A 45-year-old woman undergoes total thyroidectomy for a multinodular goitre. On postoperative day 2, she develops hoarseness but no stridor. Indirect laryngoscopy shows a paralysed left vocal cord in the paramedian position. What is the most likely cause?

• A Post-extubation laryngeal oedema
• B Bilateral recurrent laryngeal nerve injury
• C Superior laryngeal nerve injury
• D Unilateral recurrent laryngeal nerve injury ✓

Explanation

Unilateral recurrent laryngeal nerve injury causes ipsilateral vocal cord paralysis in the paramedian position, presenting with hoarseness but no airway compromise. Bilateral injury causes stridor and airway obstruction. Superior laryngeal nerve injury causes loss of high-pitched voice and aspiration, not cord paralysis. Post-extubation oedema does not cause isolated cord paralysis.

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

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