The change of voice quality after thyroidectomy without recurrent laryngeal nerve injury_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

PENG Jing ¹ ,  LI Zhihui ² ,  CEN Ying ¹

1. Department of Plastic and Burn Surgery, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
2. Department of Thyoid Surgery, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;

Corresponding author：

LI Zhihui, Email: rockoliver@163.com; CEN Ying, Email: cenying0141@163.com

Keywords：

thyroidectomy; voice quality; risk factor; review

DOI：

10.7507/1007-9424.202001012

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To summarize the risk factors of the change of voice quality after thyroidectomy without recurrent laryngeal nerve injury and to provide reference for the prevention and treatment of postoperative voice quality damages.Method The research progress of the change of voice quality after thyroidectomy without recurrent laryngeal nerve injury was reviewed by reading the related literatures at home and abroad.Results Even if there was no obvious recurrent laryngeal nerve injury during the operation, the voice quality may change after the operation for the patients undergoing thyroidectomy. The change of voice quality after thyroidectomy without recurrent laryngeal nerve injury was associated with various risk factors such as dysfunction of superior laryngeal nerve, injury of anterior laryngeal band muscles, endotracheal intubation, surgical methods, age, gender and special occupations.Conclusions The change of voice quality is a common complication after thyroidectomy, which seriously affects the quality of life of patients. In the absence of significant recurrent laryngeal nerve injury, many patients will still experience problems with voice quality. Understanding the related risk factors of voice quality change after thyroidectomy is helpful to optimize postoperative voice function, to prevent possible secondary injuries, and to improve the quality of life of patients.

Citation： PENG Jing, LI Zhihui, CEN Ying. The change of voice quality after thyroidectomy without recurrent laryngeal nerve injury. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2020, 27(10): 1319-1324. doi: 10.7507/1007-9424.202001012 Copy

