A nonsurgical trauma causing bilateral adductor palsy of the vocal folds following total thyroidectomy

Document Type : Case Report


1 Department of Otorhinolaryngology and Head and Neck Surgery, Manipal TATA Medical College, Jamshedpur-831017, Jharkhand, Manipal Academy of Higher Education, Manipal, India

2 Medical Research Laboratory, IMS and SUM Hospital, Siksha “O” Anusandhan University, Bhubaneswar, Odisha, India



Vocal fold palsy is an uncommon cause of hoarseness of voice following thyroidectomy. The vocal fold palsy can be unilateral or bilateral, with presentation varying accordingly. There are often surgeons blamed for postthyroidectomy vocal fold palsy. However, there are certain subtle factors associated with vocal fold palsy that should be known to clinicians. Bilateral adductor palsy following thyroidectomy is a morbid clinical situation where the patient presents with aphonia and aspiration. Here, we present a case of postop-total thyroidectomy with adductor palsy of bilateral vocal folds. A nonsurgical reason for the vocal fold palsy was suggested by the clinical findings and the patient's recovery. The knowledge of this case management is very important for surgeons to avoid such morbidity among patients.


Santosh Kumar Swain [Pubmed] [Google Scholar]



Gonçalves Filho J, Kowalski LP. Surgical complications after thyroid surgery performed in a cancer hospital. Otolaryngol Head Neck Surg 2005;132:490-4.  Back to cited text no. 1
Swain SK, Sahu MC, Samantray K. An unusual cause of hoarseness of voice in a pediatric patient – A case report. Pediatr Pol 2017;92:196-9.  Back to cited text no. 2
Swain SK, Nahak B, Sahoo L, Munjal S, Sahu MC. Pediatric dysphonia – A review. Ind J Child Health 2019;6:1-5.  Back to cited text no. 3
Nouraei SA, Allen J, Kaddour H, Middleton SE, Aylin P, Darzi A, et al. Vocal palsy increases the risk of lower respiratory tract infection in low-risk, low-morbidity patients undergoing thyroidectomy for benign disease: A big data analysis. Clin Otolaryngol 2017;42:1259-66.  Back to cited text no. 4
Dinc T, Kayilioglu SI, Simsek B, Guldogan CE, Gulseren MO, Saylam B, et al. The evaluation of the complications observed in patients with bilateral total and bilateral near total thyroidectomy. Ann Ital Chir 2017;88:198-201.  Back to cited text no. 5
Swain SK, Sahoo L, Panda S. Voice outcome after COBLATION-assisted microlaryngeal surgery-Our experiences at a tertiary care teaching hospital. J Laryngol Voice 2020;10:1-6.  Back to cited text no. 6
  [Full text]  
Swain SK, Choudhury J. Pediatric airway diseases. Ind J Health Sci Biomed Res (KLEU) 2019;12:196-201.  Back to cited text no. 7
Wu CW, Dionigi G, Barczynski M, Chiang FY, Dralle H, Schneider R, et al. International neuromonitoring study group guidelines 2018: Part II: Optimal recurrent laryngeal nerve management for invasive thyroid cancer-incorporation of surgical, laryngeal, and neural electrophysiologic data. Laryngoscope 2018;128 Suppl 3:S18-27.  Back to cited text no. 8
Ellis PD, Pallister WK. Recurrent laryngeal nerve palsy and endotracheal intubation. Anesthesiology 1976;45:448-9.  Back to cited text no. 9
Swain SK, Pradhan S. Impact of laryngopharyngeal reflux on professional singers. Apollo Med 2019;16:220-4.  Back to cited text no. 10
  [Full text]  
Cavo JW Jr. True vocal cord paralysis following intubation. Laryngoscope 1985;95:1352-9.  Back to cited text no. 11
Myssiorek D. Recurrent laryngeal nerve paralysis: Anatomy and etiology. Otolaryngol Clin North Am 2004;37:25-44.  Back to cited text no. 12
Chiang FY, Lu IC, Kuo WR, Lee KW, Chang NC, Wu CW. The mechanism of recurrent laryngeal nerve injury during thyroid surgery – The application of intraoperative neuromonitoring. Surgery 2008;143:743-9.  Back to cited text no. 13
Yamashita T, Harada Y, Ueda N, Tashiro T, Kanebayashi H. Recurrent laryngeal nerve paralysis associated with endotracheal anesthesia. Japan Otolaryngol Soc Coast Guard 1965;68:1452-9.  Back to cited text no. 14
Bourrel C, Uzzan B, Tison P, Despreaux G, Frachet B, Modigliani E, et al. Transient hypocalcemia after thyroidectomy. Ann Otol Rhinol Laryngol 1993;102:496-501.  Back to cited text no. 15