Study of the Use of Methylene Blue Spraying in Identification of Recurrent Laryngeal Nerve During Thyroid Surgery MC01-MC04
Dr. Rashmi Shankargouda Patil,
Assistant Professor, Department of ENT, Bapuji Hospital, JJM Medical College, Davanagere-577004, Karnataka, India.
Introduction: Thyroidectomy is one of the most commonly performed surgeries in iodine deficient regions. Injury to parathyroids and Recurrent Laryngeal Nerve (RLN) are two of the complications of thyroidectomy that cause significant postoperative morbidity. Hence, intraoperative identification of these structures and prevention of iatrogenic injury are important.
Aim: To study the use of methylene blue spray in identification of RLN during thyroid surgery.
Materials and Methods: This was a prospective study done on patients who presented to ENT OPD in teaching hospitals attached to JJM medical college, Davangere (Bapuji Hospital and Chigateri general hospital). After indirect laryngoscopic confirmation of normal vocal cord mobility, 30 patients chosen at random underwent thyroidectomy. During the surgery, after ligation of superior pole of thyroid and before ligation of inferior pole, methylene blue dye, in a 1:10 dilution (with normal saline) was sprayed over the thyroid lobe and perilobar area, in the region where RLN is expected to be found. RLN and parathyroid glands were identified and safe dissection of the thyroid, without injuring these structures was ensured.
Results: RLN was not stained and remained white in all the cases, in contrast to the blue stained surrounding tissue, and could be identified easily. The parathyroid glands washed out the stain within 3 minutes and were visible in its normal yellow colour in all cases.
Conclusion: Spraying of methylene blue dye during dissection of thyroid is a safe and effective method for identification and avoiding injury to RLN and parathyroid glands during thyroid surgeries.