Risk Factors and Causes of Recurrent Laryngeal Nerve Injury from Thermal Ablation of Hyperparathyroidism

Danling Zhang; Yuhan Qiu; Sheng Chen; Jianchuan Yang; Zhiliang Hong; Song-Song Wu

doi:10.1016/j.acra.2025.05.046

Risk Factors and Causes of Recurrent Laryngeal Nerve Injury from Thermal Ablation of Hyperparathyroidism

Acad Radiol. 2025 Jun 25:S1076-6332(25)00523-9. doi: 10.1016/j.acra.2025.05.046. Online ahead of print.

Authors

Danling Zhang¹, Yuhan Qiu², Sheng Chen³, Jianchuan Yang², Zhiliang Hong², Song-Song Wu⁴

Affiliations

¹ Department of Ultrasonography, Shengli Clinical Medical College of Fujian Medical University,Fujian Medical University Union Hospital, Fuzhou, China (D.Z.).
² Department of Ultrasonography,Shengli Clinical Medical College of Fujian Medical University,Fuzhou University Affiliated Provincial Hospital, Fuzhou, China (Y.Q., J.Y., Z.H., S-s.W.).
³ Department of Ultrasonography, Fujian Medical University Union Hospital, Fuzhou, China (S.C.).
⁴ Department of Ultrasonography,Shengli Clinical Medical College of Fujian Medical University,Fuzhou University Affiliated Provincial Hospital, Fuzhou, China (Y.Q., J.Y., Z.H., S-s.W.). Electronic address: 465269898@qq.com.

PMID: 40571543
DOI: 10.1016/j.acra.2025.05.046

Abstract

Rationale and objectives: To investigate the risk factors associated with recurrent laryngeal nerve (RLN) injury in patients with hyperparathyroidism treated with thermal ablation (MWA or RFA).

Materials and methods: A retrospective analysis was conducted on 93 patients (236 hyperplastic parathyroid nodules) who underwent thermal ablation between June 2021 and December 2022. Factors analyzed included nodule characteristics (number,size, location), procedural parameters (ablation time, energy), and fluid isolation distances from critical structures. Univariate and multivariate analyses were performed to identify risk factors for RLN injury.

Results: Post-ablation hoarseness occurred in 18 patients with 24 hyperplastic parathyroid nodules 10.2% (24/236), with full recovery within 6 months. Univariate analysis revealed significant associations with ablation time, energy, fluid isolation, nodule adhesion, and anatomical parameters (P < 0.05). Multivariate analysis identified ablation time, tracheal gap isolation fluid (TIF), posterior thyroid capsule distance (PCD), posterior thyroid capsule isolation fluid (PIF), and longus colli isolation fluid (LIF) as independent risk factors (P < 0.05). ROC curve analysis demonstrated that ablation time (>126.5 s), TIF (<4.15 mm), and PIF (<3.35 mm) were effective predictors of RLN injury, with sensitivities/specificities of 86.3%/79.2% and AUC values of 0.695/0.869, respectively.

Conclusion: Ablation time, tracheal gap isolation, and posterior thyroid capsule isolation are key factors influencing RLN injury risk in thermal ablation for hyperparathyroidism.

Keywords: Hydrodissection; Hyperparathyroidism; Microwave Ablation (MWA) / Radiofrequency Ablation (RFA); Recurrent Laryngeal Nerve Injury; Thermal Ablation.