Commentary
Kapil Dev, Gurawalia J, Pandey
Abstract
The incidence of temporary RLN paralysis is usually underestimated, which might be due to unabated or undetected vocal cord palsy or ignorance of mild hoarseness of voice by the patient himself or herself or by the physician. The rate of RLN paralysis with an overall range of 1% to 8.6%, with 1% to 5.1% as temporary paralysis, and 0 to 2.9% reported as permanent nerve paralysis. Enlarged lymph node located just anterior to the entry point of RLN into cricothyroid membrane, within a radius of 5 mm, might be a potent predictor of temporary nerve paralysis. A prospective observational study of patients who underwent thyroid surgery over a period of eighteen months, observing enlargement of lymph node in the area within a 5 mm radius of the entry point of RLN in cricothyroid membrane and correlated with incidence of temporary and permanent RLN paralysis, node was named as “SHENOY’s Node”. A total of 106 patients underwent thyroid surgery during the study period. The incidence of enlargement of lymph node was 10% and incidence of temporary RLN paralysis was 63%, twice to that in patients without an enlarged node. The relative risk of temporary and permanent RLN paralysis with enlarged node compared to without enlarging node was 2.01 (p<0.0001) and 3.03 (p=0.002), respectively. Patients with enlarged “SHENOY’s Node” is an additional risk factor of a higher rate of temporary RLN palsy during thyroid surgery.