Objective Assessment of Postoperative Swallowing Difficulty Through Ultrasound in Patients Undergoing Thyroidectomy

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Swallowing discomfort is a common postoperative complaint in patients undergoing thyroidectomy. Contraction of the strap muscles might cause resistance to elevation of the laryngotracheal unit, and downward movement of the laryngotracheal unit may lead to swallowing discomfort. However, few studies have evaluated the mechanism related to limited laryngotracheal elevation after thyroidectomy. We aimed to objectively verify the presence of postoperative impaired laryngotracheal elevation through ultrasound evaluation in patients undergoing thyroidectomy and evaluate its relationship with limitation of laryngotracheal elevation. This is a prospective clinical study. Among patients undergoing hemithyroidectomy and total thyroidectomy, the patients who were followed up for ≥ 6 months were selected (N = 40). Ultrasound evaluation was done preoperatively and at 1, 3, and 6 months postoperatively. Laryngotracheal movement was recorded and the length of elevation was measured. Symptom after thyroidectomy was evaluated through swallowing-related items of thyroidectomy-related voice questionnaire. Ultrasound evaluation verified the presence of limited laryngotracheal elevation postoperatively in patients undergoing thyroidectomy. After thyroidectomy, the swallowing-related score was significantly increased, and was recovered time-dependently at 1 month. Laryngotracheal elevation showed significant decrease after thyroidectomy. The symptom score of swallowing was significantly correlated with the length of laryngotracheal elevation. Post-thyroidectomy ultrasound evaluation verified that laryngotracheal elevation was significantly impaired. Presence of adhesion between the laryngotracheal unit and the superficial soft tissue was the probable cause of the limitation at 6 months after thyroidectomy. The length of laryngotracheal elevation was related to the symptom score of swallowing after thyroid surgery.

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  1. 1.

    Lombardi CP, Raffaelli M, D’Alatri L, Marchese MR, Rigante M, Paludetti G, Bellantone R. Voice and swallowing changes after thyroidectomy in patients without inferior laryngeal nerve injuries. Surgery. 2006;140:1026–32. discussion 1032–1024.

  2. 2.

    Pereira JA, Girvent M, Sancho JJ, Parada C, Sitges-Serra A. Prevalence of long-term upper aerodigestive symptoms after uncomplicated bilateral thyroidectomy. Surgery. 2003;133:318–22.

  3. 3.

    Lombardi CP, Raffaelli M, De Crea C, D’Alatri L, Maccora D, Marchese MR, Paludetti G, Bellantone R. Long-term outcome of functional post-thyroidectomy voice and swallowing symptoms. Surgery. 2009;146:1174–81.

  4. 4.

    Akyildiz S, Ogut F, Akyildiz M, Engin EZ. A multivariate analysis of objective voice changes after thyroidectomy without laryngeal nerve injury. Arch Otolaryngol Head Neck Surg. 2008;134:596–602.

  5. 5.

    Ertekin C, Aydogdu I. Neurophysiology of swallowing. Clin Neurophysiol. 2003;114:2226–44.

  6. 6.

    Lakhal K, Delplace X, Cottier JP, Tranquart F, Sauvagnac X, Mercier C, Fusciardi J, Laffon M. The feasibility of ultrasound to assess subglottic diameter. Anesth Analg. 2007;104:611–4.

  7. 7.

    Votruba J, Zemanova P, Lambert L, Vesela MM. The role of airway and endobronchial ultrasound in perioperative medicine. Biomed Res Int. 2015;2015:754626.

  8. 8.

    Nam IC, Bae JS, Shim MR, Hwang YS, Kim MS, Sun DI. The importance of preoperative laryngeal examination before thyroidectomy and the usefulness of a voice questionnaire in screening. World J Surg. 2012;36:303–9.

  9. 9.

    Chun BJ, Bae JS, Chae BJ, Hwang YS, Shim MR, Sun DI. Early postoperative vocal function evaluation after thyroidectomy using thyroidectomy related voice questionnaire. World J Surg. 2012;36:2503–8.

  10. 10.

    Ertekin C, Aydogdu I. Neurophysiology of swallowing. Clin Neurophysiol. 2003;114:2226–44.

  11. 11.

    Martin BJ, Logemann JA, Shaker R. Dodds WJ (1994) Coordination between respiration and swallowing: respiratory phase relationships and temporal integration. J Appl Physiol. 1985;76:714–23.

  12. 12.

    Hong KH, Kim YK. Phonatory characteristics of patients undergoing thyroidectomy without laryngeal nerve injury. Otolaryngol Head Neck Surg. 1997;117:399–404.

  13. 13.

    Kristensen MS. Ultrasonography in the management of the airway. Acta Anaesthesiol Scand. 2011;55:1155–73.

  14. 14.

    Park YM, Oh KH, Cho JG, Baek SK, Kwon SY, Jung KY, Woo JS. Changes in voice- and swallowing-related symptoms after thyroidectomy: one-year follow-up study. Ann Otol Rhinol Laryngol. 2018;127:171–7.

  15. 15.

    Alkan Z, Yigit O, Adatepe T, Uzun N, Kocak I, Sunter V, Server EA. Effect of anti-adhesive barrier use on laryngotracheal movement after total thyroidectomy: an electrophysiological study. Indian J Otolaryngol Head Neck Surg. 2014;66:71–7.

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Correspondence to Jeong-Soo Woo.

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See Table 1.

Table 1 The swallowing—related thyroidectomy-related voice questionnaire

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Cho, J., Byeon, H.K., Oh, K.H. et al. Objective Assessment of Postoperative Swallowing Difficulty Through Ultrasound in Patients Undergoing Thyroidectomy. Dysphagia (2019).

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  • Thyroidectomy
  • Swallowing difficulty
  • Laryngotracheal movement
  • Ultrasound
  • Deglutition
  • Deglutition disorder