Electrophysiologic identification and monitoring of the external branch of superior laryngeal nerve during thyroidectomy

Kandil, Emad; Mohamed, Salah Eldin; Deniwar, Ahmed; Mohamed, Hassan Ibrahim; Friedlander, Paul L.; Aslam, Rizwan; Saeed, Ahmad; Ibrahim, Musa; Randolph, Gregory W.

doi:10.1002/lary.25139

Cited by 24 publications

(9 citation statements)

References 26 publications

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“…Novel intraoperative nerve monitoring (IONM) for laryngeal nerves is being developed and may reduce the risk of UVFP following thyroid surgery. 21,22 Regularly performing IONM during thyroid surgery was suggested, but its cost-effectiveness remains unclear. 23 A more effective application of IONM is reasonable in patients with higher risks.…”

Section: Results From Ahn Et Al Showed That the Uvfp Rate Ismentioning

confidence: 99%

Risk factors for thyroid surgery–related unilateral vocal fold paralysis

Chen¹,

Pei

Fang

2018

The Laryngoscope

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Objectives/Hypothesis We aimed to identify the risk factors for iatrogenic unilateral vocal fold paralysis (UVFP) caused by thyroid surgery, to allow the identification of patients requiring nerve‐protection procedures and monitoring technologies. Study Design Retrospective case study in a medical center. Methods Patients who underwent thyroid surgery from April 2011 to February 2016 and who were diagnosed with UVFP by laryngoscopy and laryngeal electromyography were included. Patient demographics, types of surgery, and characteristics of the thyroid lesions were analyzed. Results Sixty (2.1%) of 2,815 patients who received thyroid surgery developed UVFP. The risk of UVFP was higher in patients over 60 years old (odds ratio, 1.89; 95% confidence interval, 1.01‐3.26; P = .01). Involvement of the external branch of superior laryngeal nerve (EBSLN) occurred in 19 (31.7%) of the 60 UVFP patients, and was more likely to occurr in patients with diabetes mellitus (odds ratio, 14.19; 95% confidence interval, 3.80‐52.94; P < .001). The incidence of UVFP and involvement of the EBSLN differed among surgery types, and was the highest among patients undergoing total thyroidectomy with neck dissection (TTND) (10/158, 6.3% and 5/158, 3.2%, respectively). Conclusions The risk of thyroid surgery–related UVFP is higher in older patients. EBSLN involvement is more likely in patients with diabetes mellitus. TTND is associated with higher risks of UVFP and EBSLN injury than other types of surgery, implying the need of intraoperative nerve monitoring in these high‐risk characteristics. Level of Evidence 4 Laryngoscope , 129:275–283, 2019

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Section: Results From Ahn Et Al Showed That the Uvfp Rate Ismentioning

confidence: 99%

Risk factors for thyroid surgery–related unilateral vocal fold paralysis

Chen¹,

Pei

Fang

2018

The Laryngoscope

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“…Kandil et al (23) reported lower mean EMG amplitudes for EBSLN comparing with RLN in their study in 2015. Similarly, in our study, we observed lower mean EMG amplitudes for EBLSN.…”

Section: Discussionmentioning

confidence: 77%

Effect of Intraoperative Neuromonitoring on Voice Quality in Total Thyroidectomy

Çekiç¹,

Dönmez²,

Sürmelioğlu³

et al. 2018

Haseki

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Thyroid gland surgery has a risk of serious complications. Advancements in technology have led to improvements in complications but significant challenges to preserving voice and airway function still remain. The purpose of this study was to evaluate voice quality following total thyroidectomy under neuromonitoring and effect of intraoperative neuromonitoring (IONM) on identification of the recurrent laryngeal nerve (RLN) and external branch of the superior laryngeal nerve (EBSLN). Methods: A total of 80 patients scheduled for total thyroidectomy between May 2015 and March 2016 were included in the study. All the RLNs and EBSLNs were identified. Voice assessment included preoperative and postoperative fiberoptic laryngoscopy, analysis of Jitter, Shimmer, and fundamental frequency and the Voice Handicap index-10. Results:Eighty patients were included in this study (71 females, nine males). There was no significant difference between mean initial and post-dissection electromyographic amplitudes with RLN and EBSLN stimulation. The rate of postoperative transient RLN palsy per nerve at risk was 4.375% (7/160) and null for permanent RLN palsy (0%, 0/160). Conclusion: Both subjective and objective assessments revealed preservation of voice quality in patients after total thyroidectomy under neuromonitoring. IONM may be used effectively and safely in order to identify the EBSLN during thyroid surgery.

