Postoperative Vocal Cord Mobility, Recurrent Laryngeal Nerve Injury
Conditions
Keywords
Thyroidectomy, Macintosh Laryngoscope, Videolaryngoscope, Airway Management, Vocal Cord Mobility, Recurrent Laryngeal Nerve
Brief summary
This study compares two different laryngoscopes-the C-MAC D-Blade videolaryngoscope and the Macintosh direct laryngoscope-for evaluating vocal cord mobility after thyroidectomy. Patients undergo standard anesthesia and intubation with one of the two devices. After surgery, vocal cord function is assessed to identify early postoperative vocal cord impairment. The study aims to determine whether videolaryngoscopy provides a more reliable and less traumatic method for postoperative vocal cord evaluation compared with the traditional Macintosh laryngoscope.
Detailed description
This prospective randomized study evaluates two laryngoscopic techniques used during endotracheal intubation in patients undergoing thyroidectomy. The C-MAC D-Blade videolaryngoscope provides an angulated blade and video-assisted view of the glottis, while the Macintosh laryngoscope represents the traditional direct visualization method. Because postoperative vocal cord impairment is an important early indicator of potential recurrent laryngeal nerve injury after thyroidectomy, accurate assessment immediately after surgery is clinically valuable. In this study, eligible patients were randomly assigned to intubation using either the C-MAC D-Blade videolaryngoscope or the Macintosh laryngoscope. All procedures were performed under standard anesthesia protocols by experienced anesthesiologists. After extubation and recovery, vocal cord mobility was evaluated using a standardized six-grade scoring system to assess postoperative vocal cord function. The study compares intubation characteristics, glottic views, optimization maneuvers, hemodynamic responses, and postoperative vocal cord mobility between the two devices. The primary aim is to determine whether videolaryngoscopy offers a more reliable and less traumatic method for postoperative vocal cord evaluation. Secondary objectives include evaluating ease of intubation, maneuver requirements, and perioperative physiological responses. The findings may help guide device selection for airway management in thyroid surgery and improve early detection of recurrent laryngeal nerve dysfunction.
Interventions
DEVICEVideolaryngoscope (C-MAC D-Blade)
The C-MAC D-Blade videolaryngoscope was used to perform endotracheal intubation and to obtain a video-assisted view of the glottis. Its angulated blade design allows indirect visualization, providing improved glottic exposure during intubation and postoperative vocal cord mobility assessment
DEVICEDirect Laryngoscope (Macintosh)
The Macintosh direct laryngoscope was used for endotracheal intubation with conventional direct visualization of the glottis. This standard laryngoscopic technique was also used for postoperative assessment of vocal cord mobility.
Sponsors
Inonu University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
DIAGNOSTIC
Masking
DOUBLE (Subject, Caregiver)
Masking description
Randomization was performed by an anesthesiologist not involved in the study procedures, ensuring that the participant, care provider, and investigator remained masked to group assignment. The outcomes assessor was not masked.
Intervention model description
Participants were randomly assigned in a 1:1 ratio to either the C-MAC D-Blade videolaryngoscope group or the Macintosh laryngoscope group. Both groups were followed and evaluated in parallel throughout the study.
Eligibility
Sex/Gender
ALL
Age
20 Years to 70 Years
Healthy volunteers
No
Inclusion criteria
* Age between 20 and 70 years. * Height greater than 145 cm. * Body mass index (BMI) between 20 and 35 kg/m². * American Society of Anesthesiologists (ASA) physical status * Scheduled for elective thyroid surgery under general anesthesia.
Exclusion criteria
* Prior neck surgery or radiotherapy * Large thyroid mass causing severe anatomical distortion. * Mouth opening less than 4 cm. * Short neck less than 6 cm in length. * Limited head and neck mobility * Unexpected difficult intubation. * Known history of recurrent laryngeal nerve injury * Presence of any neurological disorder.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Postoperative Vocal Cord Mobility Score | Within 30 minutes after extubation | Vocal cord mobility will be assessed using a standardized six-grade scoring system (I-VI) to detect postoperative vocal cord impairment after thyroidectomy. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Glottic View (Cormack-Lehane Grade) | During intubation procedure | The view of the glottis during intubation will be assessed using the Cormack-Lehane grading system. |
| Need for Optimization Maneuvers | During intubation procedure | Whether external laryngeal maneuvers or additional attempts were required to facilitate intubation. |
Countries
Turkey (Türkiye)
Outcome results
None listed