1.	韩婧, 康骅. 甲状腺癌的发病现状及影响因素. 实用预防医学, 2018, 25(7): 132-135.
2.	Henry LR, Helou LB, Solomon NP, <italic>et al</italic>. Functional voice outcomes after thyroidectomy: an assessment of the Dsyphonia Severity Index (DSI) after thyroidectomy. Surgery, 2010, 147(6): 861-870.
3.	Kuhn MA, Bloom G, Myssiorek D. Patient perspectives on dysphonia after thyroidectomy for thyroid cancer. J Voice, 2013, 27(1): 111-114.
4.	Delgado-Vargas B, Lloris Romero-Salazar A, Cobeta I. Vocal changes following thyroid surgery: prospective study of objective and subjective parameters. J Voice, 2019, 33(1): 27-32.
5.	Schneider M, Dahm V, Passler C, <italic>et al</italic>. Complete and incomplete recurrent laryngeal nerve injury after thyroid and parathyroid surgery: Characterizing paralysis and paresis. Surgery, 2019, 166(3): 369-374.
6.	Al-Hakami HA, Al Garni MA, Malas M, <italic>et al</italic>. Surgical complications after thyroid surgery: a 10-year experience at jeddah, saudi arabia. Indian J Otolaryngol Head Neck Surg, 2019, 71(Suppl 1): 1012-1017.
7.	Hong KH, Kim Y. Phonatory characteristics of patients undergoing thyroidectomy without laryngeal nerve injury. Otolaryngol Head Neck Surg, 1997, 117(4): 399-404.
8.	Ryu J, Ryu YM, Jung YS, <italic>et al</italic>. Extent of thyroidectomy affects vocal and throat functions: a prospective observational study of lobectomy versus total thyroidectomy. Surgery, 2013, 154(3): 611-20.
9.	Liu N, Chen B, Li L, <italic>et al</italic>. Subplatysmal or subfascial approach in totally endoscopic thyroidectomy has better postoperative efficacy for voice, sensory, swallowing symptoms and cosmetic result. Cohort study. Int J Surg, 2018, 60: 22-27.
10.	Borel F, Christou N, Marret O, <italic>et al</italic>. Long-term voice quality outcomes after total thyroidectomy: a prospective multicenter study. Surgery, 2018, 163(4): 796-800.
11.	Wojtczak B, Sutkowski K, Kaliszewski K, <italic>et al</italic>. Voice quality preservation in thyroid surgery with neuromonitoring. Endocrine, 2018, 61(2): 232-239.
12.	Naytah M, Ibrahim I, da Silva S. Importance of incorporating intraoperative neuromonitoring of the external branch of the superior laryngeal nerve in thyroidectomy: A review and meta-analysis study. Head Neck, 2019, 41(6): 2034-2041.
13.	Henry LR, Solomon NP, Howard R, <italic>et al</italic>. The functional impact on voice of sternothyroid muscle division during thyroidectomy. Ann Surg Oncol, 2008, 15(7): 2027-2033.
14.	Hong KH, Ye M, Kim YM, <italic>et al</italic>. The role of strap muscles in phonation-<italic>in vivo</italic> canine laryngeal model. J Voice, 1997, 11(1): 23-32.
15.	Lee JS, Kim JP, Ryu JS, <italic>et al</italic>. Effect of wound massage on neck discomfort and voice changes after thyroidectomy. Surgery, 2018, 164(5): 965-971.
16.	Minni A, Ruoppolo G, Barbaro M, <italic>et al</italic>. Long-term (12 to 18 months) functional voice assessment to detect voice alterations after thyroidectomy. Eur Rev Med Pharmacol Sci, 2014, 18(12): 1704-1708.
17.	Aluffi P, Policarpo M, Cherovac C, <italic>et al</italic>. Post-thyroidectomy superior laryngeal nerve injury. Eur Arch Otorhinolaryngol, 2001, 258(9): 451-454.
