Superior laryngeal nerve quantitative intraoperative monitoring is possible in all thyroid surgeries

Darr, E. Ashlie; Tufano, Ralph P.; Özdemir, Süleyman; Kamani, Dipti; Hurwitz, Shelley; Randolph, Gregory W.

doi:10.1002/lary.24446

Cited by 66 publications

(54 citation statements)

References 29 publications

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“…However, the visual identification rate of EBSLN increased to 68.3% with the aid of IONM, which is close to the rates reported in the studies that included the routine division of strap muscles during superior pole dissection. In this study, the functional identification rate of EBSLN with IONM was noted to be 93.5%, which is threefold of the visual identification rate and in accordance with the rate of 83%-100% reported in other studies (2,8,10,11,15,23). We demonstrated that IONM provided a meaningful contribution to visual (p<0.001) and functional (p<0.001) identification of EBSLN.…”

Section: Discussionsupporting

confidence: 90%

“…This connection has been described as the "human communicating nerve" and is known to contribute to the motor innervation of the thyroarytenoid muscle (25,27). The mean amplitude of EBSLN stimulation was significantly lower than that of RLN (10,15,25). Similar to these previous studies, we also achieved electromyographic responses from 74.4% of EBSLNs identified by IONM and the mean amplitude was 181±92 µV, which is lower than that of RLN (865±607 µV).…”

Section: Discussionsupporting

confidence: 88%

“…Similar to these previous studies, we also achieved electromyographic responses from 74.4% of EBSLNs identified by IONM and the mean amplitude was 181±92 µV, which is lower than that of RLN (865±607 µV). Darr et al (15) could find all EBSLNs and obtained recognizable electromyographic responses in 100% of cases via the use of a novel endotracheal tube having electrodes with an extended surface area, in their prospective study. They found that the electromyographic responses from the vocal cords had a great variability and tube position might influence the electromyographic waveform amplitudes.…”

Section: Discussionmentioning

confidence: 99%

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Contribution of intraoperative neuromonitoring to the identification of the external branch of superior laryngeal nerve

2017

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Objective:We evaluated the contribution of intraoperative neuromonitoring to the visual and functional identification of the external branch of the superior laryngeal nerve. Material and Methods:The prospectively collected data of patients who underwent thyroid surgery with intraoperative neuromonitoring for external branch of the superior laryngeal nerve exploration were assessed retrospectively. The surface endotracheal tube-based Medtronic NIM3 intraoperative neuromonitoring device was used. The external branch of the superior laryngeal nerve function was evaluated by the cricothyroid muscle twitch. In addition, contribution of external branch of the superior laryngeal nerve to the vocal cord adduction was evaluated using electromyographic records. Results:The study included data of 126 (female, 103; male, 23) patients undergoing thyroid surgery, with a mean age of 46.2±12.2 years (range, 18-75 years), and 215 neck sides were assessed. Two hundred and one (93.5%) of 215 external branch of the superior laryngeal nerves were identified, of which 60 (27.9%) were identified visually before being stimulated with a monopolar stimulator probe. Eighty-nine (41.4%) external branch of the superior laryngeal nerves were identified visually after being identified with a probe. Although 52 (24.1%) external branch of the superior laryngeal nerves were identified with a probe, they were not visualized. Intraoperative neuromonitoring provided a significant contribution to visual (p<0.001) and functional (p<0.001) identification of external branch of the superior laryngeal nerves. Additionally, positive electromyographic responses were recorded from 160 external branch of the superior laryngeal nerves (74.4%). Conclusion:Intraoperative neuromonitoring provides an important contribution to visual and functional identification of external branch of the superior laryngeal nerves. We believe that it can not be predicted whether the external branch of the superior laryngeal nerve is at risk or not and the nerve is often invisible; thus, intraoperative neuromonitoring may routinely be used in superior pole dissection. Glottic electromyography response obtained via external branch of the superior laryngeal nerve stimulation provides quantifiable information in addition to the simple visualization of the cricothyroid muscle twitch.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

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Contribution of intraoperative neuromonitoring to the identification of the external branch of superior laryngeal nerve

2017

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“…EBSLN-elicited action potentials of the TAM are felt to be mediated by the human communicating nerve described earlier and virtually all cases are amenable to this monitoring technique as long as preoperative EBSLN function is intact and proper equipment set up is implemented (19,22). Also, intraoperative CTM EMG can be easily performed with subdermal EMG needle electrodes (37)(38)(39).…”

Section: Intraoperative Ebsln Identification and The Role Of Ionmmentioning

confidence: 97%

“…This so-called "human communicating nerve" is of special interest in intraoperative nerve monitoring (IONM) of the EBSLN, for it allows the recording of electroneuromyography (EMG) waveforms elicited by electrical stimulation by endotracheal surface electrodes (19). This finding is reinforced by several studies that found clear-cut TAM activity provoked by EBSLN stimulation in 70% to 100% of patients undergoing thyroid surgery (20)(21)(22)(23)(24). Darr et al (22) found that EBSLN-evoked potential of the TAM could be recorded in all cases when a tube with dedicated surface EMG electrodes in contact with the anterior aspect of the vocal cords was employed.…”

Section: Anatomy Of the Ebslnmentioning

confidence: 99%

Injury of the external branch of the superior laryngeal nerve in thyroid surgery

Potenza¹,

Filho²,

Cernea³

2017

Gland Surg.

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Superior laryngeal nerve monitoring using laryngeal surface electrodes and intraoperative neurophysiological monitoring during thyroidectomy

et al. 2014

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The objective of this study is to establish normative waveform data for the external branch of the superior laryngeal nerve (SLN) utilizing laryngeal surface electrodes and intraoperative neurophysiological monitoring (IONM) in conjunction with a clinical neurophysiologist. A retrospective chart review of 91 consecutive at-risk SLN were identified in 51 patients in whom IONM using laryngeal surface electrodes was performed by a clinical neurophysiologist using Dragonfly (Neurovision Medical Products, Ventura, CA) recording electrodes and a Protektor (Natus Medical Inc., San Carlos, CA)16 channel- intraoperative nerve monitoring system. Inclusion criteria were met for 30 SLN. Data collected included preoperative diagnosis, surgical procedure, rates of nerve identification and stimulation, and waveform characteristics. Waveform analysis for 30 SLN yielded a peak latency of 4.0 ± 0.2 ms, onset latency 2.3 ± 0.1 ms, peak-to-peak amplitude of 220.4 ± 31.1 µV, onset-to-peak amplitude of 186.0 ± 25.0 µV, and stimulation current threshold of 0.55 ± 0.03 mA (data = mean ± SEM). Two patients had abnormal SLN function documented clinically on postoperative laryngoscopic examination. Laryngeal surface electrodes were successfully utilized to identify and monitor SLN function intraoperatively. IONM using laryngeal surface electrodes enables analysis of waveform morphology and latency in addition to threshold and amplitude data obtained with the traditional NIM system, potentially improving the performance of nerve monitoring during thyroid surgery.

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Superior laryngeal nerve quantitative intraoperative monitoring is possible in all thyroid surgeries

Abstract: 4.

Cited by 66 publications

References 29 publications

Contribution of intraoperative neuromonitoring to the identification of the external branch of superior laryngeal nerve

Contribution of intraoperative neuromonitoring to the identification of the external branch of superior laryngeal nerve

Injury of the external branch of the superior laryngeal nerve in thyroid surgery

Superior laryngeal nerve monitoring using laryngeal surface electrodes and intraoperative neurophysiological monitoring during thyroidectomy

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