Critical Review and Consensus Statement for Neural Monitoring in Otolaryngologic Head, Neck, and Endocrine Surgery

2021 ◽  
pp. 019459982110110
Author(s):  
Joseph Scharpf ◽  
Jeffrey C. Liu ◽  
Catherine Sinclair ◽  
Michael Singer ◽  
Whitney Liddy ◽  
...  
Keyword(s):  
Head And Neck ◽  
Patient Outcomes ◽  
Cranial Nerve ◽  
Consensus Statement ◽  
Task Force ◽  
Cranial Nerves ◽  
Endocrine Surgery ◽  
Nerve Monitoring ◽  
Modified Delphi ◽  
Head Neck

Background Enhancing patient outcomes in an array of surgical procedures in the head and neck requires the maintenance of complex regional functions through the protection of cranial nerve integrity. This review and consensus statement cover the scope of cranial nerve monitoring of all cranial nerves that are of practical importance in head, neck, and endocrine surgery except for cranial nerves VII and VIII within the temporal bone. Complete and applied understanding of neurophysiologic principles facilitates the surgeon’s ability to monitor the at-risk nerve. Methods The American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS) identified the need for a consensus statement on cranial nerve monitoring. An AAO-HNS task force was created through soliciting experts on the subject. Relevant domains were identified, including residency education, neurophysiology, application, and various techniques for monitoring pertinent cranial nerves. A document was generated to incorporate and consolidate these domains. The panel used a modified Delphi method for consensus generation. Results Consensus was achieved in the domains of education needs and anesthesia considerations, as well as setup, troubleshooting, and documentation. Specific cranial nerve monitoring was evaluated and reached consensus for all cranial nerves in statement 4 with the exception of the spinal accessory nerve. Although the spinal accessory nerve’s value can never be marginalized, the task force did not feel that the existing literature was as robust to support a recommendation of routine monitoring of this nerve. In contrast, there is robust supporting literature cited and consensus for routine monitoring in certain procedures, such as thyroid surgery, to optimize patient outcomes. Conclusions The AAO-HNS Cranial Nerve Monitoring Task Force has provided a state-of-the-art review in neural monitoring in otolaryngologic head, neck, and endocrine surgery. The evidence-based review was complemented by consensus statements utilizing a modified Delphi method to prioritize key statements to enhance patient outcomes in an array of surgical procedures in the head and neck. A precise definition of what actually constitutes intraoperative nerve monitoring and its benefits have been provided.

Cranial neuropathy following curative chemotherapy and radiotherapy for carcinoma of the nasopharynx

2000 ◽  
Vol 114 (4) ◽  
pp. 308-310 ◽  
Author(s):  
Matt Y. Kang ◽  
John M. Holland ◽  
Kenneth R. Stevens
Keyword(s):  
Head And Neck ◽  
Cranial Nerve ◽  
Hypoglossal Nerve ◽  
Cranial Nerves ◽  
Nasopharyngeal Cancer ◽  
Concurrent Chemotherapy ◽  
Cranial Neuropathy ◽  
Tumour Control ◽  
Cranial Nerve Palsies ◽  
Head And Neck Radiotherapy

Cranial nerve damage following head and neck radiotherapy is an unusual event. Cranial neuropathy following concurrent chemotherapy and radiotherapy is unreported. The authors report a case of a 54-year-old man treated with curative chemotherapy and radiotherapy for a stage III nasopharyngeal carcinoma who developed an unilateral hypoglossal nerve palsy five years after therapy. Follow-up examination and magnetic resonance imaging (MRI) show no evidence of recurrent disease. Hypoglossal nerve injury occurring after head and neck radiotherapy is an indirect effect due to progressive soft tissue fibrosis and loss of vascularity. This process develops over years leading to nerve entrapment and permanent damage. Cranial nerve palsies, including damage to the hypoglossal nerve, can develop years after therapy with no evidence of tumour recurrence. Chemotherapy and radiotherapy have improved progression-free and overall survival in advanced nasopharyngeal cancer. As more patients achieve long-term tumour control following chemotherapy and radiotherapy, we must be cognizant of potential late injury to cranial nerves.

