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2015 ; 4
(5
): 368-75
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Electrophysiological neural monitoring of the laryngeal nerves in thyroid
surgery: review of the current literature
#MMPMID26425449
Deniwar A
; Kandil E
; Randolph G
Gland Surg
2015[Oct]; 4
(5
): 368-75
PMID26425449
show ga
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.