Use of a single bipolar electrode in the posterior arytenoid muscles for bilateral monitoring of the recurrent laryngeal nerves in thyroid surgery

Haerle, Stephan K.; Sidler, Daniel; Linder, T.; Mueller, William A.

doi:10.1007/s00405-008-0671-3

Cited by 5 publications

(1 citation statement)

References 11 publications

(14 reference statements)

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“…applied bipolar needle electrodes to both thyroarytenoid muscle and PCA by laryngoscope and reported that IONM with PCA electrode is straightforward, efficacious, and as reliable as vocalis muscle (thyroarytenoid muscle) IONM, especially in complex laryngeal anatomy. [ 24 ]…”

Section: Laryngeal Needle Electrodesmentioning

confidence: 99%

Recent developments of intraoperative neuromonitoring in thyroidectomy

et al. 2021

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At present, intraoperative neuromonitorization (IONM) with surface electrode-based endotracheal tube (ETT) is a standard method in thyroidectomy and can be performed either intermittently IONM (I-IONM) or continuously IONM (C-IONM). Despite the valuable contribution of I-IONM to the thyroidectomy, it still has limitations regarding the recording electrodes and stimulation probe. New approaches for overcoming the limitations of I-IONM and developing the method are taking attention. Most of the technical issues of IONM with surface electrode-based ETT are related with inadequate contact of electrodes to the vocal cords. Nowadays, efficiency of various recording electrodes is under investigation. Recording electrodes such as needle electrodes applied to thyroarytenoid or posterior cricoarytenoid muscle (PCA), surface electrodes applied to the PCA, and needle or adhesive electrodes applied to the tracheal cartilage or skin, can make safe recordings similar to the ETT electrodes. Despite their invasiveness, needle electrodes record higher electromyography (EMG) amplitudes than tube electrodes do. Adhesive surface electrodes make safe EMG recordings, although amplitudes of these electrodes are usually lower than those of the tube electrodes. These different types of electrodes are less affected by tracheal manipulations and amplitude changes are lower compared to the tube electrodes. During C-IONM, an additional stimulation probe is applied to the vagus nerve after dissecting the nerve circumferentially. Recently, without applying a probe, a new continuous monitorization method called laryngeal adductor reflex CIONM (LAR-CIONM) using sensorial, central, and motor components of LAR arch which is an automatic, primitive brainstem reflex protecting the tracheoesophageal tree from foreign body aspiration, has been implemented. Afferent track of LAR communicates laryngeal mucosa to the brainstem by internal branch of the superior laryngeal nerve and efferent track reaches larynx through recurrent laryngeal nerve. Total outcome of LAR activation is the closure of laryngeal entry by bilateral vocal cord adduction. In LAR-CIONM, a stimulus is given by an electrode from one side of surface electrode-based ETT and amplitude response of the LAR at the vocal cord is followed on the operation side. Recently, it has been reported that real-time EMG response can be obtained with stimulation probe cables applied to dissectors or energy devices during the dissection through I-IONM.

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Section: Laryngeal Needle Electrodesmentioning

confidence: 99%

Recent developments of intraoperative neuromonitoring in thyroidectomy

et al. 2021

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Use of a single bipolar electrode in the posterior arytenoids muscles for bilateral monitoring of the recurrent laryngeal nerves in thyroid surgery: standardization of the technique

Dionigi

2008

Eur Arch Otorhinolaryngol

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Neuromonitoring of the laryngeal nerves in thyroid surgery: a critical appraisal of the literature

Sanábria¹,

Silver²,

Suárez³

et al. 2013

Eur Arch Otorhinolaryngol

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One of the most significant complication of thyroid surgery is injury of the recurrent laryngeal nerve. Injury of the external branch of the superior laryngeal nerve is a less obvious but occasionally significant problem. Recently, neuromonitoring during thyroidectomy has received considerable attention because of literature encouraging its use, but there is no consensus about its advantages and utility. A critical assessment of the literature on neuromonitoring was conducted in order to define its effectiveness, safety, cost-effectiveness and medical-legal impact. Available data does not show results superior to those obtained by traditional anatomical methods of nerve identification during thyroid surgery. Data about cost-effectiveness is scarce. The literature shows inconsistencies in methodology, patient selection and randomization in various published studies which may confound the conclusions of individual investigations. The current recommendation for use in "high risk" patients should be assessed because definition heterogeneity makes identification of these patients difficult. As routine use of neuromonitoring varies according to geography, its use should not be considered to be the standard of care.

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Use of a single bipolar electrode in the posterior arytenoid muscles for bilateral monitoring of the recurrent laryngeal nerves in thyroid surgery

Cited by 5 publications

References 11 publications

Recent developments of intraoperative neuromonitoring in thyroidectomy

Recent developments of intraoperative neuromonitoring in thyroidectomy

Use of a single bipolar electrode in the posterior arytenoids muscles for bilateral monitoring of the recurrent laryngeal nerves in thyroid surgery: standardization of the technique

Neuromonitoring of the laryngeal nerves in thyroid surgery: a critical appraisal of the literature

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