Prospective randomized study on injury of the external branch of the superior laryngeal nerve during thyroidectomy comparing intraoperative nerve monitoring and a conventional technique

Head & Neck ◽  
2014 ◽  
Vol 37 (10) ◽  
pp. 1456-1460 ◽  
Author(s):  
Hiroo Masuoka ◽  
Akira Miyauchi ◽  
Takuya Higashiyama ◽  
Tomonori Yabuta ◽  
Mitsuhiro Fukushima ◽  
...  
Keyword(s):  
Randomized Study ◽  
Superior Laryngeal Nerve ◽  
Conventional Technique ◽  
Laryngeal Nerve ◽  
Prospective Randomized Study ◽  
Nerve Monitoring ◽  
External Branch ◽  
Intraoperative Nerve Monitoring

scholarly journals Recurrent and superior laryngeal nerve injury in thyroid surgery: literature review

2021 ◽  
Author(s):  
Abdullatif Mahyoub ◽  
Alaa A. Aljohani ◽  
Abdullah J. Althobaiti ◽  
Sami S. Alharbi ◽  
Abdulaziz A. Alahmary ◽  
...  
Keyword(s):  
Risk Factors ◽  
Nerve Injury ◽  
Superior Laryngeal Nerve ◽  
Recurrent Laryngeal Nerve Injury ◽  
Laryngeal Nerve ◽  
Nerve Monitoring ◽  
External Branch ◽  
Surgeon Experience ◽  
Laryngeal Nerve Injury ◽  
Intraoperative Nerve Monitoring

Laryngeal nerve injury is considered one of the most common complications after thyroidectomy. It is associated with decreased quality of life because it will result in hoarseness of voice and aspiration. Identification of the risk factors and procedures to decrease the injury is crucial for handling laryngeal nerve injury. We searched the MEDLINE database using PubMed. Two independent reviewers reviewed the resulting papers and reviewed them based on our inclusion criteria. Based on the review results, the incidence of recurrent laryngeal nerve injury is higher than the external branch of the superior laryngeal nerve, but it is mainly due to under-reporting of the external branch of superior laryngeal nerve injury. Cancer surgery, surgeon experience, workload, re-operative procedures, and extent of surgery increased the incidence of the laryngeal nerve injury. Handling of these risk factors combined with visual dissection and inspection and/or intraoperative nerve monitoring decreased the incidence of the nerve injury. In conclusion, laryngeal nerve injury is a common post thyroidectomy complication. Anatomical dissection and visual inspection combined with intraoperative nerve monitoring is the most suitable option in high-risk thyroid surgeries.

Is the identification of the external branch of the superior laryngeal nerve mandatory in thyroid operation? Results of a prospective randomized study

Surgery ◽  
2001 ◽  
Vol 130 (6) ◽  
pp. 1055-1059 ◽  
Author(s):  
Rocco Bellantone ◽  
Mauro Boscherini ◽  
Celestiano P. Lombardi ◽  
Maurizio Bossola ◽  
Francesco Rubino ◽  
...  
Keyword(s):  
Randomized Study ◽  
Superior Laryngeal Nerve ◽  
Laryngeal Nerve ◽  
Prospective Randomized Study ◽  
Thyroid Operation ◽  
External Branch ◽  
Operation Results

External branch of the superior laryngeal nerve monitoring during thyroid and parathyroid surgery: International Neural Monitoring Study Group standards guideline statement

2013 ◽  
Vol 123 ◽  
pp. S1-S14 ◽  
Author(s):  
Marcin Barczyński ◽  
Gregory W. Randolph ◽  
Claudio R. Cernea ◽  
Henning Dralle ◽  
Gianlorenzo Dionigi ◽  
...  
Keyword(s):  
Superior Laryngeal Nerve ◽  
Laryngeal Nerve ◽  
Study Group ◽  
Parathyroid Surgery ◽  
Nerve Monitoring ◽  
External Branch ◽  
Monitoring Study ◽  
Neural Monitoring

scholarly journals Intraoperative Monitoring of the Recurrent Laryngeal Nerve during Thyroidectomy: A Standardized Approach (Part 1)

2011 ◽  
Vol 3 (3) ◽  
pp. 144-150 ◽  
Author(s):  
Henning Dralle ◽  
Antonio Sitges-Serra ◽  
Peter Angelos ◽  
Manuel C Durán Poveda ◽  
Gianlorenzo Dionigi ◽  
...  
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Thyroid Surgery ◽  
Superior Laryngeal Nerve ◽  
Surgical Anatomy ◽  
Laryngeal Nerve ◽  
Nerve Monitoring ◽  
Visual Identification ◽  
Current State ◽  
Monitoring Procedure ◽  
Intraoperative Nerve Monitoring

