Prospective evaluation of the utility of routine neuromonitoring for an established thyroid surgical practice

Lee, Jane; Fraser, Sheila; Glover, Anthony; Sidhu, Stan

doi:10.1111/ans.13606

Cited by 21 publications

(11 citation statements)

References 21 publications

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“…In our primary surgery cases, an additional identification rate of 31.2% of nonvisualized branches by IONM revealed the significant contribution of nerve monitoring to EBSLN identification during upper pole dissection. Recent studies have reported an IONM contribution rate of up to 50% [13181920232425]. Therefore, on the basis of our results in primary thyroid surgery, functional identification rates of the EBSLN could exceed 95% due to appropriate anatomical dissection and proper use of electrophysiological monitoring.…”

Section: Discussionmentioning

confidence: 70%

Visual and electrophysiological identification of the external branch of superior laryngeal nerve in redo thyroid surgery compared with primary thyroid surgery

et al. 2019

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Purpose Thyroid reoperations are surgically challenging because of significant anatomical variance. Visual and functional identification of the external branch of the superior laryngeal nerve (EBSLN) were studied in 2 groups of patients who underwent primary and redo thyroid surgery. Methods This study was conducted on 200 patients: 100 patients with redo and 100 patients with primary thyroid surgery. In addition to visual identification, nerve branches were functionally identified by intraoperative nerve monitoring (IONM). Visual, functional, and total identification rates of the EBSLN in both primary and redo surgery were determined and compared between the 2 groups. Results We attempted to identify 138 and 170 EBSLNs at risk in redo and primary surgery, respectively. Visual identification rates were 65.3% and 30.4% (P < 0.001) in primary and redo surgery groups, respectively. In total, 164 (96.5%) and 97 EBSLNs (70.3%) were identified in primary and redo surgery, respectively (P < 0.001), including the use of IONM. In primary surgery group, 53 nonvisualized EBSLNs of 164 identified nerves (32.3%) were determined by IONM alone. In redo surgery group, 55 of 97 identified nerves (56.7%) were determined by IONM alone (P < 0.001). Conclusion Both visual and total identification rates of the EBSLN are significantly decreased in reoperative thyroidectomy. IONM increases the total identification rate of the EBSLN in primary and redo thyroid surgery. Electrophysiological monitoring makes a substantial contribution to the identification of the EBSLN both in primary and especially in redo thyroid surgery.

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Section: Discussionmentioning

confidence: 70%

Visual and electrophysiological identification of the external branch of superior laryngeal nerve in redo thyroid surgery compared with primary thyroid surgery

et al. 2019

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“…Visual identification of the EBSLN was carried out as reported previously and confirmed using the nerve monitor. A positive result was recorded when strong and simultaneous contraction of the pars recta and pars oblique components of the cricothyroid muscle was observed.…”

Section: Methodsmentioning

confidence: 99%

Influence of neural monitoring during thyroid surgery on nerve integrity and postoperative vocal function

et al. 2018

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BackgroundIntegrity of the recurrent laryngeal nerve (RLN) and the external branch of the superior laryngeal nerve (EBSLN) can be checked by intraoperative nerve monitoring (IONM) after visualization. The aim of this study was to determine the prevalence and nature of voice dysfunction following thyroid surgery with routine IONM.MethodsThyroidectomies were performed with routine division of strap muscles and nerve monitoring to confirm integrity of the RLN and EBSLN following dissection. Patients were assessed for vocal function before surgery and at 1 and 3 months after operation. Assessment included use of the Voice Handicap Index (VHI) 10, maximum phonation time, fundamental frequency, pitch range, harmonic to noise ratio, cepstral peak prominence and smoothed cepstral peak prominence.ResultsA total of 172 nerves at risk were analysed in 102 consecutive patients undergoing elective thyroid surgery. In 23·3 per cent of EBSLNs and 0·6 per cent of RLNs nerve identification required the assistance of IONM in addition to visualization. Nerve integrity was confirmed during surgery for 98·8 per cent of EBSLNs and 98·3 per cent of RLNs. There were no differences between preoperative and postoperative VHI‐10 scores. Acoustic voice assessment showed small changes in maximum phonation time at 1 and 3 months after surgery.ConclusionWhere there is routine division of strap muscles, thyroidectomy using nerve monitoring confirmation of RLN and EBSLN function following dissection results in no clinically significant voice change.

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“…Gurleyik et al found that IONM recognized 65.3% (in the first surgical procedure) and 30.4% (in subsequent surgical procedures) of the EBSLNs that were identified by visual inspection during surgery, and 55 of the 97 unrecognized nerves were identified by IONM (26). Lee et al (27) showed that IONM could improve the identification rate of the EBSLN in high-risk surgeries (Cernea type 2B) by 15.9%. Engelsman et al reported that the identification rate of the EBSLN using IONM was as high as 98.8% (28).…”

Section: Ionm Highlightsmentioning

confidence: 99%

Improving classification of the external branch of the superior laryngeal nerve with neural monitoring: a research appraisal and narrative review

Zhao¹,

Zhao²,

Zhang³

et al. 2021

Gland Surg

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To review the published literature on external branch of superior laryngeal nerve (EBSLN) neural monitoring and propose a new EBSLN classification system using intraoperative neural monitoring (IONM). Background: The injury rate of the external branch of the superior laryngeal nerve (EBSLN) in thyroid surgery is 0-58%. Symptoms of EBSLN injury are not consistent, and patients often complain of modification of the voice timbre with the preservation of vocal cord function. Standards for the diagnosis of EBSLN injury are lacking. Methods: The PubMed database was searched using the terms 'External branch of the superior laryngeal nerve' and 'Intraoperative neuromonitoring' from 2010 through March 2020.Conclusions: This paper reviewed the anatomy of the EBSLN, the diagnosis and treatment of injury, and the application of IONM in the EBSLN. The traditional EBSLN classification method was analyzed and compared with our new classification method. The diagnosis of EBSLN injury is a problem that still needs to be resolved. For anatomic classifications of the EBSLN, we found that the conventional classification systems may not accurately reflect the real status of the EBSLN and the surgical risks that may occur intraoperatively. Using IONM, we developed an EBSLN classification method that was consistent with conventional diagnosis and treatments and can be widely and easily utilized during surgery.

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Prospective evaluation of the utility of routine neuromonitoring for an established thyroid surgical practice

Abstract: Routine IONM provides intraoperative information to a high-volume thyroid surgeon regarding the recurrent and external nerves over and above direct visualization alone, and its utility could not be predicted by operative indication.

Cited by 21 publications

References 21 publications

Visual and electrophysiological identification of the external branch of superior laryngeal nerve in redo thyroid surgery compared with primary thyroid surgery

Visual and electrophysiological identification of the external branch of superior laryngeal nerve in redo thyroid surgery compared with primary thyroid surgery

Influence of neural monitoring during thyroid surgery on nerve integrity and postoperative vocal function

Improving classification of the external branch of the superior laryngeal nerve with neural monitoring: a research appraisal and narrative review

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