The recommendations of the Greek Association of Endocrine Surgeons suggest that preoperative laryngoscopy is required in symptomatic cases, reoperations or invasive thyroid malignancy, and postoperative laryngoscopy is necessary in symptomatic patients. Further studies, especially prospective randomized studies, are required in order to draw definitive conclusions.