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

  • Image Result

    Type I NRLN (case 1). The patient was operated on for papillary thyroid cancer. The NRLN (arrow) directly arises from the vagus nerve (star) at upper neck position. There are still some small nerve br

    Type I NRLN (case 1). The patient was operated on for papillary thyroid cancer. The NRLN (arrow) directly arises from the vagus nerve (star) at upper neck position. There are still some small nerve branches (triangle) in the normal RLN position of the tracheoesophageal groove.

  • Image Result
    Type II NRLN (case 2). The patient was operated on for papillary thyroid cancer. The NRLN (arrow) arising from the vagus nerve (star) below the laryngotracheal junction and running parallel to the pat

    Type II NRLN (case 2). The patient was operated on for papillary thyroid cancer. The NRLN (arrow) arising from the vagus nerve (star) below the laryngotracheal junction and running parallel to the path of inferior thyroid artery.

  • Image Result
    Type II NRLN (case 3). The patient was operated on for right upper parathyroid adenoma (triangle). (A) The right NRLN (arrow) ran below the carotid artery (circle) after arising from the vagus nerve a

    Type II NRLN (case 3). The patient was operated on for right upper parathyroid adenoma (triangle). (A) The right NRLN (arrow) ran below the carotid artery (circle) after arising from the vagus nerve and ran between the parathyroid adenoma (triangle) and thyroid lobe before entering into the larynx. (B) The direct root of the NRLN (arrow) branching directly off the vagus nerve (circle) can be visualized after the retraction of the carotid artery laterally and mobilizing the parathyroid adenoma (triangle).

  • Image Result
    Type II NRLN (case 4). The patient was operated on for multinodular goiter. The NRLN (arrow) arises from the vagus nerve at lower neck position near the inferior thyroid pole. The NRLN could be misrec

    Type II NRLN (case 4). The patient was operated on for multinodular goiter. The NRLN (arrow) arises from the vagus nerve at lower neck position near the inferior thyroid pole. The NRLN could be misrecognized if the initial vagal stimulation level is too high.

☆ 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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