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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Journal ArticleDOI
Intraoperative neuromonitoring versus visual nerve identification for prevention of recurrent laryngeal nerve injury in adults undergoing thyroid surgery
Roberto Cirocchi,Vito D'Andrea,Alberto Arezzo,Iosief Abraha,Roberto Passera,Nicola Avenia,Justus J. Randolph,Marcin Barczyński +7 more
TL;DR: There was no firm evidence of an advantage or disadvantage comparing IONM with visual nerve identification only for permanent RILN palsy, and the evidence reported in this review was mostly of very low certainty.
Journal ArticleDOI
Continuous intraoperative neural monitoring of the recurrent nerves in thyroid surgery: a quantum leap in technology.
Rick Schneider,Gregory W. Randolph,Marcin Barczyński,Gianlorenzo Dionigi,Che-Wei Wu,Feng-Yu Chiang,Andreas Machens,Dipti Kamani,Henning Dralle +8 more
TL;DR: CIONM overcomes the key methodological limitation inherent in intermittent nerve monitoring (IINOM); which is allowing the nerve to be at risk in between the stimulations.
Journal ArticleDOI
Intraoperative neuromonitoring in thyroid surgery: Is the two-staged thyroidectomy justified?
Pietro Giorgio Calò,Fabio Medas,Giovanni Conzo,Francesco Podda,Gian Luigi Canu,Claudio Gambardella,Giuseppe Pisano,Enrico Erdas,Angelo Nicolosi +8 more
TL;DR: The results show that IONM has a very high sensitivity and negative predictive value, but also good specificity and positive predictive value and in selected patients with LOS, the surgical strategy should be reconsidered.
Journal ArticleDOI
Opportunities and challenges of intermittent and continuous intraoperative neural monitoring in thyroid surgery.
Rick Schneider,Andreas Machens,Gregory W. Randolph,Dipti Kamani,Kerstin Lorenz,Henning Dralle +5 more
TL;DR: This review summarizes the current key achievements of IONM; outlines opportunities for improvement regarding clinical implementation; and suggests areas of future research in this rapidly evolving field of intraoperative neuromonitoring.
Journal ArticleDOI
Impact of continuous intraoperative vagus stimulation on intraoperative decision making in favor of or against bilateral surgery in benign goiter.
Rick Schneider,Andreas Machens,Gregory W. Randolph,Gregory W. Randolph,Dipti Kamani,Kerstin Lorenz,Henning Dralle +6 more
TL;DR: The advent of continuous vagus stimulation (CVS), eliminating lag time between nerve preparation with potential trauma and stimulation, has transformed the intraoperative surgical strategy in thyroid surgery, delineating the extent to which CVS has changed the landscape.
References
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Journal ArticleDOI
Gender, race, and electrophysiologic characteristics of the branched recurrent laryngeal nerve.
Tatyana E. Fontenot,Gregory W. Randolph,Paul Friedlander,Hammad Masoodi,Ibrahim Musa Yola,Emad Kandil +5 more
TL;DR: It is hypothesized that racial and gender variations in prevalence of branched RLN exist and that they conveys an increased risk of nerve injury during thyroid surgery.
Journal ArticleDOI
Intraoperative Monitoring of the Recurrent Laryngeal Nerve during Thyroidectomy: A Standardized Approach (Part 1)
Henning Dralle,Antonio Sitges-Serra,Peter Angelos,Manuel C Durán Poveda,Gianlorenzo Dionigi,Marcin Barczyński,Eimear Phelan,Gregory W. Randolph +7 more
TL;DR: Two related articles will discuss in two related articles the current state of the art standardized technique of nerve monitoring in thyroid surgery and its effectiveness, including a brief review of the surgical anatomy of the recurrent laryngeal nerve and the key landmarks used to identify the nerve duringsurgery.
Journal ArticleDOI
The impact of recurrent laryngeal neuromonitoring on multi-dimensional voice outcomes following thyroid surgery†‡
Kristin Stevens,Alexander Stojadinovic,Leah B. Helou,Nancy Pearl Solomon,Robin S. Howard,Craig D. Shriver,Chester C. Buckenmaier,Leonard R. Henry +7 more
TL;DR: This work evaluated if RLN neuromonitoring correlated with non‐RLN injury‐related changes in voice after thyroidectomy and found that it did.
Journal ArticleDOI
Electrophysiologic identification and monitoring of the external branch of superior laryngeal nerve during thyroidectomy.
Emad Kandil,Salah Eldin Mohamed,Ahmed Deniwar,Hossam Eldin Mohamed,Paul Friedlander,Rizwan Aslam,Ahmad Saeed,Ibrahim Musa,Gregory W. Randolph +8 more
TL;DR: In this article, the authors examined the correlation between weight, gender, and race with external branch of superior laryngeal nerve (EBSLN) visualization and compared normative EBSLNs neural-monitoring values to those of the recurrent neural network (RLN).
Laryngeal Nerve Monitoring: Current Utilization among Head and Neck
TL;DR: The results suggest that LNM use has become more widespread and if this trend continues, LNM may eventually become routine practice among head and neck surgeons.
Related Papers (5)
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