ABSTRACT One of the most feared complications in thyroid surgery is injury to the superior laryngeal nerve or recurrent laryngeal nerve. Neural identification during surgery is insufficient to assess nerve injury. Intraoperative nerve monitoring of the vagal nerve and recurrent laryngeal nerve during thyroid surgery is a new adjunct designed to allow better identification of nerves at risk and therefore reduce complications related to their injury. This new working tool does not substitute adequate surgical technique but merely provides the surgeon with an adjunct to routine visual identification and functional assessment. The use of nerve monitoring requires standardization of the monitoring procedure. Pursuant to this, we will discuss in two related articles the current state of the art standardized technique of nerve monitoring in thyroid surgery. The aim of part 1 is to provide a concise overview of nerve monitoring in thyroid surgery and its effectiveness. This will include a brief review of the surgical anatomy of the recurrent laryngeal nerve and the key landmarks used to identify the nerve during surgery. Part 2 will describe how to perform the standardized nerve monitoring in a step by step fashion during thyroid surgery which will diminish variable results and misleading information associated with a nonstandardized nerve monitoring procedure.

scholarly journals Protection of the external branch of the superior laryngeal nerve in Transoral endoscopic thyroidectomy vestibular approach (TOETVA): an observational study

2021 ◽  
Author(s):  
Zhen Wu ◽  
Jugao Fang ◽  
Hongzhi Ma ◽  
Xiao Chen ◽  
Qi Zhong ◽  
...  
Keyword(s):  
Contractile Activity ◽  
Endoscopic Thyroidectomy ◽  
Thyroid Cartilage ◽  
Superior Laryngeal Nerve ◽  
Laryngeal Nerve ◽  
External Branch ◽  
Protective Strategies ◽  
The Right ◽  
Intraoperative Nerve Monitoring ◽  
Vestibular Approach

Abstract Background: Avoiding injury of the external branch of the superior laryngeal nerve（EBSLN） is one of the major challenges during thyroid surgery, especially in transoral endoscopic thyroidectomy vestibular approach (TOETVA). This study aimed to investigate the protective strategies of the EBSLN during TOETVA. Methods: In order to protect the EBSLN during TOETVA, we adopted the method of identification the nerve by anatomy and localization. The method of anatomy involves the dissection of EBSLN by complete transection of the sternothyroid muscle in the attachment of the thyroid cartilage. The method of localization involves nerve stimulation localization, which produces cricothyroid contractile activity through intraoperative nerve monitoring stimulation (IONM). Concurrently, patients were evaluated preoperatively and at 1 and 3 weeks postoperatively in an individual prospective cohort study using a stroboscopic laryngoscope and the voice handicap index-10 (VHI-10). The VHI-10 score was used to evaluate voice changes. Results: We retrospectively analyzed patients with papillary thyroid cancer (PTC) who underwent TOETVA in the thyroid center of the Beijing Tongren hospital between February 2018 and June 2020. Patients with recurrent laryngeal nerve（RLN）damage were excluded. Sixty patients were enrolled in this study, of which four underwent total thyroidectomy. Intraoperatively, 56 EBSLNs were located (56/64, 87.50%). Among these, the left EBSLN was identified in 20/25(80.00%) and the right EBSLN was identified in 36/39 (92.31%) cases. One week postoperatively, a blinded stroboscopic laryngoscope examination showed that no patient had paresis of the EBSLN. However, the VHI-10 score was significantly higher than the preoperative value (10.58 ± 4.54 vs. 3.00 ± 1.54, p＜0.01). At three weeks postoperatively, the overall score was still different from that preoperatively (4.83 ± 3.34 vs. 3.00 ± 1.54, p＜0.01); however, the vast majority of patients returned to their preoperative status. Conclusion: In TOETVA, the EBSLN can be well exposed by transection of the sternothyroid muscle, and combined with IONM, the protection of the function of the EBSLN can be guaranteed. Simultaneously, we observed that TOETVA could cause a short-term voice handicap in patients, with such changes generally returning to normal within three weeks.

scholarly journals Is the superior laryngeal nerve really safe when using harmonic focus in total thyroidectomy? A prospective randomized study

2018 ◽  
Vol 41 (3) ◽  
pp. 222-228 ◽  
Author(s):  
Kemal Arslan ◽  
Bulent Erenoglu ◽  
Osman Dogru ◽  
Gultekin Ovet ◽  
Ersin Turan ◽  
...  
Keyword(s):  
Total Thyroidectomy ◽  
Randomized Study ◽  
Superior Laryngeal Nerve ◽  
Laryngeal Nerve ◽  
Prospective Randomized Study ◽  
Harmonic Focus

Electrophysiologic Laryngeal Nerve Monitoring in High-Risk Thyroid Surgery

2005 ◽  
Vol 84 (6) ◽  
pp. 378-381 ◽  
Author(s):  
Phillip Song ◽  
Larry Shemen
Keyword(s):  
High Risk ◽  
Thyroid Surgery ◽  
Thermal Injury ◽  
Mediastinal Mass ◽  
Superior Laryngeal Nerve ◽  
Laryngeal Nerve ◽  
Nerve Monitoring ◽  
Large Goiter ◽  
External Branch ◽  
Stimulation Of

We recently began performing intraoperative electrophysiologic monitoring of the recurrent laryngeal nerve and the external branch of the superior laryngeal nerve during high-risk thyroidectomies. Neuromonitoring can detect stimulation of these nerves and thereby prevent a mechanical or thermal injury that can result in neurapraxia or axonotmesis. Monitoring is also useful during dissection in an already operated-on field, when performing thyroidectomy on patients who depend on their voice for their livelihood, and when removing a large goiter or mediastinal mass.

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