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World Journal of Surgery
Published in: World Journal of Surgery 3/2014

01-03-2014

Results of Intraoperative Neuromonitoring in Thyroid Surgery and Preoperative Vocal Cord Paralysis

Authors: Kerstin Lorenz, Mohammed Abuazab, Carsten Sekulla, Rick Schneider, Phuong Nguyen Thanh, Henning Dralle

Published in: World Journal of Surgery | Issue 3/2014

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Abstract

Background

Systematic studies of intermittent intraoperative neuromonitoring (IONM) have shown that IONM enhances recurrent laryngeal nerve (RLN) identification via functional assessment, but does not significantly reduce rates of vocal cord (VC) paralysis (VCP). The reliability of functional nerve assessment depends on the preoperative integrity of VC mobility. The present study was therefore performed to analyze the validity of IONM in patients with pre-existing VC paralysis.

Methods

Of 8,128 patients, 285 (3.5 %) with preoperative VCP underwent thyroid surgery using standardized IONM of the RLN and vagus nerves (VNs). VC function was assessed by pre- and postoperative direct videolaryngoscopy. Quantitative parameters of IONM in patients with VCP were compared with IONM in patients with intact VC function. Clinical symptoms and surgical outcomes of patients with pre-existing VCP were analyzed.

Results

A total of 244 patients revealed negative, and 41 revealed positive IONM on the side of the VCP. VCP with positive IONM revealed significantly lower amplitudes of VN and RLN than intact VN (p = 0.010) and RLN (p = 0.011). Symptoms of patients with VCP included hoarseness (25 %), dyspnea (29 %), stridor (13 %), and dysphagia (13 %); 13 % were asymptomatic. New VCP occurred in five patients, ten needed tracheostomy for various reasons, and one patient died.

