{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T02:44:44Z","timestamp":1773974684488,"version":"3.50.1"},"reference-count":25,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2024,10,7]],"date-time":"2024-10-07T00:00:00Z","timestamp":1728259200000},"content-version":"vor","delay-in-days":6,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["ANZ Journal of Surgery"],"published-print":{"date-parts":[[2024,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Recurrent laryngeal nerve (RLN) injury is a known complication of thyroidectomy. Most cases manifest immediately and are promptly recognized. Rarely, some patients experience delayed\u2010onset vocal cord palsy. This can occur despite normal findings on intra\u2010operative nerve monitoring and initial post\u2010operative endoscopy. This can cause considerable distress for patients, and its incidence and prognosis should be recognized.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methodology<\/jats:title><jats:p>We report seven patients experiencing delayed\u2010onset RLN palsy (RLNP) after thyroidectomy. All had normal findings on pre\u2010operative flexible nasoendoscopy (FNE), intra\u2010operative nerve monitoring at conclusion of surgery, and initial post\u2010operative FNE. All diagnoses of RLNP were confirmed on endoscopy. Serial FNE examinations were performed to evaluate recovery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of seven patients (43% male, median age 65\u2009years), the median timing of delayed\u2010onset RLNP was 12 (range 9\u201335) days. RLNP was diagnosed on the unilateral side of surgery in six out of seven patients (86%). All received conservative management, including referral to voice therapy. All seven patients recovered vocal cord function after a median duration of 24\u2009weeks (range 8\u201352\u2009weeks), and six within ~6\u2009months (28\u2009weeks). The incidence of this complication was 0.1% (among 6607 thyroidectomies).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>We report the first Australian series of delayed\u2010onset vocal cord palsy after thyroidectomy. We explore its prognosis, discussing different pathophysiological mechanisms and the timeframe for recovery compared to most other RLN injuries. This may assist recognition of a rare complication, reassure patients, and facilitate early intervention to improve a patient's quality of life.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ans.19235","type":"journal-article","created":{"date-parts":[[2024,10,7]],"date-time":"2024-10-07T09:59:22Z","timestamp":1728295162000},"page":"1794-1799","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Delayed\u2010onset vocal cord palsy after thyroidectomy occurring despite normal initial post\u2010operative endoscopy"],"prefix":"10.1111","volume":"94","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0119-4834","authenticated-orcid":false,"given":"Tianrui","family":"Ren","sequence":"first","affiliation":[{"name":"Monash University Endocrine Surgery Unit Alfred Hospital  Melbourne Victoria 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