18.	Moris D, Mantonakis E, Makris M, <italic>et al</italic>. Hoarseness after thyroidectomy: blame the endocrine surgeon alone? Hormones (Athens), 2014, 13(1): 5-15.
19.	de Pedro Netto I, Fae A, Vartanian JG, <italic>et al</italic>. Voice and vocal self-assessment after thyroidectomy. Head Neck, 2006, 28(12): 1106-1114.
20.	Paulauskiene I, Lesinskas E, Petrulionis M. The temporary effect of short-term endotracheal intubation on vocal function. Eur Arch Otorhinolaryngol, 2013, 270(1): 205-210.
21.	Kotsovolis G, Pliakos I, Panidis S, <italic>et al</italic>. Comparison between the protector<sup>TM</sup> laryngeal mask airway and the endotracheal tube for minimally invasive thyroid and parathyroid surgery. World J Surg, 2019, 43(11): 2822-2828.
22.	Gong Y, Wang J, Xu X, <italic>et al</italic>. Performance of air seal of flexible reinforced laryngeal mask airway in thyroid surgery compared with endotracheal tube: a randomized controlled trial. Anesth Analg, 2020, 130(1): 217-223.
23.	Sung ES, Kim KY, Yun BR, <italic>et al</italic>. Long-term functional voice outcomes after thyroidectomy, and effect of endotracheal intubation on voice. Eur Arch Otorhinolaryngol, 2018, 275(12): 3049-3058.
24.	Park JO, Bae JS, Lee SH, <italic>et al</italic>. The long-term prognosis of voice pitch change in female patients after thyroid surgery. World J Surg, 2016, 40(10): 2382-2390.
25.	任佳, 杨慧, 吕丹, 等. 甲状腺全切手术患者术前与术后嗓音功能对比研究. 临床耳鼻咽喉头颈外科杂志, 2019, 33(8): 757-760.
26.	Vicente DA, Solomon NP, Avital I, <italic>et al</italic>. Voice outcomes after total thyroidectomy, partial thyroidectomy, or non-neck surgery using a prospective multifactorial assessment. J Am Coll Surg, 2014, 219(1): 152-163.
27.	Minni A, Rosati D, Cavaliere C, et al. Total versus completion thyroidectomy: a multidimensional evaluation of long-term vocal alterations. Ear Nose Throat J, 2019, Dec 4: 145561319886156. [Epub ahead of print].
28.	Lee JC, Breen D, Scott A, <italic>et al</italic>. Quantitative study of voice dysfunction after thyroidectomy. Surgery, 2016, 160(6): 1576-1581.
29.	孙德云, 张雪松, 高瑞岗, 等. 甲状腺手术患者的语音评估及嗓音分析. 临床耳鼻咽喉头颈外科杂志, 2017, 31(13): 998-1002.
30.	Sahli Z, Canner JK, Najjar O, <italic>et al</italic>. Association between age and patient-reported changes in voice and swallowing after thyroidectomy. Laryngoscope, 2019, 129(2): 519-524.
31.	Park YM, Oh KH, Cho JG, <italic>et al</italic>. Changes in Voice- and swallowing-related symptoms after thyroidectomy: one-year follow-up study. Ann Otol Rhinol Laryngol, 2018, 127(3): 171-177.
32.	Papadakis CE, Asimakopoulou P, Proimos E, <italic>et al</italic>. Subjective and Objective voice assessments after recurrent laryngeal nerve-preserved total thyroidectomy. J Voice, 2017, 31(4): 515.e515-515.e521.
33.	Reiter R, Heyduck A, Hoffmann TK, <italic>et al</italic>. Quality of voice and prognostic markers for the recovery of vocal fold paralysis after thyroid surgery. Ann Otol Rhinol Laryngol, 2019, 128(12): 1104-1110.
34.	王英俊, 华辉, 葛瑞锋, 等. 甲状腺切除术后患者嗓音声学分析动态观察. 听力学及言语疾病杂志, 2016, 24(5): 469-472.
35.	Lang BHH, Wong CKH, Ma EPM. A systematic review and meta-analysis on acoustic voice parameters after uncomplicated thyroidectomy. Laryngoscope, 2016, 126(2): 528-537.
