Immediately after total thyroidectomy, a patient develops biphasic stridor and flexible endoscopy shows both vocal folds near the midline. They are alert with normal oxygen saturation. What is the best next management principle?
Bilateral near-midline vocal-fold immobility can deteriorate abruptly. Normal saturation does not remove airway risk; the team should establish a controlled strategy and assess reversible causes rather than observing unprepared.
A. Discharge with voice therapy: This ignores a potentially critical airway.
B. Assume unilateral recurrent-laryngeal-nerve palsy: The endoscopic finding is bilateral and the physiology differs.
C. Perform permanent cordotomy immediately in recovery: Definitive airway-widening surgery depends on recovery potential, cause and a planned airway assessment.
D. Wait for a six-week clinic review: That delay is unsafe with acute stridor.
E. Urgent controlled airway planning with senior ENT and anaesthetic input: Bilateral near-midline vocal-fold immobility can deteriorate abruptly. Normal saturation does not remove airway risk; the team should establish a controlled strategy and assess reversible causes rather than observing unprepared.
If one cord moved normally and the airway was adequate, aspiration/voice rehabilitation and observation could be considered instead.
Draft Clinora educational material only; not official JCIE content, an accredited programme, or a substitute for local policy and specialist judgement.
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