Mechanism of Injury

  • Gianlorenzo DionigiEmail author
  • Samuel K. Snyder
  • Feng-Yu Chiang
  • Whitney Liddy
  • Dipti Kamani
  • Natalia Kyriazidis


Causes of recurrent laryngeal nerve (RLN) injury during thyroidectomy are varied, with most injuries resulting from the following surgical errors: sectioning of the nerve, ligation, traction, clamping injury, suction, compression, contusion, electrical and thermal injury. Surgeons underestimate the actual rate of RLN injury. Intraoperative nerve monitoring (IONM) during thyroidectomy, parathyroidectomy, or related central neck procedures can elucidate actual or potential mechanisms of RLN injury that were previously unknown to the thyroid surgeon, especially in visually intact nerves. IONM is useful in open conventional thyroid surgery for localizing the point of disrupted nerve conduction in addition to identifying how and when the RLN was injured. Studying the mechanisms of RLN injury during thyroidectomy is instructive for future operations and may allow for identification of potentially reversible causes of RLN injury. During thyroidectomy and parathyroidectomy, intraoperative RLN injury is typically associated with a visually intact RLN rather than a transected nerve. The anterior motor branch of a RLN bifurcating near the ligament of Berry is particularly at risk of traction injury. Traction injury is the most frequent cause of postoperative vocal cord palsy.


Thyroidectomy Minimally invasive video-assisted thyroidectomy Recurrent laryngeal nerve Mechanism of injury Morbidity Neuromonitoring Traction injury 

Supplementary material

Video 19.1

Point traction injury of the RLN (MOV 8515 kb)


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Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • Gianlorenzo Dionigi
    • 1
    Email author
  • Samuel K. Snyder
    • 2
  • Feng-Yu Chiang
    • 3
  • Whitney Liddy
    • 4
  • Dipti Kamani
    • 4
  • Natalia Kyriazidis
    • 4
  1. 1.1st Division of Surgery, Department of Surgical Sciences and Human MorphologyUniversity of InsubriaVareseItaly
  2. 2.Division of Surgical OncologyTexas A&M University Health Science Center, Baylor Scott & White Health, Scott & White ClinicTempleUSA
  3. 3.Department of Otolaryngology—Head and Neck SurgeryKaohsiung Medical University, Chung-Ho Memorial HospitalKaohsiungTaiwan
  4. 4.Division of Thyroid and Parathyroid Endocrine, Surgery, Department of Otolaryngology—Head and Neck Surgery, Massachusetts Eye and Ear InfirmaryHarvard Medical SchoolBostonUSA

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