- Thyroid surgery is associated with vocal cord palsy due to recurrent laryngeal nerve damage from traction, contusion or transection:
- Temporary unilateral vocal cord paralysis 3–4%
- Permanent unilateral vocal cord paralysis <1%
- Bilateral vocal cord paralysis extremely rare
- Neuromonitoring can be performed to identify and protect the RLN:
- No strong evidence to suggest this reduces the risk of vocal cord palsy
- Visual identification remains the gold standard
- Neuromonitoring may be an adjunct for nerve identification
- Has been recommended by NICE for this use given its low risk of complications
