What is the most likely complication of bilateral RLN damage after a subtotal thyroidectomy?

The most likely complication of bilateral recurrent laryngeal nerve (RLN) damage after a subtotal thyroidectomy is stridor. This complication occurs because damage to the RLN can lead to bilateral vocal cord paralysis, which severely compromises the airway by preventing the vocal cords from being able to abduct properly to allow airflow during breathing.

When the vocal cords are paralyzed in a closed position, it creates an obstruction in the airway, leading to difficulties in breathing and the characteristic high-pitched wheezing sound known as stridor. Stridor is often the most acute and noticeable symptom, indicating significant airway compromise that can be life-threatening if not addressed promptly.

While bilateral vocal cord paralysis is a direct result of RLN damage, stridor is the immediate manifestation that can occur as a consequence of that paralysis. The urgency of the situation is encapsulated in the presence of stridor, highlighting the need for immediate medical intervention to secure the airway and restore breathing function.