Brain Stem and Cranial Nerve Monitoring

2016 ◽  
pp. 788-798
Author(s):  
Brian A. Crum
Keyword(s):  
Brain Stem ◽  
Cranial Nerve ◽  
Cranial Nerves ◽  
Neck Region ◽  
Accurate Identification ◽  
Nerve Monitoring ◽  
Motor Pathways ◽  
Cranial Nerve Function ◽  
The Brain ◽  
Clinical Deficits

Cranial nerves can be injured during surgical procedures performed in the middle and posterior cranial fossae as well as in the head and neck region. Damage results from compression, stretch, abrasion, or ischemia of the nerve. If axonal disruption occurs, recovery is limited, resulting in significant clinical deficits. Cranial nerve function can be monitored during anesthesia by recording spontaneous or stimulus-evoked electrical activity directly from the nerve or the cranial muscles. Activity in other pathways in the brain stem can be monitored by following changes in evoked potentials of sensory and motor pathways. These methods can detect damage to either the intra-axial or the extra-axial portion of cranial nerves and can localize cranial nerves during an operation when normal anatomy is altered, making accurate identification of nerves difficult. Finally, information from intraoperative cranial nerve monitoring may lead to an altered surgical plan to preserve neurological function.

Brain Stem and Cranial Nerve Monitoring

2009 ◽  
pp. 739-750
Author(s):  
Brian A. Crum
Keyword(s):  
Brain Stem ◽  
Nerve Injury ◽  
Cranial Nerve ◽  
Cranial Nerves ◽  
Posterior Fossa Surgery ◽  
Surgical Team ◽  
Nerve Monitoring ◽  
Cranial Nerve Injury ◽  
Clinical Detection ◽  
Multimodality Approach

Various modalities are available for monitoring the function of the cranial nerves and brain stem during intracranial or extracranial head and neck operations. After consideration of the surgical risks, a multimodality approach can be tailored to the needs of each patient. Close communication between the IOM team and the surgical team is vital in order to obtain appropriate electrophysiological information and provide useful feedback at a time when clinical detection of nerve injury is impossible. IOM has been shown to decrease the incidence of cranial nerve injury during posterior fossa surgery.

scholarly journals Use of Dexmedetomidine as an Adjuvant to Propofol along with Neurophysiological Monitoring of the Seventh Cranial Nerve during Cerebello- Pontine Tumour Excision Surgery

2021 ◽  
Author(s):  
Pooja Arpan Shah ◽  
Gayatri Vasagadekar ◽  
Akhilesh Chhaya
Keyword(s):  
Cranial Nerve ◽  
Cranial Nerves ◽  
Anaesthetic Management ◽  
Neuromuscular Blocking ◽  
Neuromuscular Blocking Agents ◽  
Neurophysiological Monitoring ◽  
Propofol Infusion Syndrome ◽  
Nerve Monitoring ◽  
Blocking Agents ◽  
Seventh Cranial Nerve

Cerebello‑Pontine Angle (CPA) surgeries are very challenging for neurosurgeons as it lies very close to brain stem so various cranial nerves are at risk of damage. Generally, such surgeries require neuromuscular monitoring of various cranial nerves. For that we have to discontinue neuromuscular blocking agents and inhalational agents. Total Intravenous Anaesthesia (TIVA) avoids the use of neuromuscular blocking agents as well as inhalational agents. However, prolonged infusion of propofol is associated with risks, such as hypotension, delayed awakening, and metabolic acidosis, known as “Propofol Infusion Syndrome”. Dexmedetomidine now‑a‑days is used very commonly as an adjuvant to propofol and it significantly reduces the anaesthetic requirement. Addition of dexmedetomidine provides haemodynamic stability during such neurosurgeries. Here, authors have described anaesthetic management of a 46‑year‑old female patient posted for CPA excision along with seventh cranial nerve monitoring using dexmedetomidine with propofol.

scholarly journals Teaching Recurrent Laryngeal Nerve Dissection to Residents in Head and Neck Endocrine Surgery

2012 ◽  
Vol 3 (1) ◽  
pp. 5-7 ◽  
Author(s):  
Krishnamurthi Sundaram ◽  
Behrad Ben Aynehchi
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Head And Neck ◽  
Early Identification ◽  
Vocal Fold ◽  
Vocal Fold Paralysis ◽  
Laryngeal Nerve ◽  
Endocrine Surgery ◽  
Morbidity Rate ◽  
Nerve Monitoring ◽  
Dissection Technique