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“…No todos los centros asistenciales disponen del neuroestimulador para individualizar el nervio, de todos modos e independientemente de este detalle, el conocimiento de la anatomía topográfica del RLNLS es vital para su reconocimiento. El uso del neuroestimulador logra un mayor individualización del nervio y se nutre mejor del aporte brindado por la clasificación de Friedman (Aina & Hisham;Friedman et al;Kandil et al, 2015;Arun et al, 2016;Ekhar et al;Bruno;Gurleyik et al, 2019).…”

Section: Discussionunclassified

Anatomía Topográfica del Nervio Laríngeo Superior: Importancia Quirúrgica en las Tiroidectomías

et al. 2020

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MEDINA-RUIZ, B. A.; MEDINA-IZCURDIA, J. J.; MEDINA-IZCURDIA, B. A.; MARTÍNEZ-VERA, R. B.; MARTÍNEZ-VERA, P. R.; IZCURDIA, C. E. & OTTONE, N. E. Anatomía topográfica del nervio laríngeo superior: Importancia quirúrgica en las tiroidectomías. Int. J. Morphol., 38(4):766-773, 2020. RESUMEN:En las cirugías sobre la glándula tiroides se ha prestado mucha atención al manejo del nervio laríngeo inferior y de las glándulas paratiroides, no así del ramo lateral del nervio laríngeo superior, el cual es satélite del pedículo vascular superior de la glándula tiroides. El manejo del polo superior de la glándula tiroides requiere de un conocimiento acabado de su anatomía topográfica del área y está determinada por sus relaciones más importantes, dadas por el citado nervio y la arteria tiroidea superior principalmente. En este trabajo se pretende estudiar estas relaciones en base a la disección meticulosa del triángulo laringo-esternotiroideo ("Triángulo de Joll") de 25 cadáveres adultos formolizados. Como hallazgo relevante se informa que los "nervios en riesgo", según la clasificación de Cernea, que se basa en una distancia menor a un centímetro en el entrecruzamiento del nervio con la arteria tiroidea superior con respecto al polo superior de la glándula tiroides, es del 52 % para el lado derecho y 44 % para el lado izquierdo del cuello. El origen bajo de la arteria a nivel de la bifurcación carotídea se presenta asociada a un mayor número de "nervios en riesgo" en el lado izquierdo. Según el punto de penetración del ramo lateral del nervio laríngeo superior en el músculo constrictor inferior de la faringe se establece la clasificación de Friedman, muy útil sobre todo en cirugías ayudadas por la neuroestimulación. En esta clasifiacción los "nervios en riesgo" son aquellos que transcurrren superficial al músculo, mientras que los "nervios protegidos" serían aquellos que perforan el músculo en su porción superior. En este trabajo los "nervios en riesgo" se presentaron del lado izquierdo en el 56 % de los casos y del derecho en el 60 %, mientras que los "nervios protegidos" en el 24 % y 16 %, respectivamente.PALABRAS CLAVE: Ramo lateral del nervio laríngeo superior; Arteria tiroidea superior; Polo superior de la glándula tiroides; Anatomía topográfica.

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Electrophysiologic identification and monitoring of the external branch of superior laryngeal nerve during thyroidectomy

Abstract: 4.

Cited by 24 publications

References 26 publications

Risk factors for thyroid surgery–related unilateral vocal fold paralysis

Risk factors for thyroid surgery–related unilateral vocal fold paralysis

Effect of Intraoperative Neuromonitoring on Voice Quality in Total Thyroidectomy

Anatomía Topográfica del Nervio Laríngeo Superior: Importancia Quirúrgica en las Tiroidectomías

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