{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T00:05:09Z","timestamp":1787702709583,"version":"build-2784847793"},"reference-count":38,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,11,30]],"date-time":"2021-11-30T00:00:00Z","timestamp":1638230400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100011645","name":"Kaohsiung Medical University Chung-Ho Memorial Hospital","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100011645","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004694","name":"Kaohsiung Medical University","doi-asserted-by":"publisher","award":["KMHK-DK(C)110009, KMHK-I-109-04, KMHK-H-109-05, KMHK-I-108-02"],"award-info":[{"award-number":["KMHK-DK(C)110009, KMHK-I-109-04, KMHK-H-109-05, KMHK-I-108-02"]}],"id":[{"id":"10.13039\/501100004694","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004663","name":"Ministry of Science and Technology, Taiwan","doi-asserted-by":"publisher","award":["MOST 108-2628-B-037-006, MOST 109-2628-B-037-014, MOST 110-2636-B-009-008, MOST 110-2314-B-037-104-MY2, MOST 110-2314-B-037-120"],"award-info":[{"award-number":["MOST 108-2628-B-037-006, MOST 109-2628-B-037-014, MOST 110-2636-B-009-008, MOST 110-2314-B-037-104-MY2, MOST 110-2314-B-037-120"]}],"id":[{"id":"10.13039\/501100004663","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>In patients with recurrent laryngeal nerve (RLN) injury after thyroid surgery, unrecovered vocal fold motion (VFM) and subjective voice impairment cause extreme distress. For surgeons, treating these poor outcomes is extremely challenging. To enable early treatment of VFM impairment, this study evaluated prognostic indicators of non-transection RLN injury and VFM impairment after thyroid surgery and evaluated correlations between intraoperative neuromonitoring (IONM) findings and perioperative voice parameters.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>82 adult patients had postoperative VFM impairment after thyroidectomy were enrolled. Demographic characteristics, RLN electromyography (EMG), and RLN injury mechanism were compared. Multi-dimensional voice program, voice range profile and Index of voice and swallowing handicap of thyroidectomy (IVST) were administered during I-preoperative; II-immediate, III-short-term and IV-long-term postoperative periods. The patients were divided into R\/U Group according to the VFM was recovered\/unrecovered 3 months after surgery. The patients in U Group were divided into U1\/U2 Group according to total IVST score change was &amp;lt;4 and \u22654 during period-IV.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Compared to R Group (42 patients), U Group (38 patients) had significantly more patients with EMG &amp;gt;90% decrease in the injured RLN (p&amp;lt;0.001) and thermal injury as the RLN injury mechanism (p=0.002). Voice parameter impairments were more severe in U Group compared to R Group. Compared to U1 group (19 patients), U2 Group (19 patients) had a significantly larger proportion of patients with EMG decrease &amp;gt;90% in the injured RLN (p=0.022) and thermal injury as the RLN injury mechanism (p=0.017). A large pitch range decrease in period-II was a prognostic indicator of a moderate\/severe long-term postoperative subjective voice impairment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This study is the first to evaluate correlations between IONM findings and voice outcomes in patients with VFM impairment after thyroid surgery. Thyroid surgeons should make every effort to avoid severe type RLN injury (e.g., thermal injury or injury causing EMG decrease &amp;gt;90%), which raises the risk of unrecovered VFM and moderate\/severe long-term postoperative subjective voice impairment. Using objective voice parameters (e.g., pitch range) as prognostic indicators not only enables surgeons to earlier identify patients with low voice satisfaction after surgery, and also enable implementation of interventions sufficiently early to maintain quality of life.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fendo.2021.755231","type":"journal-article","created":{"date-parts":[[2021,12,1]],"date-time":"2021-12-01T18:17:24Z","timestamp":1638382644000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":9,"title":["Prognostic Indicators of Non-Transection Nerve Injury and Vocal Fold Motion Impairment After Thyroid Surgery \u2013 Correlation Between Intraoperative Neuromonitoring Findings and Perioperative Voice Parameters"],"prefix":"10.3389","volume":"12","author":[{"given":"Tzu-Yen","family":"Huang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wing-Hei Viola","family":"Yu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Feng-Yu","family":"Chiang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Che-Wei","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shih-Chen","family":"Fu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"An-Shun","family":"Tai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi-Chu","family":"Lin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hsin-Yi","family":"Tseng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ka-Wo","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheng-Hsuan","family":"Lin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2021,11,30]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1097\/MLG.0b013e3180de4d49","article-title":"Vocal Fold Immobility: A Longitudinal Analysis of Etiology Over 20 