Laryngoscopy in thyroid surgery--essential standard or unnecessary routine?

BACKGROUND: Preoperative and postoperative laryngoscopy has been recommended for diagnostic and forensic reasons as a standard procedure in all patients who undergo thyroid surgery. The aim of this study was to find a more selective approach by defining patients at risk of developing vocal fold palsy (VFP).
METHODS: The history of neck explorations, results of laryngoscopy, and histology were registered in all patients who underwent thyroid surgery at our institution between 1995 and 1999. Patients with pathologic findings at postoperative laryngoscopy underwent reassessment of voice and vocal fold (VF) mobility 6 months later.
RESULTS: Unilateral VFP was detected preoperatively in 13 of 695 patients (1.9%). Of the 13 patients, only 1 patient was asymptomatic, had no history of neck surgery, and had no suspected malignancy. Postoperative laryngoscopy revealed a new development of VFP in 68 of 695 patients (9.8%). All patients with a permanent VFP had symptoms immediately after operation. Asymptomatic VFPs always recovered.
CONCLUSIONS: Preoperative laryngoscopy is justified in symptomatic patients who undergo reoperation or in patients when malignancy is suspected. The necessity of a preoperative laryngoscopy in all other patients must be questioned. Postoperative laryngoscopy and additional diagnostic testing should be reserved for symptomatic patients.