A Prospective study for effect of wound or scar tissue massage after thyroidectomy on neck discomfort and voice change


  • Hemin Qabel Hasan General Directorate of Health, Erbil, Iraq.
  • Ali Al Dabbagh College of Medicine, Hawler Medical University, Erbil, Iraq.




Thyroidectomy, Wounds, Phonation, Cicatrix


Objectives: This study aimed to found and selecting the causes behind neck discomfort and change in the voice following thyroidectomy and to determine the efficacy of wound massaging technique on decreasing and relief such symptoms.

Methods: Totally 55 patients all females who underwent thyroidectomy were included in our study, the patients were divided in to two groups (26 in the experimental group and 29 in the control group). The massaging technique was instructed to all patients in the experimental group 1 week postoperatively and the feedback were received from patients after 2 weeks and 4 weeks from instruction time. The analysis was achieved for both groups of patients.

Results: After exclusion of laryngeal pathologies post operatively. The recovery rate of the patients in the experimental group from post operation adhesions was obviously and significantly much more better recovery from subjective voice impairment score (SVIS) and neck discomfort score (NDS) which was represented by swallowing impairment score (SIS). (all P < 0.01) in compare with the patients in control group. Those results indicates that localized adhesions following total thyroidectomy operation could be included in affection of general movement as well as vertical movements of the larynx and the wound massaging technique might help patients recovering the normal general movement of the larynx postoperatively.

Conclusion: Discomfort of the neck, pulling neck sensation, and voice or phonation changes after total thyroidectomy surgery might due to local surgical adhesions of the wound which possibly accompanied with impairment of vertical movement of larynx. so, releasing of such adhesions could help the patients to recover much more quickly from mentioned undesirable symptoms postoperatively and start their normal daily activities.


1. Park WS, Chung YS, Lee KE, Kim HY, Choe JH, Koh SH, et al. Anti-adhesive effect and safety of sodium hyaluronate and sodium carboxymethyl cellulose solution in thyroid surgery. Asian J Surg. 2010; 33:25–30.
2. Hong KH, Kim YK. Phonatory characteristics of patients undergoing thy- roidectomy without laryngeal nerve injury. Otolaryngol Head Neck Surg. 1997; 117:399–404.
3. Sataloff RT, Spiegel JR, Carroll LM, Heuer RJ. Male soprano voice: a rare compli- cation of thyroidectomy. Laryngoscope. 1992; 102:90–93.
4. Holt GR, McMurray GT, Joseph DJ. Recurrent laryngeal nerve injury following thyroid operations. Surg Gynecol Obstet. 1977; 144:567–570.
5. Hunt CJ. The superior and inferior laryngeal nerve as related to thvroid surgery.
Am Surg. 1961; 27:548–552.
6. Painter NS. The results of surgery in the treatment of toxic goitre. A review of 172 cases. Br J Surg. 1960; 48:291–296.
7. Woo SH. Endoscope-assisted transoral thyroidectomy using a frenotomy inci- sion. J Laparoendosc Adv Surg Tech A. 2014; 24:345–349.
8. Woo SH. Endoscope-assisted intraoral removal of the thyroid isthmus mass us- ing a frenotomy incision. J Laparoendosc Adv Surg Tech A. 2013; 23:787–790.
9. Woo SH, Jeong HS, Kim JP, Park JJ, Baek CH. Endoscope-assisted intrao- ral removal of ectopic thyroid tissue using a frenotomy incision. Thyroid. 2013; 23:605–608.
10. Kim JP, Park JJ, Woo SH. No-Scar Transoral Thyroglossal Duct Cyst Excision in Children. Thyroid. 2018; 28:755–761.
11. Boyles R, Toy P, Mellon Jr J, Hayes M, Hammer B. Effectiveness of manual phys- ical therapy in the treatment of cervical radiculopathy: a systematic review. J Man Manip Ther. 2011; 19:135–142.
12. Senbursa G, Baltaci G, Atay A. Comparison of conservative treatment with and without manual physical therapy for patients with shoulder impingement syn- drome: a prospective, randomized clinical trial. Knee Surg Sports Traumatol Arthrosc. 2007; 15:915–921.
13. Lombardi CP, Raffaelli M, D’Alatri L, Marchese MR, Rigante M, Paludetti G, et al. Voice and swallowing changes after thyroidectomy in patients without inferior laryngeal nerve injuries. Surgery. 2006; 140:1026–1032 discussion 32-4.
14. Lombardi CP, Raffaelli M, De Crea C, D’Alatr i L, Maccora D, Marchese MR, et al. Long-term outcome of functional post-thyroidectomy voice and swallow- ing symptoms. Surgery. 2009; 146:1174–1181.
15. Kim K, Gu MO, Jung JH, Hahm JR, Kim SK, Kim JH, Woo SH. Efficacy of a Home-
-Based Exercise Program After Thyroidectomy for Thyroid Cancer Patients. Thy- roid. 2018; 28:236–245.
16. Kim KH, Woo SH. An Occupational Study in Nurses: Prevalence of Thyroid Nod- ules and Cancer in Comparison to Health Check-up Female. Clin Exp Otorhino- laryngol. 2016; 9:252–256.

