Time to Revisit a Low-Cost Alternative? Palpation Assessment Nerve Monitoring (PANM) for Recurrent Laryngeal Nerve to Predict Postoperative Vocal Cord Function—a Validation Study Using an In-House Neuromonitoring Device

2021 ◽  
Author(s):  
Thomas Shawn Sam ◽  
Anish Jacob Cherian ◽  
N Siddhartha Chakravarthy ◽  
Syrpailyne Wankhar ◽  
Roshna Rose Paul ◽  
...  
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Vocal Cord ◽  
Validation Study ◽  
Low Cost ◽  
Laryngeal Nerve ◽  
Nerve Monitoring ◽  
Vocal Cord Function

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.

scholarly journals Vocal cord function during recurrent laryngeal nerve injury assessed by accelerometry and EMG

2020 ◽  
Vol 130 (4) ◽  
pp. 1090-1096 ◽  
Author(s):  
Geir Olav Dahle ◽  
Erling Johan Setså ◽  
Øyvind Sverre Svendsen ◽  
Lodve Stangeland ◽  
John‐Helge Heimdal ◽  
...  
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Vocal Cord ◽  
Nerve Injury ◽  
Recurrent Laryngeal Nerve Injury ◽  
Laryngeal Nerve ◽  
Vocal Cord Function ◽  
Laryngeal Nerve Injury

Outcome of vocal cord function after partial layer resection of the recurrent laryngeal nerve in patients with invasive papillary thyroid cancer

Surgery ◽  
2014 ◽  
Vol 155 (1) ◽  
pp. 184-189 ◽  
Author(s):  
Minoru Kihara ◽  
Akira Miyauchi ◽  
Tomonori Yabuta ◽  
Takuya Higashiyama ◽  
Mitsuhiro Fukushima ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Recurrent Laryngeal Nerve ◽  
Vocal Cord ◽  
Papillary Thyroid Cancer ◽  
Laryngeal Nerve ◽  
Papillary Thyroid ◽  
Vocal Cord Function

scholarly journals Intraoperative recurrent laryngeal nerve monitoring using endotracheal electromyography during parathyroidectomy for secondary hyperparathyroidism

2021 ◽  
Vol 49 (3) ◽  
pp. 030006052110009
Author(s):  
Takahisa Hiramitsu ◽  
Toshihide Tomosugi ◽  
Manabu Okada ◽  
Kenta Futamura ◽  
Norihiko Goto ◽  
...  
Keyword(s):  
Secondary Hyperparathyroidism ◽  
Recurrent Laryngeal Nerve ◽  
Vocal Cord ◽  
Parathyroid Gland ◽  
Vocal Cord Paralysis ◽  
Laryngeal Nerve ◽  
Nerve Monitoring ◽  
Nodular Hyperplasia ◽  
Neural Monitoring ◽  
Recurrent Laryngeal Nerve Monitoring

Objective To investigate the factors associated with adherence of an enlarged parathyroid gland to the recurrent laryngeal nerve (RLN) and the effectiveness of intraoperative neural monitoring (IONM). Methods This single-center retrospective study involved samples from 197 consecutive patients (394 RLNs; 733 parathyroid glands) who underwent parathyroidectomy and transcervical thymectomy between September 2010 and December 2014. The presence of parathyroid gland adhesion to the RLN and the clinical characteristics of patients with and without nerve adhesion were recorded. All patients underwent intraoperative monitoring of the electromyographic responses of the vocal cords using the endotracheal NIM-Response 3.0 system. The patients’ postoperative clinical outcomes were recorded. Results Parathyroid gland adhesion to the RLN was significantly associated with maximum gland diameter (>15 mm), weight (>500 mg), and the presence of nodular hyperplasia. IONM demonstrated a sensitivity of 97.8%, specificity of 43.5%, and accuracy of 94.7% for detecting nerve damage. Parathyroid gland adhesion to 17 RLNs occurred in 3 cases (17.6%) of vocal cord paralysis, whereas the 377 glands without nerve adhesion resulted in vocal cord paralysis in 20 cases (5.3%). Conclusion Our findings demonstrated the effectiveness of IONM using endotracheal electromyography in patients who underwent parathyroidectomy for secondary hyperparathyroidism.

scholarly journals Continuous intraoperative nerve monitoring in thyroidectomy using automatic periodic stimulation in 256 at-risk nerves

2019 ◽  
Vol 101 (6) ◽  
pp. 432-435 ◽  
Author(s):  
N Hamilton ◽  
H Morley ◽  
M Haywood ◽  
S Arman ◽  
G Mochloulis
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Vocal Cord ◽  
Predictive Value ◽  
Nerve Palsy ◽  
Recurrent Laryngeal Nerve Palsy ◽  
Laryngeal Nerve ◽  
Nerve Function ◽  
Nerve Monitoring ◽  
Laryngeal Nerve Palsy ◽  
Periodic Stimulation

Introduction Automatic periodic stimulation of the vagal nerve during thyroidectomy provides real-time feedback of recurrent laryngeal nerve function intraoperatively. To assess the validity of this device, the ability of monitoring to predict recurrent laryngeal nerve palsy was determined and the incidence of recurrent laryngeal nerve palsy recorded. Materials and methods All thyroidectomies using APS® (Automatic Periodic Stimulation, Medtronic) nerve monitoring were reviewed over a 27-month period. Changes in signal amplitude and latency during thyroidectomy were recorded from saved data. Postoperative fibreoptic laryngoscopy determined the incidence of vocal cord immobility and recovery of nerve function was assessed from follow-up letters. Results A total of 256 at-risk nerves were examined (132 hemi- and 62 total thyroidectomies) in cases involving benign and malignant disease. Permanent recurrent laryngeal nerve palsy occurred in six (2.3%) lobectomies and transient recurrent laryngeal nerve palsy occurred in two lobectomies (< 1%). Sensitivity for detecting postoperative vocal cord immobility was 100% and specificity 85% if the end amplitude was 50% below baseline. The positive predictive value when amplitude was 50% below baseline was 18%. The negative predictive value when amplitude was 50% above or equal to baseline was 100%. Intraoperatively, the amplitude was 50% below baseline more frequently in the vocal cord immobility group (t-test, P < 0.015). No vagal nerve complications occurred. Conclusion Whilst the incidence of recurrent laryngeal nerve palsy is comparable to rates in the literature, the incidence of transient palsy is lower than published averages. APS is able to reliably predict recurrent laryngeal nerve palsy based on end amplitude.

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