36.	Cheng J, Woo P. Correlation between the Voice Handicap Index and voice laboratory measurements after phonosurgery. Ear Nose Throat J, 2010, 89(4): 183-188.
37.	Kim CS, Park JO, Bae JS, <italic>et al</italic>. Long-lasting voice-related symptoms in patients without vocal cord palsy after thyroidectomy. World J Surg, 2018, 42(7): 2109-2116.
38.	Van Houtte E, Van Lierde K, Claeys S. Pathophysiology and treatment of muscle tension dysphonia: a review of the current knowledge. J Voice, 2011, 25(2): 202-207.
39.	Behlau M, Zambon F, Madazio G. Managing dysphonia in occupational voice users. Curr Opin Otolaryngol Head Neck Surg, 2014, 22(3): 188-194.
40.	Christakis I, Klang P, Talat N, <italic>et al</italic>. Long-term quality of voice is usually acceptable after initial hoarseness caused by a thyroidectomy or a parathyroidectomy. Gland Surg, 2019, 8(3): 226-236.
41.	Van Lierde K, D'Haeseleer E, Wuyts FL, <italic>et al</italic>. Impact of thyroidectomy without laryngeal nerve injury on vocal quality characteristics: an objective multiparameter approach. Laryngoscope, 2010, 120(2): 338-345.
42.	Tedla M, Chakrabarti S, Suchankova M, <italic>et al</italic>. Voice outcomes after thyroidectomy without superior and recurrent laryngeal nerve injury: VoiSS questionnaire and GRBAS tool assessment. Eur Arch Otorhinolaryngol, 2016, 273(12): 4543-4547.
43.	Kletzien H, Macdonald CL, Orne J, <italic>et al</italic>. Comparison between patient-perceived voice changes and quantitative voice measures in the first postoperative year after thyroidectomy: a secondary analysis of a randomized clinical trial. JAMA Otolaryngol Head Neck Surg, 2018, 144(11): 995-1003.
44.	Elsheikh E, Quriba AS, El-Anwar MW. Voice changes after late recurrent laryngeal nerve identification thyroidectomy. J Voice, 2016, 30(6): 762.e761-762.e769.
45.	Gumus T, Makay O, Eyigor S, <italic>et al</italic>. Objective analysis of swallowing and functional voice outcomes after thyroidectomy: A prospective cohort study. Asian J Surg, 2020, 43(1): 116-123.
46.	Minuto MN, Reina S, Monti E, <italic>et al</italic>. Morbidity following thyroid surgery: acceptable rates and how to manage complicated patients. J Endocrinol Invest, 2019, 42(11): 1291-1297.
47.	Lang BHH, Wong CKH, Ma EPM, <italic>et al</italic>. A propensity-matched analysis of clinical outcomes between open thyroid lobectomy and high-intensity focused ultrasound (HIFU) ablation of benign thyroid nodules. Surgery, 2019, 165(1): 85-91.
48.	Nasiri S, Shafag S, Khorgami Z, <italic>et al</italic>. Does corticosteroid have any beneficial effect on voice change after thyroidectomy? Am Surg, 2013, 79(12): 1258-1262.
49.	Worni M, Schudel HH, Seifert E, <italic>et al</italic>. Randomized controlled trial on single dose steroid before thyroidectomy for benign disease to improve postoperative nausea, pain, and vocal function. Ann Surg, 2008, 248(6): 1060-1066.
50.	Kim JS, Kwon SH, Lee SE, <italic>et al</italic>. Effect of single-dose intravenous dexamethasone on subjective voice quality after thyroidectomy: A meta-analysis. Medicine (Baltimore), 2018, 97(36): e11832.

