Thyroidectomy Results in Permanent Recurrent Laryngeal Nerve Injury

Case Overview

This case study delves into an incident involving an adult patient who underwent an elective thyroidectomy for benign thyroid disease. The procedure, which took place in December, involved the ligation of the recurrent laryngeal nerve on one side. Despite the use of nerve monitoring during the operation, the patient now experiences dysphagia and hoarseness that are not expected to improve further.

The crux of this case is whether the standard of care was upheld during this procedure. An expert otolaryngologist with a wealth of experience in thyroid surgery has been called upon to review the medical records and provide their professional opinion.

Questions to the Otolaryngology expert and their responses

How frequently do you perform thyroidectomies for benign thyroid diseases?

As a board-certified head and neck surgeon with fellowship training from Memorial Sloan-Kettering Cancer Center, I have been performing thyroid surgeries for both benign and malignant conditions regularly over the last 20+ years.

My role as Chair of the Division of Otolaryngology at Harbor-UCLA Medical Center, a Level I Trauma Center within Los Angeles county, involves direct involvement in training resident trainees and overseeing numerous procedures.

What aspects of a patient's records who had an RLN injury following thyroidectomy that is deemed permanent are important in determining why the injury occurred and what could have been done, if anything, to prevent the injury?

Reviewing the operative report and pathology report can often shed light on how or why the recurrent laryngeal nerve was injured. These documents contain crucial information about the procedure itself and any anomalies or complications encountered during surgery.

Have you ever reviewed a similar case? If yes, please elaborate.

Yes, I have reviewed at least ten previous cases involving injury to the recurrent laryngeal nerve during thyroid surgery. Each case presents unique circumstances and challenges, but the common thread is understanding how the injury occurred and whether it could have been prevented.

About the expert

This expert is a seasoned otolaryngologist with over two decades of experience, board-certified and an active member of the American Academy of Otolaryngology. They have a distinguished academic background, including a fellowship in head and neck surgical oncology from a renowned cancer center, and have contributed significantly to medical literature with over 20 peer-reviewed publications. Currently serving as the chief of otolaryngology and ENT at a top university-affiliated medical center, their extensive clinical and academic expertise makes them highly relevant for this case study involving thyroid surgery complications.

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Specialties:

Otolaryngology

Dr. Wendy Ketner is a distinguished medical professional with a comprehensive background in surgery and medical research. Currently serving as the Senior Vice President of Medical Affairs at the Expert Institute, she plays a pivotal role in overseeing the organization's most important client relationships. Dr. Ketner's extensive surgical training was completed at Mount Sinai Beth Israel, where she gained hands-on experience in various general surgery procedures, including hernia repairs, cholecystectomies, appendectomies, mastectomies for breast cancer, breast reconstruction, surgical oncology, vascular surgery, and colorectal surgery. She also provided care in the surgical intensive care unit.

Her research interests have focused on post-mastectomy reconstruction and the surgical treatment of gastric cancer, including co-authoring a textbook chapter on the subject. Additionally, she has contributed to research on the percutaneous delivery of stem cells following myocardial infarction.

Dr. Ketner's educational background includes a Bachelor's degree from Yale University in Latin American Studies and a Doctor of Medicine (M.D.) from SUNY Downstate College of Medicine. Moreover, she is a member of the Board of Advisors for Opollo Technologies, a fintech healthcare AI company, contributing her medical expertise to enhance healthcare technology solutions. Her role at Expert Institute involves leveraging her medical knowledge to provide insights into legal cases, underscoring her unique blend of medical and legal acumen.