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 Comparison of Recurrent Laryngeal Nerve Identification Time in the Lower Central Triangle During Thyroid Surgery Using Neurophysiological Mapping and Monitoring

Medicina ◽  
2021 ◽  
Vol 57 (8) ◽  
pp. 748
Author(s):  
Eunhye Lee ◽  
Keunchul Lee ◽  
Hyeongwon Yu ◽  
Sujin Kim ◽  
Youngjun Chai ◽  
...  
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Vocal Cord ◽  
Thyroid Surgery ◽  
Vocal Cord Palsy ◽  
Laryngeal Nerve ◽  
Follicular Neoplasm ◽  
National University ◽  
Seoul National University ◽  
Definition Of ◽  
Intraoperative Nerve Monitoring

Background and Objectives: Preserving the recurrent laryngeal nerve (RLN) is important in thyroid surgery. However, no standardized surgical method for locating the RLN has been established. We defined a new anatomical definition termed “lower central triangle” (LCT) for consistent identification of RLN and used intraoperative nerve monitoring (IONM) to aid in identification and dissection of RLN. Materials and Methods: Patients undergone thyroidectomy were reviewed retrospectively in Seoul National University Bundang Hospital from January to September 2017. Patients with papillary thyroid carcinoma, follicular neoplasm, and Graves’ Disease were included while right side non-RLN in arteriosus lusoria, cancer invasion, pre-existing vocal cord palsy, or under the age of 18 were excluded. RLNs were tested with IONM within LCT consisting of the lower pole as the apex and the common carotid artery as the opposite side. The samples were divided into two groups, IONM and non-IONM. Results: Forty lobes in total were included, 22 in IONM group and 18 in non-IONM group. Groups were not significantly different in age, cancer proportion, and accompanying thyroiditis while sex and nodule size differed. RLN detection time was 10.43 sec shorter (p < 0.001), and confirmation time was 10.67 sec shorter (p = 0.09) in IONM group than in non-IONM group. Both right and left RLNs were located predominately in the middle of LCT. No transient or permanent vocal cord palsy occurred. Conclusions: While IONM is an appropriate aid for thyroidectomy, our approach using LCT to locate the RLN is a novel definition of anatomy that provides prompt identification of the RLN in thyroid surgery.

scholarly journals Intraoperative Monitoring of the Recurrent Laryngeal Nerve during Thyroidectomy: A Standardized Approach (Part 1)

2011 ◽  
Vol 3 (3) ◽  
pp. 144-150 ◽  
Author(s):  
Henning Dralle ◽  
Antonio Sitges-Serra ◽  
Peter Angelos ◽  
Manuel C Durán Poveda ◽  
Gianlorenzo Dionigi ◽  
...  
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Thyroid Surgery ◽  
Superior Laryngeal Nerve ◽  
Surgical Anatomy ◽  
Laryngeal Nerve ◽  
Nerve Monitoring ◽  
Visual Identification ◽  
Current State ◽  
Monitoring Procedure ◽  
Intraoperative Nerve Monitoring

ABSTRACT One of the most feared complications in thyroid surgery is injury to the superior laryngeal nerve or recurrent laryngeal nerve. Neural identification during surgery is insufficient to assess nerve injury. Intraoperative nerve monitoring of the vagal nerve and recurrent laryngeal nerve during thyroid surgery is a new adjunct designed to allow better identification of nerves at risk and therefore reduce complications related to their injury. This new working tool does not substitute adequate surgical technique but merely provides the surgeon with an adjunct to routine visual identification and functional assessment. The use of nerve monitoring requires standardization of the monitoring procedure. Pursuant to this, we will discuss in two related articles the current state of the art standardized technique of nerve monitoring in thyroid surgery. The aim of part 1 is to provide a concise overview of nerve monitoring in thyroid surgery and its effectiveness. This will include a brief review of the surgical anatomy of the recurrent laryngeal nerve and the key landmarks used to identify the nerve during surgery. Part 2 will describe how to perform the standardized nerve monitoring in a step by step fashion during thyroid surgery which will diminish variable results and misleading information associated with a nonstandardized nerve monitoring procedure.

