M. Arif Karakaya1, Okay Koç2, Feza Ekiz3, A. Feran Ağaçhan4, Nuri Emrah Göret4

1Department of General Surgery, Forensic Medicine Institute, İstanbul, Turkey
2Clinic of Gastroenterology, Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey
3Department of General Surgery, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
4Clinic of General Surgery, Kartal Dr. Lütfi Kırdar Training and Research Hospital, İstanbul, Turkey


Objective: The aim of this study was to evaluate the approach of Forensic Medicine Institution for recurrent laryngeal nerve injuries. In addition, parameters that were taken into consideration by Forensic Medicine Institution in the differentiation of complication and malpractice were evaluated.
Material and Methods: The files of 38 patients, with recurrent laryngeal nerve injury following thyroidectomy, that were referred to Istanbul Forensic Medicine Institute with request of expert opinion between 2008-2012 were retrospectively investigated. Data regarding expert decisions, age, gender, diagnosis, hospital type, preoperative vocal cord examination, intraoperative nerve monitoring (IONM), identification of nerve injury during operation, repair of nerve during operation, and type of injury were assessed.
Results: Surgeons were found to be faulty in all files with bilateral nerve injury, however, one-sided injury files were considered as a medical complication. Twenty-one (55.2%) patients were female, and 17 (44.8%) were male, with a mean age of 35,8 in women, and 34,1 in men. None of these patients had undergone preoperative vocal cord assessment. The recurrent laryngeal nerve was intraoperatively identified in 21 (55.2%) patients, while it was not seen in 17 (44.8%) patients. IONM was not applied in any patients. There was no attempt for nerve repair during any operation. Nineteen patients had unilateral, and 19 patients had bilateral nerve damage.
Conclusion: Bilateral recurrent laryngeal nerve injuries are considered as malpractice, when imaging or pathology reports fail to state a cause for difficulty in nerve identification.

Keywords: Recurrent laryngeal nerve, thyroidectomy, complications, forensic medicine


Ethics Committee Approval

Ethics committee approval was received for this study from the ethics committee of İstanbul Forensic Medicine Institution.

Peer Review

Externally peer-reviewed.

Author Contributions

Concept - M.A.K., A.F.A.; Design - M.A.K.; Supervision - A.F.A.; Funding - M.A.K., O.K.; Materials - M.A.K., N.E.G.; Data Collection and/or Processing - M.A.K.; Analysis and/or Interpretation - A.F.A., F.E.; Literature Review - O.K.; Writer - O.K., A.F.A.; Critical Review - M.A.K., A.F.A.

Conflict of Interest

No conflict of interest was declared by the authors.

Financial Disclosure

The authors declared that this study has received no financial support.