laryngoscopy, thyroid surgery and recurrent nerve lesions:who is to blame?

As a personal opinion, we do not perform routine VC assessment after thyroid surgery, for either nociceptive stimulation and hemodynamic response, while we rather plan a protected extubation strategy in all cases where a difficult intubation was observed or a difficult extubation might be expected8. Finally, we would remark that despite controversial results, intraoperative neuromonitoring in thyroidectomy represents today a standard of care9, and we further suggest the potential role of ultrasounds which could be easily used to assess vocal cords before and after surgery in the context of a perioperative airway evaluation10. We should never forget that larynx and vocal cords are highly reactive and sensible structures, so we do believe that the less we stimulate them and the lower the manipulation, the better will be laryngeal outcome in our patients.