Electrophysiological neural monitoring of the laryngeal nerves in thyroid surgery: review of the current literature.
TLDR
The article will discuss the value of continuous IONM (C-IOMN) that may prevent nerve injury by detecting EMG waveform changes indicating impending nerve injury.Abstract:
Recurrent laryngeal nerve (RLN) injury is one of the most common complications of thyroid surgery. RLN injury can cause vocal cord paralysis, affecting the patient's voice and the quality of life. Injury of the external branch of the superior laryngeal nerve (EBSLN) can cause cricothyroid muscle denervation affecting high vocal tones. Thus, securing the laryngeal nerves in these surgeries is of utmost importance. Visual identification of the nerves has long been the standard method for this precaution. Intraoperative neuromonitoring (IONM) has been introduced as a novel technology to improve the protection of the laryngeal nerves and reduce the rate of RLN injury. The aim of this article is to provide a brief description of the technique and review the literature to illustrate the value of IONM. IONM can provide early identification of anatomical variations and unusual nerve routes, which carry a higher risk of injury if not detected. IONM helps in prognosticating postoperative nerve function. Moreover, by detecting nerve injury intraoperatively, it aids in staging bilateral surgeries to avoid bilateral vocal cord paralysis and tracheostomy. The article will discuss the value of continuous IONM (C-IOMN) that may prevent nerve injury by detecting EMG waveform changes indicating impending nerve injury. Herein, we are also discussing anatomy of laryngeal nerves and aspects of its injury.read more
Citations
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Risk Factors That Influence Surgical Decision-Making for Patients with Low-Risk Differentiated Thyroid Cancer with Tumor Diameters of 1-4 cm.
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Shield for recurrent laryngeal nerve and associated method of use
TL;DR: In this paper, a portion of a recurrent laryngeal nerve of a subject with a shield including extra embryonic tissue is covered during a neck surgery of the subject, and the covering occurs during the surgery itself.
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Influence of rocuronium on achieving optimal vagal stimulation during intraoperative nerve monitoring in thyroid surgery
Erman Alçi,Murat Özdemir,Almir Mi̇ftari̇,Safa Vatansever,Demet Sergin,Mustafa Nuri Deniz,Sezgin Ulukaya,Gökhan İçöz,Mahir Akyildiz,Özer Makay +9 more
TL;DR: It can be expected that as soon as the effects of neuromuscular blockers on the peripheral muscles begin to abate, it will be possible to obtain the ipsilateral vagus signal prior to recurrent laryngeal nerve dissection at the desired levels.
References
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Journal ArticleDOI
Electrophysiologic recurrent laryngeal nerve monitoring during thyroid and parathyroid surgery: international standards guideline statement.
Gregory W. Randolph,Gregory W. Randolph,Henning Dralle,Hisham Abdullah,Marcin Barczyński,Rocco Domenico Alfonso Bellantone,Michael Brauckhoff,Bruno Carnaille,Sergii Cherenko,Fen‐Yu Chiang,Gianlorenzo Dionigi,Camille Finck,Dana M. Hartl,Dipti Kamani,Kerstin Lorenz,Paolo Miccolli,Radu Mihai,Akira Miyauchi,Lisa A. Orloff,Nancy D. Perrier,Manuel C Durán Poveda,Anatoly Romanchishen,Jonathan W. Serpell,Antonio Sitges-Serra,Tod Sloan,Sam Van Slycke,Samuel K. Snyder,Hiroshi Takami,Erivelto Volpi,Gayle E. Woodson +29 more
TL;DR: A review of the literature and cumulative experience of the multidisciplinary International Neural Monitoring Study Group with IONM spanning nearly 15 years confirms there is little uniformity in application of and results from nerve monitoring across different centers and helps identify areas where additional research is necessary.
Journal ArticleDOI
Risk factors of paralysis and functional outcome after recurrent laryngeal nerve monitoring in thyroid surgery.
Henning Dralle,Carsten Sekulla,Johannes Haerting,Wolfgang Timmermann,Hans Jürgen Neumann,Eberhard Kruse,Stefan Grond,Hans Peter Mühlig,Christian Richter,Johannes Voss,Oliver Thomusch,Hans Lippert,Ingo Gastinger,Michael Brauckhoff,Oliver Gimm +14 more
TL;DR: Visual nerve identification was identified to be the gold standard of RLN treatment in thyroid surgery because of the overall low frequency of RLNP and no statistical difference compared with visual nerve identification only was reached in the setting of this study.
Journal ArticleDOI
Randomized clinical trial of visualization versus neuromonitoring of recurrent laryngeal nerves during thyroidectomy
TL;DR: The aim of this study was to test the hypothesis that identification of the recurrent laryngeal nerve during thyroid surgery reduces injury and that intraoperative nerve monitoring may be of additional benefit.
Journal ArticleDOI
Clinical Practice Guideline: Improving Voice Outcomes after Thyroid Surgery
Sujana S. Chandrasekhar,Gregory W. Randolph,Michael D. Seidman,Richard M. Rosenfeld,Peter Angelos,Julie Barkmeier-Kraemer,Michael S. Benninger,Joel H. Blumin,Gregory Dennis,John B. Hanks,Megan R. Haymart,Richard T. Kloos,Brenda Seals,Jerry M. Schreibstein,Mack A. Thomas,Carolyn Waddington,Barbara Warren,Peter J. Robertson +17 more
TL;DR: This clinical practice guideline provides evidence-based recommendations for management of the patient’s voice when undergoing thyroid surgery during the preoperative, intraoperative, and postoperative period.
Journal ArticleDOI
Complications of central neck dissection in patients with papillary thyroid carcinoma: results of a study on 1087 patients and review of the literature.
Davide Giordano,Roberto Valcavi,Geoffrey B. Thompson,Corrado Pedroni,Luigi Renna,Paolo Gradoni,Verter Barbieri +6 more
TL;DR: The increased rates of transient and permanent hypoparathyroidism in the series suggest a critical review of indications for the routine use of prophylactic CND for PTC and suggests that ipsilateral CND ipsilaterally to the tumor associated with total thyroidectomy may represent an effective strategy for reducing the rate of permanent Hypoparathiroidism.
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Electrophysiologic recurrent laryngeal nerve monitoring during thyroid and parathyroid surgery: international standards guideline statement.
Gregory W. Randolph,Gregory W. Randolph,Henning Dralle,Hisham Abdullah,Marcin Barczyński,Rocco Domenico Alfonso Bellantone,Michael Brauckhoff,Bruno Carnaille,Sergii Cherenko,Fen‐Yu Chiang,Gianlorenzo Dionigi,Camille Finck,Dana M. Hartl,Dipti Kamani,Kerstin Lorenz,Paolo Miccolli,Radu Mihai,Akira Miyauchi,Lisa A. Orloff,Nancy D. Perrier,Manuel C Durán Poveda,Anatoly Romanchishen,Jonathan W. Serpell,Antonio Sitges-Serra,Tod Sloan,Sam Van Slycke,Samuel K. Snyder,Hiroshi Takami,Erivelto Volpi,Gayle E. Woodson +29 more