Thyroid reoperations are surgically challenging because of scarring and disturbances in the anatomy of the recurrent laryngeal\nnerve (RLN). This study was conducted on 49 patients who underwent redo surgery. 61 RLNs were identified and completely\nexposed. Their functional integrity was evaluated using intraoperative nerve monitoring (IONM). Indications for secondary\nsurgery, anatomical changes secondary to recurrent goiter mass and prior surgery, and results of IONM were studied. Frequent\nindications for redo surgery were multinodular goiter (MNG) in 19 (38.8%) and results of cytology in 14 (28.5%) patients. The\nmean time interval between primary and redo thyroid surgery was 23.4 years. We laterally approached 41 (67.2%) thyroid lobes\nbetween the sternocleidomastoid and sternohyoid muscles. 16 (26.2%) RLNs were found to be adherent to the lateral surface of the\ncorresponding thyroid lobe. The functional integrity of all RLNs was confirmed by IONM. The remnant thyroid tissue can then\nlead to goiter recurrence requiring secondary surgery after a long period of time.The indications for redo surgery were similar to\nprimary cases. Lateral displacement of the RLNwhich is adherent to the lateral surface of recurrent goiter mass is common anatomic\nvariation.Thyroid reoperations based on awareness of anatomical disturbances can be performed safely by an experienced surgeon\nwith support of ancillary electrophysiological technology.
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