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Head and neck surgeons are familiar with the technique of identifying motor nerves in the head and neck region by using electrical stimulation especially in the identification of the facial and the spinal accessory nerves. The identification of the motor laryngeal nerves by electrical stimulation intra-operatively has been described; but, the difficulty of visualization of intrinsic laryngeal muscle movement has prevented the wide spread use of this technique. This paper will introduce a simple, safe and reliable method to allow the surgeon to recognize true vocal cord movement while stimulating the recurrent laryngeal nerve. The movement of a two inch 27 gauge needle placed through the cricothyroid membrane into the ipsilateral true vocal cord permits identification of intrinsic laryngeal muscle movement during electrical stimulation of the recurrent laryngeal nerve. This method has been successfully used in confirming conductivity of the laryngeal nerve during thyroid surgery, Zenker's diverticulum surgery, cricotracheal trauma and recurrent nerve neurectomy for spasmodic dysphonia.

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A 27-year-old male smoker went to his family physician with a nonproductive cough and low-grade fever of several days' duration. In addition, he reported having dyspnea on exertion and intermittent wheezing for at least 1 year. A chest x ray revealed a mass in the distal trachea. Subsequent computed tomography (CT) of the chest demonstrated a 2.5-cm mass in the trachea at the level of the aortic arch, which occupied approximately 60% of the tracheal lumen. CT did not reveal any extratracheal spread or mediastinal adenopathy.The patien t was referred to Indiana University Medical Center where bronchoscopy confirmed a 2.5cm tracheal mass located 2 cm above the carina. The mass was smooth, firm, and white, and had prominent telangiectasia on its surface (Fig. 1). A biopsy revealed pleomorphic adenoma.Th e patient subsequently underwent definitive surgical resection, which included suprahyoid laryngeal release, tracheal mobilization, and tracheal resection with primary anastomosis performed through a right thoracotomy. Surgical margins were clear, and the tumor was confined to the trachea. The patient is asymptomatic and doing well 6 months after surgery.