Sezer AKBULUT, Tuğba MATLIM ÖZEL, Aykut ÇELİK, Murat ALTAY, Begüm Bahar YILMAZ, Hamit Yücel BARUT, Serkan SARI
İstanbul Medical Journal - 2026;27(3):207-211
Introduction: Recurrent laryngeal nerve injury is a major complication of thyroid and parathyroid surgery and may cause vocal cord movement impairment (VCMI), which can be symptomatic or silent. Early postoperative evaluation is essential. Flexible nasolaryngoscopy (FNL) is the reference standard, but may be limited by invasiveness and practical constraints. Transcutaneous laryngeal ultrasonography (TLUS) has emerged as a non-invasive alternative, although its diagnostic performance remains controversial. Methods: This observational study included patients undergoing thyroid or parathyroid surgery between January 2026 and April 2026. Patients younger than 18 years or those with known vocal cord pathology were excluded. All patients underwent preoperative and postoperative FNL. Postoperative TLUS was performed in a blinded manner by an experienced radiologist (H.Y.B). VCMI was defined as reduced, asymmetric, or absent vocal cord mobility. TLUS performance was evaluated using FNL as the reference standard. Results: A total of 102 patients were included. Postoperative FNL identified VCMI in 4 patients (3.9%). TLUS suggested VCMI in 1 patient (1.0%), whereas laryngeal landmarks were visualized in all patients (100%). Using FNL as the reference standard, TLUS demonstrated a specificity of 99.0%, a negative predictive value of 96.0%, and an overall diagnostic accuracy of 95.1%. No true-positive cases were observed, and sensitivity could not be meaningfully assessed. Conclusion: TLUS is a feasible, non-invasive adjunct for postoperative vocal cord assessment after thyroid and parathyroid surgery. It may serve as a practical complementary tool when laryngeal landmarks are adequately visualized; FNL, however remains the reference standard for definitive evaluation.
