Tatyana E Fontenot1, Gregory W Randolph2, Tedhar E Setton1, Nuha Alsaleh1, Emad Kandil1. 1. Department of Surgery, School of Medicine, Tulane University, New Orleans, Louisiana, U.S.A. 2. Division of Thyroid and Parathyroid Surgery, Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A.
Abstract
OBJECTIVES/HYPOTHESIS: Demonstrate whether intraoperative nerve monitoring is an effective tool in staging bilateral thyroid and neck surgeries in cases of intraoperative injury to the recurrent laryngeal nerve on the side of initial dissection. We hypothesized that IONM provides reliable and appropriate feedback on the functional status of the RLN on side of initial dissection during total thyroidectomy and central neck surgery. STUDY DESIGN: Case series with planned data collection. METHODS: All patients receiving total thyroidectomies or central neck surgeries were reviewed. The outcomes of patients treated whose procedures were staged based on intraoperative nerve monitoring are described. RESULTS: Ten (4.9%) of 206 procedures were staged based on unfavorable signal change including six patients with thyroid cancers and four with compressive substernal goiters. The overall signal drop in the 10 patients with unfavorable signal change was 63%. Three patients had complete loss of signal. In the other seven patients, the signal dropped by a mean of 48%. In the eight patients with laryngoscopy-proven vocal fold paresis, the signal dropped by a mean of 68%. CONCLUSIONS: Intraoperative nerve monitoring results accurately indicated postoperative ipsilateral vocal cord dysfunction with high reliability. Intraoperative nerve monitoring is a reliable tool in staging thyroid surgery. LEVEL OF EVIDENCE: 4.
OBJECTIVES/HYPOTHESIS: Demonstrate whether intraoperative nerve monitoring is an effective tool in staging bilateral thyroid and neck surgeries in cases of intraoperative injury to the recurrent laryngeal nerve on the side of initial dissection. We hypothesized that IONM provides reliable and appropriate feedback on the functional status of the RLN on side of initial dissection during total thyroidectomy and central neck surgery. STUDY DESIGN: Case series with planned data collection. METHODS: All patients receiving total thyroidectomies or central neck surgeries were reviewed. The outcomes of patients treated whose procedures were staged based on intraoperative nerve monitoring are described. RESULTS: Ten (4.9%) of 206 procedures were staged based on unfavorable signal change including six patients with thyroid cancers and four with compressive substernal goiters. The overall signal drop in the 10 patients with unfavorable signal change was 63%. Three patients had complete loss of signal. In the other seven patients, the signal dropped by a mean of 48%. In the eight patients with laryngoscopy-proven vocal fold paresis, the signal dropped by a mean of 68%. CONCLUSIONS: Intraoperative nerve monitoring results accurately indicated postoperative ipsilateral vocal cord dysfunction with high reliability. Intraoperative nerve monitoring is a reliable tool in staging thyroid surgery. LEVEL OF EVIDENCE: 4.
Authors: Brandon Michael Henry; Matthew J Graves; Jens Vikse; Beatrice Sanna; Przemysław A Pękala; Jerzy A Walocha; Marcin Barczyński; Krzysztof A Tomaszewski Journal: Langenbecks Arch Surg Date: 2017-04-04 Impact factor: 3.445