Years","volume":"117","author":"Rosenthal","year":"2007","journal-title":"Laryngoscope"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1002\/hed.21970","article-title":"Verdicts on Malpractice Claims After Thyroid Surgery: Emerging Trends and Future Directions","volume":"34","author":"Dralle","year":"2012","journal-title":"Head Neck"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2008.02.006","article-title":"The Mechanism of Recurrent Laryngeal Nerve Injury During Thyroid Surgery\u2013the Application of Intraoperative Neuromonitoring","volume":"143","author":"Chiang","year":"2008","journal-title":"Surgery"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamcollsurg.2007.07.017","article-title":"Elucidating Mechanisms of Recurrent Laryngeal Nerve Injury During Thyroidectomy and Parathyroidectomy","volume":"206","author":"Snyder","year":"2008","journal-title":"J Am Coll Surg"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-009-0316-8","article-title":"Standardization of Intraoperative Neuromonitoring of Recurrent Laryngeal Nerve in Thyroid Operation","volume":"34","author":"Chiang","year":"2010","journal-title":"World J Surg"},{"key":"B6","doi-asserted-by":"publisher","first-page":"S1","DOI":"10.1002\/lary.21119","article-title":"Electrophysiologic Recurrent Laryngeal Nerve Monitoring During Thyroid and Parathyroid Surgery: International Standards Guideline Statement","author":"Randolph","year":"2011","journal-title":"Laryngoscope"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1111\/j.1742-1241.2008.01875.x","article-title":"Diagnosis of Recurrent Laryngeal Nerve Palsy After Thyroidectomy: A Systematic Review","volume":"63","author":"Jeannon","year":"2009","journal-title":"Int J Clin Pract"},{"key":"B8","article-title":"The Lateral Thyroid Ligament of Berry","volume":"83","author":"Leow","year":"1998","journal-title":"Int Surg"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijsu.2017.01.086","article-title":"Systematic Review With Meta-Analysis of Intraoperative Neuromonitoring During Thyroidectomy","volume":"39","author":"Yang","year":"2017","journal-title":"Int J Surg"},{"key":"B10","doi-asserted-by":"publisher","first-page":"S1","DOI":"10.1177\/0194599813487301","article-title":"Clinical Practice Guideline: Improving Voice Outcomes After Thyroid Surgery","volume":"148","author":"Chandrasekhar","year":"2013","journal-title":"Otolaryngology\u2014Head Neck Surg"},{"key":"B11","doi-asserted-by":"publisher","first-page":"79","DOI":"10.1016\/S0892-1997(05)80323-6","article-title":"Unilateral Recurrent Laryngeal Nerve Paralysis","volume":"8","author":"Crumley","year":"1994","journal-title":"J voice"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2004.09.008","article-title":"Recurrent Laryngeal Nerve Palsy After Thyroidectomy With Routine Identification of the Recurrent Laryngeal Nerve","volume":"137","author":"Chiang","year":"2005","journal-title":"Surgery"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-016-3415-3","article-title":"Severity of Recurrent Laryngeal Nerve Injuries in Thyroid Surgery","volume":"40","author":"Dionigi","year":"2016","journal-title":"World J Surg"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2013.08.015","article-title":"Intraoperative Neuromonitoring for the Early Detection and Prevention of RLN Traction Injury in Thyroid Surgery: A Porcine Model","volume":"155","author":"Wu","year":"2014","journal-title":"Surgery"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1002\/lary.26409","article-title":"Neuromuscular Compensation Mechanisms in Vocal Fold Paralysis and Paresis","volume":"127","author":"Dewan","year":"2017","journal-title":"Laryngoscope"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2021.788878","article-title":"Correlation Between Objective and Subjective High-Pitched Voice Impairment in Patients After Thyroid Surgery","volume":"12","author":"Huang","year":"2021","journal-title":"Front Endocrinol"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1002\/lary.21097","article-title":"Early Versus Late Injection Medialization for Unilateral Vocal Cord Paralysis","volume":"120","author":"Friedman","year":"2010","journal-title":"Laryngoscope"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1002\/lary.21965","article-title":"Effect of Temporary Vocal Fold Injection Medialization on the Rate of Permanent Medialization Laryngoplasty in Unilateral Vocal Fold Paralysis Patients","volume":"121","author":"Yung","year":"2011","journal-title":"Laryngoscope"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1016\/S1607-551X(10)70089-9","article-title":"Anatomical Variations of Recurrent Laryngeal Nerve During Thyroid Surgery: How to Identify and Handle the Variations With Intraoperative Neuromonitoring","volume":"26","author":"Chiang","year":"2010","journal-title":"Kaohsiung J Med Sci"},{"key":"B20","doi-asserted-by":"publisher","first-page":"88","DOI":"10.1016\/S0892-1997(97)80028-8","article-title":"Unilateral Recurrent Laryngeal Nerve Paralysis: The Importance of \u201cPreoperative\u201d Voice Therapy","volume":"11","author":"Heuer","year":"1997","journal-title":"J voice"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1016\/S1743-9191(13)60014-X","article-title":"Continuous Monitoring of the Recurrent Laryngeal Nerve in Thyroid Surgery: A Critical Appraisal","volume":"11","author":"Dionigi","year":"2013","journal-title":"Int J Surg"},{"key":"B22","doi-asserted-by":"publisher","first-page":"607","DOI":"10.21037\/gs.2016.11.10","article-title":"Continuous Intraoperative