17. Won SJ, Kim RB, Kim JP, Park JJ, Kwon MS, Woo SH. The prevalence and factors associate with vocal nodules in general population: Cross-sectional epidemio- logical study. Medicine (Baltimore). 2016;95: e4971.
18. Pereira JA, Girvent M, Sancho JJ, Parada C, Sitges-Serra A. Prevalence of long-term upper aerodigestive symptoms after uncomplicated bilateral thy- roidectomy. Surgery. 2003; 133:318–322.
19. Rosato L, Carlevato MT, De Toma G, Avenia N. Recurrent laryngeal nerve damage and phonetic modifications after total thyroidectomy: surgical malpractice only or predictable sequence? World J Surg 2005; 29:780-4.
20. Sinagra DL, Montesinos MR, Tacchi VA, Moreno JC, Falco JE, Mezzadri NA, et al. Voice changes after thyroidectomy without recurrent laryngeal nerve in- jury. J Am Coll Surg. 2004; 199:556–560.
21. Stojadinovic A, Shaha AR, Orlikoff RF, Nissan A, Kornak MF, Singh B, et al. Prospective functional voice assessment in patients undergoing thyroid surgery. Ann Surg. 2002; 236:823–832.
22. Lombardi CP, Raffaelli M, D’Alatri L, De Crea C Marchese MR, Maccora D, et al. Video-assisted thyroidectomy significantly reduces the risk of early post- thyroidectomy voice and swallowing symptoms. World J Surg. 2008; 32:693–700.
23. Stojadinovic A, Henry LR, Howard RS, Gurevich-Uvena J, Makashay MJ, Cop- pit GL, et al. Prospective trial of voice outcomes after thyroidectomy: evaluation of patient-reported and clinician-determined voice assessments in identifying postthyroidectomy dysphonia. Surgery. 2008; 143:732–742.
24. Henry LR, Solomon NP, Howard R, Gurevich-Uvena J, Horst LB, Coppit G, et al. The functional impact on voice of sternothyroid muscle division during thyroidectomy. Ann Surg Oncol. 2008; 15:2027–2033.
25. Akyildiz S, Ogut F, Akyildiz M, Engin EZ. A multivariate analysis of objective voice changes after thyroidectomy without laryngeal nerve injury. Arch Oto- laryngol Head Neck Surg. 2008; 134:596–602.
26. Sonninen A, Hurme P, Laukkanen AM. The external frame function in the con- trol of pitch, register, and singing mode: radiographic observations of a female singer. J Voice. 1999; 13:319–340.
27. Williams RG, Lesser TH, Foster M, Griffith G. Altered laryngeal function follow- ing thyroidectomy. Clin Otolaryngol Allied Sci. 1989; 14:281–283.
28. Hong KH, Yang WS, Park MJ, Oh JS, Han BH. Changes in Oral Vowel Sounds and Hyoid Bone Movement After Thyroidectomy. Clin Exp Otorhinolaryngol. 2017; 10:168–173.
29. Ault P, Plaza A, Paratz J. Scar massage for hypertrophic burns scarring: a sys- tematic review. Burns. 2018; 44:24–38.
30. Min ZH, Zhou Y, Jing L, Zhang HM, Wang S, Chen WH, et al. [Case-control study on Chinese medicine fumigation and massage therapy for the treatment of knee stability and func tional recovery after anterior cruciate ligament reconstruction operation]. Zhongguo Gu Shang. 2016; 29:397–403.
31. Moyer CA. Affective massage therapy. Int J Ther Massage Bodywork. 2008; 1:3–5.
32. Hong KH, Ye M, Kim YM, Kevorkian KF, Berke GS. The role of strap muscles in phonation—in vivo canine laryngeal model. J Voice. 1997; 11:23–32.
33. Kark AE, Kissin MW, Auerbach R, Meikle M. Voice changes after thyroidectomy: role of the external laryngeal nerve. Br Med J (Clin Res Ed). 1984; 289:1412–1415.
34. Hong KH, Kim HK, Kim YH. The role of the pars recta and pars oblique of cricothyroid muscle in speech production. J Voice. 2001; 15:512–518.
35. Niimi S HS, Kobayashi N. Fo raising role of the sternothyroid muscle—an elec- tromyographic study of two tenors. 1991.
36. Hirano M, Koike Y, von Leden H. The sternohyoid muscle during phonation.
Electromyographic studies. Acta Otolaryngol. 1967; 64:500–507.
37. Robinson JL, Mandel S, Sataloff RT. Objective voice measures in non- singing patients with unilateral superior laryngeal nerve paresis. J Voice. 2005; 19:665–667.
38. de Pedro Netto I, Fae A, Vartanian JG, Barros AP, Correia LM, Toledo RN, et al. Voice and vocal self-assessment after thyroidectomy. Head Neck. 2006; 28:1106–1114.
39. Musholt TJ, Musholt PB, Garm J, Napiontek U, Keilmann A. Changes of the speaking and singing voice after thyroid or parathyroid surgery. Surgery. 2006; 140:978–988 discussion 88-9.
40. Soylu L, Ozbas S, Uslu HY, Kocak S. The evaluation of the causes of subjective voice disturbances after thyroid surgery. Am J Surg. 2007; 194:317–322.




How to Cite

Hasan, H. Q., & Al Dabbagh, A. (2021). A Prospective study for effect of wound or scar tissue massage after thyroidectomy on neck discomfort and voice change. Iraq Medical Journal, 5(4). https://doi.org/10.22317/imj.v5i4.1138