What is the most likely complication after a subtotal thyroidectomy if the patient is unable to phonate and develops stridor?

The most likely complication after a subtotal thyroidectomy when a patient is unable to phonate and develops stridor points to bilateral recurrent laryngeal nerve (RLN) damage. The recurrent laryngeal nerves are responsible for innervating the muscles that control the vocal cords. Damage to both of these nerves can lead to paralysis of the vocal cords, resulting in an inability to phonate effectively.

Stridor, which is a high-pitched wheezing sound often indicative of airway obstruction, can occur as a direct result of the vocal cords being paralyzed in a position that narrows the airway. When both nerves are affected, the patient may experience more significant respiratory distress, thus highlighting the severity of this complication.

Other potential complications, while serious, would typically present with different symptoms or occur under different circumstances. For example, a hematoma could certainly cause stridor if it resulted in significant compression of the airway, but the inability to phonate would not be as direct as with bilateral RLN damage. Vocal cord paralysis can happen as a single nerve injury, leading to symptoms but without necessarily resulting in stridor or inability to phonate. Thyroid storm is a critical condition related to hyperthyroidism, not directly caused by surgical complications