ACDF, solid thyroid nodule and unilateral vocal fold paralysis
My c6-c7 acdf surgery resulted in a permanently paralyzed recurrent laryngeal nerve (RLN). It has been a year and a hope for a recovery is now completely gone. I have a very hoarse voice and other problems associated with unilateral vocal fold paralysis. I am curious if anyone knows whether a thyroid nodule located directly behind the incision could have contributed to this?
The RLN is located directly behind the thyroid close to the trachea and esophagus. During the acdf surgery the thyroid gets pushed into the trachea in order to gain access to the spine. When the retractors are put in place the thyroid, RLN, and trachea are squeezed and stretched (I have a diagram that articulates this very well but I don't know how to attach, if possible). My point is, can an enlarged thyroid located behind the incision increase the stretch of the RLN making it prone to injury?
I am curious if anyone familiar with the anatomy of the neck and the acdf procedure can provide their input. If you know of any studies on thyroid nodules and the effect they have on RLN stretch during acdf procedures I would greatly appreciate your input.