Conclusions

Patients with pre-existing VCP revealed significantly reduced amplitude of ipsilateral VN and RLN, indicating retained nerve conductivity despite VC immobility. Preoperative laryngoscopy is therefore indispensable for reliable IONM and risk assessment, even in patients without voice abnormalities.
Literature
1.
Snyder SK, Hendricks JC (2005) Intraoperative neurophysiology testing of the recurrent laryngeal nerve: plaudits and pitfalls. Surgery 138:1191–1192CrossRef
2.
Randolph GW, Dralle H, International Intraoperative Neural Monitoring Study Group et al (2011) Electrophysiologic recurrent laryngeal nerve monitoring during thyroid surgery and parathyroid surgery: international standards guideline statement. Laryngoscope 121:S1–S16PubMedCrossRef
3.
Chan WF, Lang BH, Lo CY (2006) The role of intraoperative nerve monitoring of recurrent laryngeal nerve during thyroidectomy: a comparative study on 1,000 nerves at risk. Surgery 140:866–873PubMedCrossRef
4.
Tomoda C, Hirokawa Y, Uruno T et al (2006) Sensitivity and specificity of intraoperative recurrent laryngeal nerve stimulation test for predicting vocal cord palsy after thyroid surgery. World J Surg 30:1230–1233. doi:10.​1007/​s00268-005-0351-z PubMedCrossRef
5.
Shindo M, Chheda NN (2007) Incidence of vocal cord paralysis with and without recurrent laryngeal nerve monitoring during thyroidectomy. Arch Otolaryngol Head Neck Surg 133:481–485PubMedCrossRef
6.
Hopkins SK, Gal TJ, Brennan JA (2007) Prevalence and patterns of intraoperative nerve monitoring for thyroidectomy. Otolaryngol Head Neck Surg 136:954–956
7.
8.
9.
Dralle H, Lorenz K (2010) Intraoperative neuromonitoring of thyroid gland operations: surgical standards and aspects of expert assessment. Chirurg 81:612–619 (in German)PubMedCrossRef
10.
11.
Yarborough DE, Thompson GB, Kasperbauer JL et al (2004) Intraoperative electromyographic monitoring of the recurrent laryngeal nerve in reoperative thyroid and parathyroid surgery. Surgery 136:1107–1115CrossRef
12.
Hermann M, Hellebarth C, Freissmuth M (2004) Neuromonitoring in thyroid surgery: prospective evaluation of intraoperative electrophysiologic responses for the prediction of recurrent laryngeal nerve injury. Ann Surg 240:26–27CrossRef
13.
Schneider R, Randolph GW, Sekulla C et al (2013) Continuous intraoperative vagus nerve stimulation for identification of imminent recurrent laryngeal nerve injury. Head Neck 35:1591–1598PubMedCrossRef
14.
Sadowski SM, Soardo P, Leuchter I et al (2013) Systematic use of recurrent laryngeal nerve neuromonitoring changes the operative strategy in planned bilateral thyroidectomy. Thyroid 23:329–333PubMedCrossRef
15.
Melin M, Schwarz K, Lammers BJ et al (2013) IONM-guided goiter surgery leading to two-stage thyroidectomy: indication and results. Langenbecks Arch Surg 398:411–418PubMedCrossRef
16.
Lorenz K, Sekulla C, German Monitoring Study Group et al (2010) What are normal quantitative parameters of intraoperative neuromonitoring (IONM) in thyroid surgery? Langenbecks Arch Surg 395:901–909PubMedCrossRef
17.
Lamade W, Ulmer C, Rieber F et al (2011) New backstrap vagus electrode for continuous intraoperative neuromonitoring in thyroid surgery. Surg Innov 18:206–213PubMedCrossRef
18.
Van Slycke S, Gillardin JP, Brusselaers N et al (2013) Initial experience with S-shaped electrode for continuous vagal nerve stimulation in thyroid surgery. Langenbecks Arch Surg 398:717–722PubMedCrossRef
19.
Bergenfelz A, Jansson S, Kristofferson A et al (2008) Complications to thyroid surgery: results as reported in a database from a multicenter audit comprising 3,660 patients. Langenbecks Arch Surg 393:667–673PubMedCrossRef
20.
Dralle H, Sekulla C, Haerting J et al (2004) Risk factors of paralysis and functional outcome after recurrent laryngeal nerve monitoring in thyroid surgery. Surgery 136:1310–1322PubMedCrossRef
21.
Chandrasehkhar SS, Randolph GW, Seidman MS et al (2013) Clinical practice guideline: improving voice outcomes after thyroid surgery. Otolaryngol Head Neck Surg 148:S1–S37CrossRef
22.
Loch-Wilkinson TJ, Stalberg PL, Sidhu S et al (2007) Nerve stimulation in thyroid surgery: is it really useful? ANZ J Surg 77:377–380PubMedCrossRef
23.
Higgins TS, Gupta R, Ketcham AS et al (2011) Recurrent laryngeal nerve monitoring versus identification alone on post-thyroidectomy true vocal fold palsy: a meta-analysis. Laryngoscope 121:1009–1017PubMedCrossRef
24.
Goretzki PE, Schwarz K, Brinkmann J et al (2010) The impact of intraoperative neuromonitoring (IONM) on surgical strategy in bilateral thyroid diseases: is it worth the effort? World J Surg 4:1274–1284. doi:10.​1007/​s00268-009-0353-3 CrossRef
25.
Brauckhoff M, Machens A, Sekulla C et al (2011) Latencies shorter than 3.5 ms after vagus stimulation signify nonrecurrent inferior recurrent laryngeal nerve before dissection. Ann Surg 253:1172–1177PubMedCrossRef
26.
Dralle H, Damm I, Scheumann GF et al (1994) Compartment-oriented microdissection of regional lymph nodes in medullary thyroid carcinoma. Surg Today 24:112–121PubMedCrossRef
27.
Barczyński M, Randolph GW, Cernea CR, Dralle H, Dionigi G, Alesina PF, Mihai R, Finck C, Lombardi D, Hartl DM, Miyauchi A, Serpell J, Snyder S, Volpi E, Woodson G, Kraimps JL, Hisham AN (2013) External branch of the superior laryngeal nerve monitoring during thyroid and parathyroid surgery: International Neural Monitoring Study Group standards guideline statement. Laryngoscope 123:1–14CrossRef
28.
Casella C, Pata G, Nascimbeni R et al (2009) Does extralaryngeal branching have an impact on the rate of postoperative transient or permanent recurrent recurrent laryngeal nerve palsy? World J Surg 33:261–265. doi:10.​1007/​s00268-008-9832-1 PubMedCrossRef
29.
Barczynski M, Konturek A, Cichon S (2009) Randomized clinical trial of visualization versus neuromonitoring of recurrent laryngeal nerves during thyroidectomy. Br J Surg 96:240–246PubMedCrossRef
30.
Cernea CR, Bandao LG, Hojaij FC, DeCarlucci D, Brandao J, Cavalheiro B, Sondermann A (2010) Negative and positive predictive values of nerve monitoring in thyroidectomy. Head Neck 34:175–179CrossRef
31.
32.
Jarhult J, Lindestad PA, Nordenstrom J et al (1991) Routine examination of the vocal cords before and after thyroid and parathyroid surgery. Br J Surg 78:357–360CrossRef
33.
Randolph GW, Kamani D (2006) The importance of preoperative laryngoscopy in patients undergoing thyroidectomy: voice, vocal cord function, and the preoperative detection of invasive thyroid malignancy. Surgery 139:357–362PubMedCrossRef
34.
35.
Dralle H, Lorenz K, Machens A (2012) Verdicts on malpractice claims after thyroid surgery: emerging trends and future directions. Head Neck 34:1591–1596PubMedCrossRef
36.
Chi SY, Lammers B, Boehner H et al (2008) Is it meaningful to preserve a palsied recurrent laryngeal nerve? Thyroid 18:363–366PubMedCrossRef
37.
Serpell JW, Yeung MJ, Grodski S (2009) The motor fibers of the recurrent laryngeal nerve are located in the anterior extralaryngeal branch. Ann Surg 249:648–652PubMedCrossRef
Metadata
Title
Results of Intraoperative Neuromonitoring in Thyroid Surgery and Preoperative Vocal Cord Paralysis
Authors
Kerstin Lorenz
Mohammed Abuazab
Carsten Sekulla
Rick Schneider
Phuong Nguyen Thanh
Henning Dralle
Publication date
01-03-2014
Publisher
Springer US
Published in
World Journal of Surgery / Issue 3/2014
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-013-2402-1

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