A patient undergoing total thyroidectomy for papillary thyroid carcinoma develops bilateral vocal cord paralysis immediately after extubation. What is the immediate life-saving maneuver?

• A Bilateral arytenoidectomy
• B Intravenous methylprednisolone and observation
• C Emergency reintubation or tracheostomy ✓
• D Vocal cord lateralization procedure

Explanation

Bilateral recurrent laryngeal nerve injury causes adduction of both vocal cords to the paramedian position, resulting in severe stridor and acute airway obstruction — a life-threatening emergency. Immediate reintubation or emergency tracheostomy is required to secure the airway. Bilateral arytenoidectomy or vocal cord lateralization are elective surgical procedures performed weeks later to achieve a functional airway. Steroids may reduce post-operative edema but cannot address mechanical cord adduction rapidly enough. Airway security takes absolute priority.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.