RECURRENT LARYNGEAL NERVE AND PARATHYROID GLAND SAVING BY SPRAYING METHYLENE BLUE DURING THYROIDECTOMY

Background:Visualization and saving of the recurrent laryngeal nerve (RLN) and parathyroid glands (PGs) are the most important two points during thyroid surgery. The aim of the study is evatulation of the use of intra operative methylene blue spraying during thyroidectomy in saving RLN and PGs. Patient and methods: Our study was done in general surgery department of Zagazig University hospital from March 2017 to September 2018 and follow up for about 6 months, included (53) patients with different types of goiter operated by total thyroidectomy with intra operative methylene blue spraying. Patients with recurrent thyroid surgery, preoperative vocal cords paresis, or retrosternal goiter were excluded. The patients underwent complete history taking, clinical examination, laboratory investigations including serum calcium level,TSH,freeT3,T4, neck US, C.T neck in some cases and indirect laryngoscopy pre and post operatively to assess the vocal cords mobility pre-and postoperatively. Informed consent was taken from all patients. Results: the study involved (53) cases, 43 females (81.1%) and 10 males (18.9%); age ranged from 27 to 61 years (mean: 41,5 year),the patients had; 35 (66.04%) simple nodular goiters, 9(16.98%) solitary thyroid adenoma,5 (9.43%) papillary thyroid carcinoma and 4 (7.55%) Graves? disease. Patients mean dischargedwere 1.6 days (1?4 days) with no cases of wound complications or operative mortality. 4 cases (7.55%) suffered from transient hypocalcaemia, for a maximum of four days. the RLN can be visualized in 47 cases (88.7%) after spraying the MB firstly but in the remaining six cases(11.3%) the RLN was present in deeper level and need more dissection until it is detected and saved. No cases were encountered of RLN injury with vocal cords paralysis or hypoparathyroidism