scholarly journals Intraoperative nerve monitoring in thyroid surgery: Analysis of recurrent laryngeal nerve identification and operative time

2021 ◽  
Vol 6 (2) ◽  
pp. 354-361
Author(s):  
Prachya Maneeprasopchoke ◽  
Cheerasook Chongkolwatana ◽  
Warut Pongsapich ◽  
Ayaka J. Iwata ◽  
Dipti Kamani ◽  
...  
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Thyroid Surgery ◽  
Operative Time ◽  
Laryngeal Nerve ◽  
Nerve Monitoring ◽  
Intraoperative Nerve Monitoring ◽  
Nerve Identification

scholarly journals Intraoperative Monitoring of the Recurrent Laryngeal Nerve during Thyroidectomy: A Standardized Approach Part 2

2012 ◽  
Vol 4 (1) ◽  
pp. 33-40 ◽  
Author(s):  
Henning Dralle ◽  
Antonio Sitges-Serra ◽  
Peter Angelos ◽  
Manuel C Durán Poveda ◽  
Gianlorenzo Dionigi ◽  
...  
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Thyroid Surgery ◽  
Intraoperative Monitoring ◽  
Surgical Anatomy ◽  
Laryngeal Nerve ◽  
Nerve Monitoring ◽  
Concise Overview ◽  
Monitoring Procedure ◽  
Intraoperative Nerve Monitoring ◽  
Neural Monitoring

ABSTRACT This is the second of two articles on intraoperative neural monitoring. The aim of part one was to provide a concise overview of intraoperative nerve monitoring in thyroid surgery and its effectiveness. Part 1 included a brief review of the surgical anatomy of the recurrent laryngeal nerve and described the surgical landmarks which can be used to identify the nerve during surgery. Part 2 will describe in detail a standardized approach to intraoperative nerve monitoring during thyroid surgery. A brief review of the nerve monitoring procedure and all its requirements will be discussed. The article concludes with the description of a troubleshooting algorithm for intraoperative loss of signal. How to cite this article Poveda MCD, Dionigi G, Sitges- Serra A, Barczynski M, Angelos P, Dralle H, Phelan E, Randolph G. Intraoperative Monitoring of the Recurrent Laryngeal Nerve during Thyroidectomy: A Standardized Approach Part 2. World J Endocr Surg 2012;4(1):33-40.

Neonatal Vocal Cord Paralysis Following Extracorporeal Membrane Oxygenation

PEDIATRICS ◽  
1989 ◽  
Vol 84 (5) ◽  
pp. 793-796 ◽  
Author(s):  
Robert E. Schumacher ◽  
Irvin J. Weinfeld ◽  
Robert H. Bartlett
Keyword(s):  
Respiratory Failure ◽  
Extracorporeal Membrane Oxygenation ◽  
Recurrent Laryngeal Nerve ◽  
Vocal Cord ◽  
Vocal Cord Paralysis ◽  
Vocal Cord Palsy ◽  
Laryngeal Nerve ◽  
Membrane Oxygenation ◽  
The Right ◽  
Unilateral Vocal Cord Paralysis

Five cases of unilateral vocal cord paralysis/ paresis were diagnosed following extracorporeal membrane oxygenation for newborn respiratory failure. All were right sided and transient in nature. None of the five patients had other findings commonly associated with vocal cord palsy. The extracorporeal membrane oxygenation procedure requires surgical dissection in the carotid sheath on the right side of the neck, an area immediately adjacent to both the vagus and recurrent laryngeal nerve. It is speculated that vocal cord paralysis in these infants was acquired as a result of the extracorporeal membrane oxygenation cannulation. Although the vocal cord paralysis resolved in all cases, two patients had difficult courses after extracorporeal membrane oxygenation. Therefore, laryngoscopic examination should be considered for patients after extracorporeal membrane oxygenation.

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