1. 韩婧, 康骅. 甲状腺癌的发病现状及影响因素. 实用预防医学, 2018, 25(7): 132-135.
2. Henry LR, Helou LB, Solomon NP, <italic>et al</italic>. Functional voice outcomes after thyroidectomy: an assessment of the Dsyphonia Severity Index (DSI) after thyroidectomy. Surgery, 2010, 147(6): 861-870.
3. Kuhn MA, Bloom G, Myssiorek D. Patient perspectives on dysphonia after thyroidectomy for thyroid cancer. J Voice, 2013, 27(1): 111-114.
4. Delgado-Vargas B, Lloris Romero-Salazar A, Cobeta I. Vocal changes following thyroid surgery: prospective study of objective and subjective parameters. J Voice, 2019, 33(1): 27-32.
5. Schneider M, Dahm V, Passler C, <italic>et al</italic>. Complete and incomplete recurrent laryngeal nerve injury after thyroid and parathyroid surgery: Characterizing paralysis and paresis. Surgery, 2019, 166(3): 369-374.
6. Al-Hakami HA, Al Garni MA, Malas M, <italic>et al</italic>. Surgical complications after thyroid surgery: a 10-year experience at jeddah, saudi arabia. Indian J Otolaryngol Head Neck Surg, 2019, 71(Suppl 1): 1012-1017.
7. Hong KH, Kim Y. Phonatory characteristics of patients undergoing thyroidectomy without laryngeal nerve injury. Otolaryngol Head Neck Surg, 1997, 117(4): 399-404.
8. Ryu J, Ryu YM, Jung YS, <italic>et al</italic>. Extent of thyroidectomy affects vocal and throat functions: a prospective observational study of lobectomy versus total thyroidectomy. Surgery, 2013, 154(3): 611-20.
9. Liu N, Chen B, Li L, <italic>et al</italic>. Subplatysmal or subfascial approach in totally endoscopic thyroidectomy has better postoperative efficacy for voice, sensory, swallowing symptoms and cosmetic result. Cohort study. Int J Surg, 2018, 60: 22-27.
10. Borel F, Christou N, Marret O, <italic>et al</italic>. Long-term voice quality outcomes after total thyroidectomy: a prospective multicenter study. Surgery, 2018, 163(4): 796-800.
11. Wojtczak B, Sutkowski K, Kaliszewski K, <italic>et al</italic>. Voice quality preservation in thyroid surgery with neuromonitoring. Endocrine, 2018, 61(2): 232-239.
12. Naytah M, Ibrahim I, da Silva S. Importance of incorporating intraoperative neuromonitoring of the external branch of the superior laryngeal nerve in thyroidectomy: A review and meta-analysis study. Head Neck, 2019, 41(6): 2034-2041.
13. Henry LR, Solomon NP, Howard R, <italic>et al</italic>. The functional impact on voice of sternothyroid muscle division during thyroidectomy. Ann Surg Oncol, 2008, 15(7): 2027-2033.
14. Hong KH, Ye M, Kim YM, <italic>et al</italic>. The role of strap muscles in phonation-<italic>in vivo</italic> canine laryngeal model. J Voice, 1997, 11(1): 23-32.
15. Lee JS, Kim JP, Ryu JS, <italic>et al</italic>. Effect of wound massage on neck discomfort and voice changes after thyroidectomy. Surgery, 2018, 164(5): 965-971.
16. Minni A, Ruoppolo G, Barbaro M, <italic>et al</italic>. Long-term (12 to 18 months) functional voice assessment to detect voice alterations after thyroidectomy. Eur Rev Med Pharmacol Sci, 2014, 18(12): 1704-1708.
17. Aluffi P, Policarpo M, Cherovac C, <italic>et al</italic>. Post-thyroidectomy superior laryngeal nerve injury. Eur Arch Otorhinolaryngol, 2001, 258(9): 451-454.
18. Moris D, Mantonakis E, Makris M, <italic>et al</italic>. Hoarseness after thyroidectomy: blame the endocrine surgeon alone? Hormones (Athens), 2014, 13(1): 5-15.
19. de Pedro Netto I, Fae A, Vartanian JG, <italic>et al</italic>. Voice and vocal self-assessment after thyroidectomy. Head Neck, 2006, 28(12): 1106-1114.
20. Paulauskiene I, Lesinskas E, Petrulionis M. The temporary effect of short-term endotracheal intubation on vocal function. Eur Arch Otorhinolaryngol, 2013, 270(1): 205-210.
21. Kotsovolis G, Pliakos I, Panidis S, <italic>et al</italic>. Comparison between the protector<sup>TM</sup> laryngeal mask airway and the endotracheal tube for minimally invasive thyroid and parathyroid surgery. World J Surg, 2019, 43(11): 2822-2828.
22. Gong Y, Wang J, Xu X, <italic>et al</italic>. Performance of air seal of flexible reinforced laryngeal mask airway in thyroid surgery compared with endotracheal tube: a randomized controlled trial. Anesth Analg, 2020, 130(1): 217-223.
23. Sung ES, Kim KY, Yun BR, <italic>et al</italic>. Long-term functional voice outcomes after thyroidectomy, and effect of endotracheal intubation on voice. Eur Arch Otorhinolaryngol, 2018, 275(12): 3049-3058.
24. Park JO, Bae JS, Lee SH, <italic>et al</italic>. The long-term prognosis of voice pitch change in female patients after thyroid surgery. World J Surg, 2016, 40(10): 2382-2390.
25. 任佳, 杨慧, 吕丹, 等. 甲状腺全切手术患者术前与术后嗓音功能对比研究. 临床耳鼻咽喉头颈外科杂志, 2019, 33(8): 757-760.
26. Vicente DA, Solomon NP, Avital I, <italic>et al</italic>. Voice outcomes after total thyroidectomy, partial thyroidectomy, or non-neck surgery using a prospective multifactorial assessment. J Am Coll Surg, 2014, 219(1): 152-163.
