Unexpected postoperative incidental recurrent laryngeal nerve palsy post total thyroidectomy after intraoperative nerve monitoring (overstimulation and fatigability): a case report.

Background: Postoperative recurrent or permanent recurrent laryngeal nerve injury is one of the most serious complications in the field of thyroid surgery, in either benign or malignant thyroid disease, significantly affecting patients' quality of life. The importance of recurrent laryngeal nerve identification intraoperatively reduces the risk of injury. We report herein a young patient who underwent nerve monitoring in total thyroidectomy that led to recurrent laryngeal nerve injury.

Case presentation: We report a 30-year-old Arab male patient who presented to our clinic with a longstanding thyroid swelling, which was reported as papillary thyroid carcinoma, and was scheduled for total thyroidectomy and lymph node dissection. Nerve monitoring was used to identify the recurrent laryngeal nerve, leading to recurrent laryngeal nerve nerve fatigability/paresis that was seen during the postoperative course.

Conclusion: Visual identification of the recurrent laryngeal nerve is the gold standard for nerve protection. We recommend the use of nerve monitoring as an adjunct in challenging cases but not in routine settings, as it does not decrease the incidence of injuries compared with visualization alone in our experience.