Continuous vagal monitoring value in prevention of vocal cord paralysis following thyroid surgery

The Laryngoscope
Emad KandilGregory Randolph

Abstract

Continuous intraoperative neuromonitoring (CIONM) of the vagus nerve was proposed to obtained frequent repetitive electromyography (EMG) data to recognize early change in intraoperative function of the recurrent laryngeal nerve. We examine our initial experience using this technology. Retrospective review. Data for all patients who underwent neck surgery by a single surgeon at a North American institution over a 5-year period were reviewed. CIONM was used in cases with possible higher risk of traction injury and according to surgeon preference. In these cases, stretch injury was established by warning alarm with threshold of ≥50% reduction in amplitude and/or ≥ 10% increase in latency. Preoperative and postoperative direct laryngoscopy was performed for all patients. A total of 879 endocrine neck surgeries were performed. CIONM was used to monitor 455 recurrent laryngeal nerves (RLNs) in 344 (39.1%) surgeries. An automatic periodic stimulation (APS) alarm detected impending nerve injury in 33 (9.6%) cases by 64.9% ± 12.7% decrease in amplitude and by 27.3% increase in latency in one case. A total loss of signal (LOS) was detected in 15 (4.36%) cases. The immediate release of causative retraction successfully preserved the nerve...Continue Reading

References

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Citations

Jun 17, 2020·The Laryngoscope·Tzu-Yen HuangChe-Wei Wu
Aug 28, 2019·Laryngoscope Investigative Otolaryngology·Naoyoshi OnodaMasaichi Ohira
Jan 1, 2020·Laryngoscope Investigative Otolaryngology·Nobuyoshi TsuzukiKaoru Ogawa
Dec 17, 2020·Journal of Clinical Medicine·Elisabeth MaurerDetlef K Bartsch
Aug 4, 2021·Head & Neck·Dominic KuGregory Randolph

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