American Journal of Otolaryngology - Head and Neck Medicine and Surgery
Volume 33, Issue 1 , Pages 1-5, January 2012

Detecting and identifying nonrecurrent laryngeal nerve with the application of intraoperative neuromonitoring during thyroid and parathyroid operation☆☆☆★

  • Feng-Yu Chiang, MD

      Affiliations

    • Department of Otolaryngology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
    • Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
    • ,
  • I-Cheng Lu, MD

      Affiliations

    • Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
    • Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
    • ,
  • Cheng-Jing Tsai, MD

      Affiliations

    • Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
    • ,
  • Pi-Jung Hsiao, MD

      Affiliations

    • Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
    • Department of Endocrinology and Metabolism Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
    • ,
  • Ka-Wo Lee, MD

      Affiliations

    • Department of Otolaryngology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
    • Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
    • ,
  • Che-Wei Wu, MD

      Affiliations

    • Department of Otolaryngology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
    • Department of Otolaryngology, Kaohsiung Municipal Hsaio-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
    • Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
    • Corresponding Author InformationCorresponding author. Department of Otolaryngology-Head and Neck Surgery, Kaohsiung Medical University Hospital, No.100, Tzyou First Road, Kaohsiung City 807, Taiwan. Tel.: +886 7 3121101x5009; fax: +886 7 3208264.

Received 28 August 2010 published online 09 February 2011.

Abstract 

Purpose

The nonrecurrent laryngeal nerve (NRLN) is a rare anatomical variant but associated with high risk of nerve injury during thyroid and parathyroid operations. Therefore, intraoperative detection and verification of NRLN are necessary.

Method

A total of 390 consecutive patients who underwent thyroid and parathyroid operations (310 RLNs dissected on the right side and 293 nerves on the left side) were enrolled. Electrically evoked electromyography was recorded from the vocalis muscles via an endotracheal tube with glottis surface recording electrodes. At an early stage of operation, vagal nerve was routinely stimulated at the level of inferior thyroid pole to ensure normal path of RLN. If there is a negative response from lower position but positive response from upper vagal stimulation, it indicates the occurrence of a NRLN, and we localize its separation point and path.

Results

Four right NRLNs (1.3%) without preoperative recognition were successfully detected at an early stage of operation. Three patients were operated on for thyroid disease, one for parathyroid adenoma and all were associated with right aberrant subclavian artery. All NRLNs were localized and identified precisely with intraoperative neuromonitoring. Functional integrity of all nerves was confirmed by the intraoperative neuromonitoring and postoperative laryngeal examination.

Conclusions

Vagal stimulation at the early stage of operation is a simple, useful, and reliable procedure to detect and identify the NRLN.

 

☆ Trial registration: Clinicaltrials.gov. Identifier: NCT00629746.

☆☆ Part of this work was presented at the Fourth World Congress of International Federation of Head and Neck Oncologic Societies in Seoul, Korea, June 15–19, 2010.

★ There are no conflicts of interest or financial support from any company.

PII: S0196-0709(10)00243-7

doi:10.1016/j.amjoto.2010.11.011

American Journal of Otolaryngology - Head and Neck Medicine and Surgery
Volume 33, Issue 1 , Pages 1-5, January 2012

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