What is recurrent laryngeal nerve palsy complication of thyroidectomy?

Most feared one, due to total or partial transection, traction, contusion, crush, burn, misplaced ligamture, compromised blood supply Intraop identification of RLN is necessary Consequences (vocal cord paresis/paralysis, transient in 2.6-10% recover w/in 6 months, permenant 0-5.5% no recovery after 6-12 months postop Unilateral paralysis [hoarseness, breathiness, dysphagia aspiration] Bilateral paralysis after intubation [stridor, respiratory distress or both]) Tx: unilateral paralysis after 6 months go for surgery medialization Bilateral emergency tracheotomy may be required but first endotracheal intubation, cordotomy and arytendoidectomy done to enlarge airway and permit decanulation of tracheasotomy