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Research Journal of Medical Sciences
Volume 18, Issue 3 (2024)

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Research Paper

A Study on Intraoperative Identification of Parathyroid Glands and Recurrent Laryngeal Nerves during Thyroid Surgery Using Methylene Blue Spray: A Randomized Control Trial

Sathishkumar Lakshmanan, Elakkiya Selvaraj, A. Muzamil Ahmed and Vinothkumar Gunasekaran
Page: 298-303 | Received 26 Jan 2024, Published online: 06 Mar 2024

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https://doi.org/10.36478/makrjms.2024.3.298.303

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Abstract

Thyroidectomy, a common procedure in iodine‐deficient regions, poses risks of recurrent laryngeal nerve (RLN) injury and parathyroid gland damage. Intraoperative techniques, such as methylene blue spraying, are crucial for minimizing complications. To evaluate post‐operative vocal cord mobility and assess signs of hypocalcemia. A randomized study at Sri Venkateshwaraa Medical College and Research Centre (October 2017 to May 2018) included 60 patients undergoing conventional thyroidectomy (Group 1) or methylene blue spraying (Group 2). Methylene blue was applied before inferior pole ligation to identify RLN, parathyroid and vascular structures. Postoperative assessments included serum calcium levels and repeat laryngoscopic examination. Predominant preoperative diagnoses were multinodular goitre and papillary carcinoma in both groups. Group B showed significantly higher postoperative calcium levels (9.46±0.13 vs. 8.14±0.18; p<0.0001). Preoperative parathyroid hormone (PTH) levels were comparable (Group A: 20.7±8.08, Group B: 21.12± 8.37). Notably, Group B exhibited a significantly higher mean postoperative PTH level (19.72±1.67; p = 0.001). Complications in Group A had an overall incidence of 16.7%, with 3 out of 5 patients showing recovery in vocal cord mobility at the 6‐month follow‐up. Methylene blue spraying is a safe and effective method for identifying and protecting RLN and parathyroid glands during thyroidectomy.

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