Methylene Blue Spray for Identification of Recurrent Laryngeal Nerve and Parathyroid Gland

Study Overview
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Brief Summary
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Thyroidectomy is the procedure by which surgeons treat various thyroid diseases and is considered the commonest endocrinal surgery. Yet, it carries a risk for intraoperative complications. The most distressing complications are recurrent laryngeal nerve and parathyroid injuries. Methylene blue spray is a technique than can be used for easy identification of both recurrent laryngeal nerve and parathyroid glands so we can avoid their injuries.

Detailed Description
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Thyroid disorders constitute the second most common endocrine disease following diabetes mellitus. Thyroid surgery is one of the most frequently operated Head and Neck surgeries. Post-thyroidectomy complications are not uncommon. Parathyroids and Recurrent Laryngeal Nerve (RLN) are two of the complications of thyroidectomy that cause significant postoperative morbidity Due to the advances in thyroids surgeries, the occurrence of postoperative complications has been decreased, but when occurred, they cause lifelong handicap. The most important complications encountered are injury to the RLN and parathyroids. Meticulous dissection is a key factor in minimizing the occurrence of complications During thyroidectomy, careful dissection can protect the parathyroid glands and RLN. Various methods were used including capsular dissection, attention to protection of the arterial supply to parathyroids, avoiding unnecessary manipulation in the area of RLN Methylene blue spraying is a new technique that allows identification of both parathyroid glands and recurrent laryngeal nerves

Official Title
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Methylene Blue Spray for Identification of Recurrent Laryngeal Nerve and Parathyroid Glands During Thyroidectomy: A Randomized Controlled Trial

Conditions
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Methylene Blue, Recurrent Laryngeal Nerve Injuries, Parathyroid Gland

Intervention / Treatment
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* Diagnostic Test: methylene blue identification


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age of 16 years and older. Both sexes. Patients who are candidate for thyroid surgery and euthyroid. Exclusion Criteria: - Patients with hyper- or hypo-thyroid status. Patients who were unfit for surgery. Patients with unilateral or bilateral vocal cord palsy on preoperative indirect laryngoscopy Patients with thyroid malignancy by preoperative FNAC. Patients with hypersensitivity to methylene blue were excluded.

Ages Eligible for Study
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Minimum Age: 16 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| No Intervention: anatomical identification<br>thyroidectomy was done with identification of both RLN and parathyroid gland done on anatomical basis | |
| Sham Comparator: methylene blue identification<br>thyroidectomy was done with identification of both RLN and parathyroid gland done using methylene blue spray (0.5 ml methylene blue 2% was diluted by 5ml normal saline) was sprayed over the lower thyroid pole and the perilobar area | Diagnostic Test: methylene blue identification<br>* After ligation of the middle thyroid vein and the upper pole of the thyroid, the thyroid lobe was retracted medially and diluted methylene blue (0.5 ml methylene blue 2% was diluted by 5ml normal saline) was sprayed over the lower thyroid pole and the perilobar area. This area contains structures including recurrent laryngeal nerve, parathyroid glands, and inferior thyroid vessels which were observed After spraying. The vocal cord mobility was assessed intraoperatively by the anesthesiologist at time of extubation. The serum calcium was measured on the 2nd postoperative day. There was no routine use of postoperative calcium supplementation. Hypocalcemia was defined when the serum calcium level was less than 8 mg/dl.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| detection of the recurrent larngeal nerve unstained | the methylene blue dye stain the background and the RLN appears unstained | one minute after dye application | 
| detection of the parathyroig glands | the methylene blue dye stain washed out and the parathyroid gland remained stained after 3 minutes | 3 minutes after dye application |