ABSTRACT Background Various approaches can be employed when teaching thyroidectomy. Delivery of the gland prior to complete dissection and identification of the recurrent laryngeal nerve (RLN) is sometimes utilized in the absence of laryngeal nerve monitoring (LNM), while identification and dissection of the RLN from the gland is more feasible in the presence of LNM. We hypothesized that teaching RLN dissection technique to residents as primary surgeons (using loupes and nerve monitoring) did not increase postoperative morbidity in head and neck endocrine surgery. Materials and methods In 101 consecutive patients who underwent thyroidectomies/parathyroidectomies, we have modified our technique to teach our residents consistent early identification of the RLN in the paratracheal region by direct visualization (loupe magnification) and nerve stimulation. All patients had preoperative fiberoptic laryngoscopy and a repeat laryngoscopy 1 week after surgery. Presence or absence of true vocal fold paralysis/paresis was documented. Results One hundred and nineteen surgical procedures were available for study. One patient developed a permanent vocal fold paralysis (1/119 or 0.84%). There was another patient with a vocal fold paresis which recovered in 4 weeks (1/119 or 0.84%). Conclusion The RLN dissection technique with early identification, dissection and preservation of the nerve using magnification combined with nerve monitoring has emerged as an important resident teaching tool. The morbidity rate is acceptable. Notably in light of the increasing rates of thyroid surgery and LNM utilization, resident physicians may benefit from exposure to this technique as a component of their training. How to cite this article Sundaram K, Aynehchi BB. Teaching Recurrent Laryngeal Nerve Dissection to Residents in Head and Neck Endocrine Surgery. Int J Head and Neck Surg 2012;3(1):5-7.

Developing South Asia’s first structured head and neck surgery multicenter fellowship initiative.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 11037-11037
Author(s):  
Shamit Chopra ◽  
Dushyant Mandlik ◽  
Deepak Balasubramanian ◽  
Vikram Kekatpure ◽  
Subramania Iyer ◽  
...  
Keyword(s):  
South Asia ◽  
Head And Neck ◽  
Neck Cancer ◽  
Cancer Incidence ◽  
Task Force ◽  
Entrance Examination ◽  
Head Neck Cancer ◽  
High Head ◽  
Minimum Criteria ◽  
Head Neck

11037 Background: Despite high head neck cancer incidence in South Asia, there exist few fellowship programs, which are limited by lack of structure, review processes and standard curricula. Our aim was a regionwide multicenter head and neck fellowship initiative to address the above limitations. Methods: A 10-member task force was constituted in January 2018 under the aegis of the Foundation for Head and Neck Oncology. First phase: Initial curriculum drafted by incorporating region-specific perspectives, aided by multiple source documents. Candidate eligibility criteria outlined, accommodating multiple pertinent disciplines and an international applicant base. Format for a structured entrance examination, and a mandatory/desirable rotation schedule were developed. Second Subcommittee(SC) phase: Creation of a web portal ( www.fhnofellowship.org ) by Outreach SC, approval of applicant centers by Accreditation SC, layout of exam structure by the Examination SC, and defining a rank order list-driven match process by the Match SC. Third phase: Development of standard documentation including suggested bibliography, log book format, recommended grand rounds topics, common minimum criteria for fellowship graduation. A common entrance exam was conducted in Feb 2019, which incorporated written screening, center-candidate interactions, objective interview, and the merit-based institution-fellow match. Results: Total number of applicants: 92, the majority Oral Maxillofacial Surgeons(83.7%). Seventeen fellows matched in the first cycle, the initial and 6-month program compliance 94.1% and 88.2% respectively. More eligible institutions accredited(36.8% increase) prior to the second cycle in Nov 2019, during which 19 fellows(11.8% increase) were matched. An interim review was done in Oct 2019, and periodic reviewing set at 6-month intervals. Planned fourth phase: Objective center/candidate feedback, surgical video repository, online training schedule, develop the fellowship exit examination, and expand outreach to other countries. Conclusions: Owing to high head neck cancer incidence in the subcontinent, anatomic complexity, need to balance outcomes/toxicities and requirement of expert multidisciplinary care; structured head neck fellowship training is imperative. Despite inherent challenges of concept and implementation in a diverse multicultural resource-limited setting, we foresee the application of region-relevant perspectives helping us achieve the objective of furthering subspecialty head neck training in South Asia.

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