Review: Thyroid Surgery Neural Dysfunction Guidelines
Detailed critical review of: Dhillon VK, Randolph GW, Stack BC Jr, et al. Head & Neck 2020. Takes on flawed terminology (“immediate VFP”) and offers corrected statements for each of the paper’s 5 consensus points.
Key arguments: “Vocal fold paralysis” is wrong terminology for surgical nerve injury — it should be “nerve injury/paresis.” Pre- and post-operative neurolaryngeal exam (audio + video) is the only way to document and reveal surgical nerve injury incidence. Stroboscopy must be performed across a range of pitch and volume to unmask compensation. Waiting “two months” before checking patient complaints = the “Ostrich approach to surgery.”
Specific vocal capabilities measures: Maximum phonation time, vocal range, volume. If vocal capabilities are not equivalent post-op, a nerve injury has occurred. Recovery may continue for up to 20 years after injury (e.g., laryngospasm worsening over decades).
Migration note: Highly substantive. Relevant to Neurolaryngology (Part II) and Part III Examination sections. Could anchor a “Thyroid Surgery and the Voice” educational page.