27. Minni A, Rosati D, Cavaliere C, et al. Total versus completion thyroidectomy: a multidimensional evaluation of long-term vocal alterations. Ear Nose Throat J, 2019, Dec 4: 145561319886156. [Epub ahead of print].
28. Lee JC, Breen D, Scott A, <italic>et al</italic>. Quantitative study of voice dysfunction after thyroidectomy. Surgery, 2016, 160(6): 1576-1581.
29. 孙德云, 张雪松, 高瑞岗, 等. 甲状腺手术患者的语音评估及嗓音分析. 临床耳鼻咽喉头颈外科杂志, 2017, 31(13): 998-1002.
30. Sahli Z, Canner JK, Najjar O, <italic>et al</italic>. Association between age and patient-reported changes in voice and swallowing after thyroidectomy. Laryngoscope, 2019, 129(2): 519-524.
31. Park YM, Oh KH, Cho JG, <italic>et al</italic>. Changes in Voice- and swallowing-related symptoms after thyroidectomy: one-year follow-up study. Ann Otol Rhinol Laryngol, 2018, 127(3): 171-177.
32. Papadakis CE, Asimakopoulou P, Proimos E, <italic>et al</italic>. Subjective and Objective voice assessments after recurrent laryngeal nerve-preserved total thyroidectomy. J Voice, 2017, 31(4): 515.e515-515.e521.
33. Reiter R, Heyduck A, Hoffmann TK, <italic>et al</italic>. Quality of voice and prognostic markers for the recovery of vocal fold paralysis after thyroid surgery. Ann Otol Rhinol Laryngol, 2019, 128(12): 1104-1110.
34. 王英俊, 华辉, 葛瑞锋, 等. 甲状腺切除术后患者嗓音声学分析动态观察. 听力学及言语疾病杂志, 2016, 24(5): 469-472.
35. Lang BHH, Wong CKH, Ma EPM. A systematic review and meta-analysis on acoustic voice parameters after uncomplicated thyroidectomy. Laryngoscope, 2016, 126(2): 528-537.
36. Cheng J, Woo P. Correlation between the Voice Handicap Index and voice laboratory measurements after phonosurgery. Ear Nose Throat J, 2010, 89(4): 183-188.
37. Kim CS, Park JO, Bae JS, <italic>et al</italic>. Long-lasting voice-related symptoms in patients without vocal cord palsy after thyroidectomy. World J Surg, 2018, 42(7): 2109-2116.
38. Van Houtte E, Van Lierde K, Claeys S. Pathophysiology and treatment of muscle tension dysphonia: a review of the current knowledge. J Voice, 2011, 25(2): 202-207.
39. Behlau M, Zambon F, Madazio G. Managing dysphonia in occupational voice users. Curr Opin Otolaryngol Head Neck Surg, 2014, 22(3): 188-194.
40. Christakis I, Klang P, Talat N, <italic>et al</italic>. Long-term quality of voice is usually acceptable after initial hoarseness caused by a thyroidectomy or a parathyroidectomy. Gland Surg, 2019, 8(3): 226-236.
41. Van Lierde K, D'Haeseleer E, Wuyts FL, <italic>et al</italic>. Impact of thyroidectomy without laryngeal nerve injury on vocal quality characteristics: an objective multiparameter approach. Laryngoscope, 2010, 120(2): 338-345.
42. Tedla M, Chakrabarti S, Suchankova M, <italic>et al</italic>. Voice outcomes after thyroidectomy without superior and recurrent laryngeal nerve injury: VoiSS questionnaire and GRBAS tool assessment. Eur Arch Otorhinolaryngol, 2016, 273(12): 4543-4547.
43. Kletzien H, Macdonald CL, Orne J, <italic>et al</italic>. Comparison between patient-perceived voice changes and quantitative voice measures in the first postoperative year after thyroidectomy: a secondary analysis of a randomized clinical trial. JAMA Otolaryngol Head Neck Surg, 2018, 144(11): 995-1003.
44. Elsheikh E, Quriba AS, El-Anwar MW. Voice changes after late recurrent laryngeal nerve identification thyroidectomy. J Voice, 2016, 30(6): 762.e761-762.e769.
45. Gumus T, Makay O, Eyigor S, <italic>et al</italic>. Objective analysis of swallowing and functional voice outcomes after thyroidectomy: A prospective cohort study. Asian J Surg, 2020, 43(1): 116-123.
46. Minuto MN, Reina S, Monti E, <italic>et al</italic>. Morbidity following thyroid surgery: acceptable rates and how to manage complicated patients. J Endocrinol Invest, 2019, 42(11): 1291-1297.
47. Lang BHH, Wong CKH, Ma EPM, <italic>et al</italic>. A propensity-matched analysis of clinical outcomes between open thyroid lobectomy and high-intensity focused ultrasound (HIFU) ablation of benign thyroid nodules. Surgery, 2019, 165(1): 85-91.
48. Nasiri S, Shafag S, Khorgami Z, <italic>et al</italic>. Does corticosteroid have any beneficial effect on voice change after thyroidectomy? Am Surg, 2013, 79(12): 1258-1262.
49. Worni M, Schudel HH, Seifert E, <italic>et al</italic>. Randomized controlled trial on single dose steroid before thyroidectomy for benign disease to improve postoperative nausea, pain, and vocal function. Ann Surg, 2008, 248(6): 1060-1066.
50. Kim JS, Kwon SH, Lee SE, <italic>et al</italic>. Effect of single-dose intravenous dexamethasone on subjective voice quality after thyroidectomy: A meta-analysis. Medicine (Baltimore), 2018, 97(36): e11832.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

The change of voice quality after thyroidectomy without recurrent laryngeal nerve injury

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