Neural Monitoring of the Recurrent Nerves in Thyroid Surgery: A Quantum Leap in Technology","volume":"5","author":"Schneider","year":"2016","journal-title":"Gland Surg"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-021-06225-x","article-title":"Intraoperative Neural Monitoring for Early Vocal Cord Function Assessment After Thyroid Surgery: A Systematic Review and Meta-Analysis","volume":"45","author":"Kim","year":"2021","journal-title":"World J Surg"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2021.638608","article-title":"Comparison of Surgical Complications Rates Between LigaSure Small Jaw and Clamp-And-Tie Hemostatic Technique in 1,000 Neuro-Monitored Thyroidectomies","volume":"12","author":"Liu","year":"2021","journal-title":"Front Endocrinol"},{"key":"B25","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1007\/978-3-030-23475-1_3","article-title":"Early Management of Unilateral Vocal Fold Paralysis","author":"Leclerc","year":"2019","journal-title":"Decision Making in Vocal Fold Paralysis"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2021.0155","article-title":"Varied RLN Course Is Associated With Increased Risk of Nerve Dysfunction During Thyroidectomy: Results of the Surgical Anatomy of the RLN in Thyroid Surgery (SAR) Study, an International Multicenter Prospective Anatomic and Electrophysiologic Study of 1000 Monitored Nerves at Risk From the International Neural Monitoring Study Group (INMSG)","volume":"31","author":"Liddy","year":"2021","journal-title":"Thyroid"},{"key":"B27","doi-asserted-by":"publisher","first-page":"226","DOI":"10.21037\/gs.2018.09.02","article-title":"Long-Term Quality of Voice Is Usually Acceptable After Initial Hoarseness Caused by a Thyroidectomy or a Parathyroidectomy","volume":"8","author":"Christakis","year":"2019","journal-title":"Gland Surg"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1177\/0194599819855379","article-title":"The Impact of Post-Thyroidectomy Paresis on Quality of Life in Patients With Nodular Thyroid Disease","volume":"161","author":"Sorensen","year":"2019","journal-title":"Otolaryngology\u2013Head Neck Surg"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1177\/0003489419858629","article-title":"Quality of Voice and Prognostic Markers for the Recovery of Vocal Fold Paralysis After Thyroid Surgery","volume":"128","author":"Reiter","year":"2019","journal-title":"Ann Otol Rhinol Laryngol"},{"key":"B30","doi-asserted-by":"publisher","first-page":"299","DOI":"10.1007\/s00268-005-0399-9","article-title":"The Efficacy of Intraoperative Corticosteroids in Recurrent Laryngeal Nerve Palsy After Thyroid Surgery","volume":"30","author":"Wang","year":"2006","journal-title":"World J Surg"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1177\/000348940911800709","article-title":"Diagnosis and Prognosis of Iatrogenic Injury of the Recurrent Laryngeal Nerve","volume":"118","author":"Hydman","year":"2009","journal-title":"Ann Otol Rhinol Laryngol"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1080\/02656736.2018.1554826","article-title":"Management Strategy for Nerve Damage During Radiofrequency Ablation of Thyroid Nodules","volume":"36","author":"Chung","year":"2019","journal-title":"Int J Hyperthermia"},{"key":"B33","doi-asserted-by":"publisher","first-page":"796","DOI":"10.1016\/j.surg.2017.09.023","article-title":"Long-Term Voice Quality Outcomes After Total Thyroidectomy: A Prospective Multicenter Study","volume":"163","author":"Borel","year":"2018","journal-title":"Surgery"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.1007\/s00423-016-1381-8","article-title":"Recurrent Laryngeal Nerve Injury With Incomplete Loss of Electromyography Signal During Monitored Thyroidectomy\u2014Evaluation and Outcome","volume":"402","author":"Wu","year":"2017","journal-title":"Langenbeck\u2019s Arch Surg"},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2009.0397","article-title":"Utility of Injection Laryngoplasty in the Management of Post-Thyroidectomy Vocal Cord Paralysis","volume":"20","author":"Lee","year":"2010","journal-title":"Thyroid"},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.1002\/lary.27140","article-title":"A Long-Term Comparative Prospective Study Between Reinnervation and Injection Laryngoplasty","volume":"128","author":"Lee","year":"2018","journal-title":"Laryngoscope"},{"key":"B37","doi-asserted-by":"publisher","first-page":"S43","DOI":"10.21037\/gs.2019.10.24","article-title":"Neural Monitoring in Thyroid Surgery Is Here to Stay","volume":"9","author":"Zhang","year":"2020","journal-title":"Gland Surg"},{"key":"B38","doi-asserted-by":"publisher","DOI":"10.1002\/lary.25739","article-title":"A Comparison of Outcomes in Interventions for Unilateral Vocal Fold Paralysis: A Systematic Review","volume":"126","author":"Siu","year":"2016","journal-title":"Laryngoscope"}],"container-title":["Frontiers in Endocrinology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2021.755231\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,1]],"date-time":"2021-12-01T18:17:28Z","timestamp":1638382648000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2021.755231\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,11,30]]},"references-count":38,"alternative-id":["10.3389\/fendo.2021.755231"],"URL":"https:\/\/doi.org\/10.3389\/fendo.2021.755231","relation":{},"ISSN":["1664-2392"],"issn-type":[{"value":"1664-2392","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,11,30]]},"article-number":"755231"}}