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Lateral neck dissection affects the voice in thyroid cancer patients

  • I-C Nam (a1), J-S Bae (a2), S-H Lee (a2), J-O Park (a3), S-Y Kim (a1), Y-H Joo (a1), Y-H Park (a1) and D-I Sun (a1)...



This study aimed to identify the effect of lateral neck dissection on voice change in thyroidectomised patients.


Medical records from 264 patients who underwent thyroidectomy with (n = 65) or without (n = 199) lateral neck dissection were reviewed. Clinical and voice evaluation data were compared between the two groups.


Patients who underwent surgery that included lateral neck dissection had lower fundamental frequencies and speaking fundamental frequencies. They also had a higher incidence of asymmetric mucosal wave and vocal fold oedema on videostroboscopy during the first month after surgery, with the incidence of vocal fold oedema remaining significantly higher at three months. Self-assessed voice quality scores were significantly higher in lateral neck dissection patients at both one and three months after surgery.


In thyroidectomised patients, lateral neck dissection lowers the vocal pitch in the initial period after surgery and induces vocal fold oedema that persists for several months. Although most objective parameters improved within a month, subjective symptoms lasted for longer.


Corresponding author

Address for correspondence: Dr D-I Sun, Department of Otolaryngology – Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea Fax: +82 2 595 1354 E-mail:


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1 Musholt, TJ, Musholt, PB, Garm, J, Napiontek, U, Keilmann, A. Changes of the speaking and singing voice after thyroid or parathyroid surgery. Surgery 2006;140:978–88
2 Rosato, L, Carlevato, MT, De Toma, G, Avenia, N. Recurrent laryngeal nerve damage and phonetic modifications after total thyroidectomy: surgical malpractice only or predictable sequence? World J Surg 2005;29:780–4
3 Stojadinovic, A, Shaha, AR, Orlikoff, RF, Nissan, A, Kornak, MF, Singh, B et al. Prospective functional voice assessment in patients undergoing thyroid surgery. Ann Surg 2002;236:823–32
4 Aluffi, P, Policarpo, M, Cherovac, C, Olina, M, Dosdegani, R, Pia, F. Post-thyroidectomy superior laryngeal nerve injury. Eur Arch Otorhinolaryngol 2001;258:451–4
5 Bellantone, R, Boscherini, M, Lombardi, CP, Bossola, M, Rubino, F, De Crea, C et al. Is the identification of the external branch of the superior laryngeal nerve mandatory in thyroid operation? Results of a prospective randomized study. Surgery 2001;130:1055–9
6 Van Lierde, K, D'Haeseleer, E, Wuyts, FL, Baudonck, N, Bernaert, L, Vermeersch, H. Impact of thyroidectomy without laryngeal nerve injury on vocal quality characteristics: an objective multiparameter approach. Laryngoscope 2010;120:338–45
7 Nam, IC, Bae, JS, Chae, BJ, Shim, MR, Hwang, YS, Sun, DI. Therapeutic approach to patients with a lower-pitched voice after thyroidectomy. World J Surg 2013;37:1940–50
8 Sinagra, DL, Montesinos, MR, Tacchi, VA, Moreno, JC, Falco, JE, Mezzadri, NA et al. Voice changes after thyroidectomy without recurrent laryngeal nerve injury. J Am Coll Surg 2004;199:556–60
9 Nam, IC, Cho, YJ, Bae, JS, Lee, SH, Park, JO, Shim, MR et al. Female sex, central lymph node metastasis and dissection are causes of globus symptom after thyroidectomy. Eur Arch Otorhinolaryngol 2016;273:1607–13
10 Nam, IC, Bae, JS, Shim, MR, Hwang, YS, Kim, MS, Sun, DI. The importance of preoperative laryngeal examination before thyroidectomy and the usefulness of a voice questionnaire in screening. World J Surg 2012;36:303–9
11 Debruyne, F, Ostyn, F, Delaere, P, Wellens, W. Acoustic analysis of the speaking voice after thyroidectomy. J Voice 1997;11:479–82
12 Hong, KH, Kim, YK. Phonatory characteristics of patients undergoing thyroidectomy without laryngeal nerve injury. Otolaryngol Head Neck Surg 1997;117:399404
13 Kark, AE, Kissin, MW, Auerbach, R, Meikle, M. Voice changes after thyroidectomy: role of the external laryngeal nerve. Br Med J (Clin Res Ed) 1984;289:1412–15
14 McIvor, NP, Flint, DJ, Gillibrand, J, Morton, RP. Thyroid surgery and voice-related outcomes. Aust N Z J Surg 2000;70:179–83
15 Soylu, L, Ozbas, S, Uslu, HY, Kocak, S. The evaluation of the causes of subjective voice disturbances after thyroid surgery. Am J Surg 2007;194:317–22
16 Vilkman, E, Sonninen, A, Hurme, P, Korkko, P. External laryngeal frame function in voice production revisited: a review. J Voice 1996;10:7892
17 Lee, J, Na, KY, Kim, RM, Oh, Y, Lee, JH, Lee, J et al. Postoperative functional voice changes after conventional open or robotic thyroidectomy: a prospective trial. Ann Surg Oncol 2012;19:2963–70
18 Maeda, T, Saito, M, Otsuki, N, Morimoto, K, Takahashi, M, Iwaki, S et al. Voice quality after surgical treatment for thyroid cancer. Thyroid 2013;23:847–53
19 Ryu, J, Ryu, YM, Jung, YS, Kim, SJ, Lee, YJ, Lee, EK et al. Extent of thyroidectomy affects vocal and throat functions: a prospective observational study of lobectomy versus total thyroidectomy. Surgery 2013;154:611–20
20 Chun, BJ, Bae, JS, Lee, SH, Joo, J, Kim, ES, Sun, DI. A prospective randomized controlled trial of the laryngeal mask airway versus the endotracheal intubation in the thyroid surgery: evaluation of postoperative voice, and laryngopharyngeal symptom. World J Surg 2015;39:1713–20
21 Worni, M, Schudel, HH, Seifert, E, Inglin, R, Hagemann, M, Vorburger, SA et al. Randomized controlled trial on single dose steroid before thyroidectomy for benign disease to improve postoperative nausea, pain, and vocal function. Ann Surg 2008;248:1060–6



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