We Asked the Experts: How Can One Troubleshoot Loss of Intraoperative Nerve Monitoring During Head and Neck Surgery?

Excerpt

Intraoperative monitoring of the recurrent laryngeal nerve (RLN) has become a widely accepted adjunct to visual nerve identification during head and neck surgery. While it has not been shown to reduce definitively the risk of RLN injury, it can be helpful in early identification of the nerve, detection of nonrecurrent RLN on the right side, and in high-risk cases (i.e., reoperations and Graves’ disease) where visual identification of the RLN may be difficult. It can also help prevent bilateral RLN injury. Here, we discuss practical tips and potential pitfalls that may aid surgeons in using the monopolar nerve stimulator for laryngeal neuromonitoring with a device that transforms laryngeal muscle activity into audible and visual electromyographic (EMG) signals. …