The Role of Intraoperative Nerve Monitoring in the Detection of the Nonrecurrent Laryngeal Nerve During Thyroid Surgery

2014 ◽  
Vol 1 (3) ◽  
Author(s):  
Salem I. Noureldine ◽  
Ralph P. Tufano
Keyword(s):  
Thyroid Surgery ◽  
Laryngeal Nerve ◽  
Nerve Monitoring ◽  
Nonrecurrent Laryngeal Nerve ◽  
Intraoperative Nerve Monitoring

scholarly journals Nonrecurrent Laryngeal Nerve in the Era of Intraoperative Nerve Monitoring

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
Emin Gurleyik ◽  
Gunay Gurleyik
Keyword(s):  
Early Stage ◽  
Anatomical Variation ◽  
Vocal Cord Palsy ◽  
Laryngeal Nerve ◽  
Proximal Point ◽  
Nerve Monitoring ◽  
Risk Of Injury ◽  
Nonrecurrent Laryngeal Nerve ◽  
The Right ◽  
Intraoperative Nerve Monitoring

Nonrecurrent laryngeal nerve (non-RLN) is an anatomical variation increasing the risk of vocal cord palsy. Prediction and early identification of non-RLN may minimize such a risk of injury. This study assessed the effect of intraoperative neuromonitoring (IONM) on the detection of non-RLN. A total of 462 (236 right) nerves in 272 patients were identified and totally exposed, and all intraoperative steps of IONM were sequentially applied on the vagus nerve (VN) and RLN. Right predissection VN stimulation at a distal point did not create a sound signal in three cases (3/236; 1.27%). Proximal dissection of the right VN under IONM guidance established a proximal point, creating a positive signal. The separation point of non-RLN from VN was discovered in all three patients. Non-RLNs were exposed from separation to laryngeal entry. Positive IONM signals were obtained after resection of thyroid lobes, and postoperative period was uneventful in patients with non-RLN. Absence of distal VN signal is a precise predictor of the non-RLN. IONM-guided proximal dissection of the right VN leads to identification of the non-RLN. The prediction of non-RLN by the absence of the VN signal at an early stage of surgery may prevent or minimize the risk of nerve injury.

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 Assessment of recurrent laryngeal nerve function during thyroid surgery

2014 ◽  
Vol 96 (2) ◽  
pp. 130-135 ◽  
Author(s):  
J Smith ◽  
J Douglas ◽  
B Smith ◽  
T Dougherty ◽  
C Ayshford
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Vocal Cord ◽  
Direct Laryngoscopy ◽  
Thyroid Surgery ◽  
Vocal Cord Palsy ◽  
Laryngeal Nerve ◽  
Laryngeal Function ◽  
Nerve Monitoring ◽  
Vocal Cord Function ◽  
Intraoperative Nerve Monitoring

Introduction There is disparity in the reported incidence of temporary and permanent recurrent laryngeal nerve (RLN) palsy following thyroidectomy. Much of the disparity is due to the method of assessing vocal cord function. We sought to identify the incidence and natural history of temporary and permanent vocal cord palsy following thyroid surgery. The authors wanted to establish whether intraoperative nerve monitoring and stimulation aids in prognosis when managing vocal cord palsy. Methods Prospective data on consecutive thyroid operations were collected. Intraoperative nerve monitoring and stimulation, using an endotracheal tube mounted device, was performed in all cases. Endoscopic examination of the larynx was performed on the first postoperative day and at three weeks. Results Data on 102 patients and 123 nerves were collated. Temporary and permanent RLN palsy rates were 6.1% and 1.7%. Most RLN palsies were identified on the first postoperative day with all recognised at the three-week review. No preoperative clinical risk factors were identified. Although dysphonia at the three-week follow-up visit was the only significant predictor of vocal cord palsy, only two-thirds of patients with cord palsies were dysphonic. Intraoperative nerve monitoring and stimulation did not predict outcome in terms of vocal cord function. Conclusions Temporary nerve palsy rates were consistent with other series where direct laryngoscopy is used to assess laryngeal function. Direct laryngoscopy is the only reliable measure of cord function, with intraoperative monitoring being neither a reliable predictor of cord function nor a predictor of eventual laryngeal function. The fact that all temporary palsies recovered within four months has implications for staged procedures.

The value of neurostimulation and intraoperative nerve monitoring of inferior laryngeal nerve in thyroid surgery

2009 ◽  
Vol 140 (6) ◽  
pp. 866-870 ◽  
Author(s):  
Ottavio Cavicchi ◽  
Umberto Caliceti ◽  
Ignacio Javier Fernandez ◽  
Giovanni Macrì ◽  
Cristiana Di Lieto ◽  
...  
Keyword(s):  
Thyroid Surgery ◽  
Laryngeal Nerve ◽  
Inferior Laryngeal Nerve ◽  
Nerve Monitoring ◽  
Intraoperative Nerve Monitoring

scholarly journals Intraoperative nerve monitoring in thyroid surgery: Analysis of recurrent laryngeal nerve identification and operative time

2021 ◽  
Vol 6 (2) ◽  
pp. 354-361
Author(s):  
Prachya Maneeprasopchoke ◽  
Cheerasook Chongkolwatana ◽  
Warut Pongsapich ◽  
Ayaka J. Iwata ◽  
Dipti Kamani ◽  
...  
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Thyroid Surgery ◽  
Operative Time ◽  
Laryngeal Nerve ◽  
Nerve Monitoring ◽  
Intraoperative Nerve Monitoring ◽  
Nerve Identification

scholarly journals Intraoperative Monitoring of the Recurrent Laryngeal Nerve during Thyroidectomy: A Standardized Approach Part 2

2012 ◽  
Vol 4 (1) ◽  
pp. 33-40 ◽  
Author(s):  
Henning Dralle ◽  
Antonio Sitges-Serra ◽  
Peter Angelos ◽  
Manuel C Durán Poveda ◽  
Gianlorenzo Dionigi ◽  
...  
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Thyroid Surgery ◽  
Intraoperative Monitoring ◽  
Surgical Anatomy ◽  
Laryngeal Nerve ◽  
Nerve Monitoring ◽  
Concise Overview ◽  
Monitoring Procedure ◽  
Intraoperative Nerve Monitoring ◽  
Neural Monitoring

ABSTRACT This is the second of two articles on intraoperative neural monitoring. The aim of part one was to provide a concise overview of intraoperative nerve monitoring in thyroid surgery and its effectiveness. Part 1 included a brief review of the surgical anatomy of the recurrent laryngeal nerve and described the surgical landmarks which can be used to identify the nerve during surgery. Part 2 will describe in detail a standardized approach to intraoperative nerve monitoring during thyroid surgery. A brief review of the nerve monitoring procedure and all its requirements will be discussed. The article concludes with the description of a troubleshooting algorithm for intraoperative loss of signal. How to cite this article Poveda MCD, Dionigi G, Sitges- Serra A, Barczynski M, Angelos P, Dralle H, Phelan E, Randolph G. Intraoperative Monitoring of the Recurrent Laryngeal Nerve during Thyroidectomy: A Standardized Approach Part 2. World J Endocr Surg 2012;4(1):33-40.

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