Rick Schneider1, Gregory Randolph2, Gianlorenzo Dionigi3, Marcin Barczyński4, Feng-Yu Chiang5, Frédéric Triponez6, Kyriakos Vamvakidis7, Katrin Brauckhoff8, Thomas J Musholt9, Martin Almquist10, Nadia Innaro11, Antonio Jimenez-Garcia12, Jean-Louis Kraimps13, Akira Miyauchi14, Beata Wojtczak15, Gianluca Donatini13, Davide Lombardi16, Uwe Müller17, Luciano Pezzullo18, Tomas Ratia19, Sam Van Slycke20, Phuong Nguyen Thanh1, Kerstin Lorenz1, Carsten Sekulla1, Andreas Machens1, Henning Dralle1. 1. Department of General, Visceral, and Vascular Surgery, University Hospital of Martin Luther University, Halle (Saale), Germany. 2. Division of Thyroid and Parathyroid Surgery, Harvard Medical School, Boston, Massachusetts, U.S.A. 3. Department for Endocrine Surgery, University of Insubria, Varese, Italy. 4. Department of Endocrine Surgery, 3rd Chair of General Surgery, Jagiellonian University, Krakow, Poland. 5. Department of Otolaryngology-Head and Neck Surgery, Kaohsiung Medical University, Kaohsiung City, Taiwan. 6. Thoracic and Endocrine Surgery, University Hospitals of Geneva, Geneva, Switzerland. 7. Department of Endocrine Surgery, Central Clinic of Athens, Athens, Greece. 8. Department of Surgery, Haukeland University Hospital, Bergen, Norway. 9. Endocrine Surgery Section, Clinic of General, Visceral, and Transplantation Surgery, University Medical Center, Mainz, Germany. 10. Department of Surgery, Lund University Hospital, Lund, Sweden. 11. Department of General Surgery, University of Catanzaro, Catanzaro, Italy. 12. Department of Surgery, University Hospital "Virgen Macarena", Seville, Spain. 13. Department of Endocrine Surgery, University Hospital of Poitiers, Poitiers, France. 14. Department of Surgery, Kuma Hospital, Kobe, Japan. 15. Department of General, Gastroenterological and Endocrine Surgery, Medical University Wrocław, Wrocław, Poland. 16. Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Brescia, Italy. 17. Department of General, Viszeral and Thoracic Surgery, Bundeswehr Hospital, Berlin, Germany. 18. Thyroid and Parathyroid Surgery Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori, Fondazione G. Pascale, Naples, Italy. 19. Department of General Surgery, "Principe de Asturias" University Hospital, Madrid, Spain. 20. Department of General and Endocrine Surgery, OLV Clinic Aalst, Aalst, Belgium.
Abstract
OBJECTIVES/HYPOTHESIS: Intraoperative neuromonitoring identifies recurrent laryngeal nerve (RLN) injury and gives prognostic information regarding postoperative glottic function. Loss of the neuromonitoring signal (LOS) signifies segmental type 1 or global type 2 RLN injury. This study aimed at identifying risk factors for RLN injury and determining vocal fold (VF) function initially and 6 months after definitive LOS. STUDY DESIGN: Prospective study encompassing 21 hospitals from 13 countries. METHODS: Included in this study were patients with persistent intraoperative LOS. RESULTS: At first postoperative laryngoscopy, early VF palsy was present in 94 of all 115 patients with LOS (81.7%): in 53 of 56 patients (94.6%) with type 1 injury and 41 of 59 patients (69.5%) with type 2 injury. In LOS type 1, women outnumbered men >5-fold. Traction produced LOS type 1 in 38 of 56 patients (67.9%) and LOS type 2 in 54 of 59 patients (91.5%). Course of the RLN posterior and/or anterior to the inferior thyroid artery, extralaryngeal branching, or tuberculum of Zuckerkandl did not increase VF palsy rates. Permanent VF palsy rates were also lower (P = .661) after LOS type 2 than after LOS type 1: 6.8% (four of 59 patients) versus 10.7% (six of 56 patients). Intraoperative administration of steroids did not diminish postoperative VF palsy rates. CONCLUSIONS: LOS type 1 entails more severe nerve damage than LOS type 2, affecting women disproportionately. Both LOS types, being primarily associated with traction injury, are unaffected by variant neck anatomy in expert hands and unresponsive to steroids. LEVEL OF EVIDENCE: 2b Laryngoscope, 126:1260-1266, 2016.
OBJECTIVES/HYPOTHESIS: Intraoperative neuromonitoring identifies recurrent laryngeal nerve (RLN) injury and gives prognostic information regarding postoperative glottic function. Loss of the neuromonitoring signal (LOS) signifies segmental type 1 or global type 2 RLN injury. This study aimed at identifying risk factors for RLN injury and determining vocal fold (VF) function initially and 6 months after definitive LOS. STUDY DESIGN: Prospective study encompassing 21 hospitals from 13 countries. METHODS: Included in this study were patients with persistent intraoperative LOS. RESULTS: At first postoperative laryngoscopy, early VF palsy was present in 94 of all 115 patients with LOS (81.7%): in 53 of 56 patients (94.6%) with type 1 injury and 41 of 59 patients (69.5%) with type 2 injury. In LOS type 1, women outnumbered men >5-fold. Traction produced LOS type 1 in 38 of 56 patients (67.9%) and LOS type 2 in 54 of 59 patients (91.5%). Course of the RLN posterior and/or anterior to the inferior thyroid artery, extralaryngeal branching, or tuberculum of Zuckerkandl did not increase VF palsy rates. Permanent VF palsy rates were also lower (P = .661) after LOS type 2 than after LOS type 1: 6.8% (four of 59 patients) versus 10.7% (six of 56 patients). Intraoperative administration of steroids did not diminish postoperative VF palsy rates. CONCLUSIONS: LOS type 1 entails more severe nerve damage than LOS type 2, affecting women disproportionately. Both LOS types, being primarily associated with traction injury, are unaffected by variant neck anatomy in expert hands and unresponsive to steroids. LEVEL OF EVIDENCE: 2b Laryngoscope, 126:1260-1266, 2016.
Authors: Rick Schneider; Andreas Machens; Michael Bucher; Christoph Raspé; Konstantin Heinroth; Henning Dralle Journal: Langenbecks Arch Surg Date: 2016-04-30 Impact factor: 3.445