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
A prospective evaluation of recurrent laryngeal nerve paralysis during thyroidectomy.
TL;DR: Thyroid surgery for malignant neoplasms and recurrent substernal goiter was associated with an increased risk of permanent recurrent nerve damage, and postoperative vocal cord dysfunction recovered in most patients without documented nerve damage.
Journal ArticleDOI
External branch of the superior laryngeal nerve monitoring during thyroid and parathyroid surgery: International Neural Monitoring Study Group standards guideline statement
Marcin Barczyński,Gregory W. Randolph,Gregory W. Randolph,Claudio Roberto Cernea,Henning Dralle,Gianlorenzo Dionigi,Piero F. Alesina,Radu Mihai,Camille Finck,Davide Lombardi,Dana M. Hartl,Akira Miyauchi,Jonathan W. Serpell,Samuel K. Snyder,Erivelto Volpi,Gayle E. Woodson,Jean Louis Kraimps,Abdullah N. Hisham +17 more
TL;DR: The hypothesis explored in this review is that the use of a standardized approach to the functional preservation of the EBSLN can be facilitated by application of IONM resulting in improved preservation of voice following thyroidectomy or parathyroidectomy.
Journal ArticleDOI
Elucidating Mechanisms of Recurrent Laryngeal Nerve Injury During Thyroidectomy and Parathyroidectomy
TL;DR: RLN injury during thyroidectomy or parathyroidectomy occurs intraoperatively significantly more often to a visually intact RLN than to a transected nerve.
Journal ArticleDOI
The importance of preoperative laryngoscopy in patients undergoing thyroidectomy: voice, vocal cord function, and the preoperative detection of invasive thyroid malignancy.
TL;DR: The importance of preoperative diagnosis of invasive disease in operative planning and patient counseling, and the importance of vocal cord functional analysis in recurrent laryngeal nerve management algorithms for nerves found infiltrated at operation, and laryngoscopic examination is recommended for all patients undergoing thyroid operation.
Journal ArticleDOI
Continuous intraoperative vagus nerve stimulation for identification of imminent recurrent laryngeal nerve injury.
Rick Schneider,Gregory W. Randolph,Carsten Sekulla,Eimear Phelan,Phuong Nguyen Thanh,Michael Bucher,Andreas Machens,Henning Dralle,Kerstin Lorenz +8 more
TL;DR: Conventional intraoperative nerve monitoring, predicated on intermittent stimulation, can predict recurrent laryngeal nerve palsy only after the damage has been done.
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Electrophysiologic recurrent laryngeal nerve monitoring during thyroid and parathyroid surgery: international standards guideline statement.
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