Importance of incorporating intraoperative neuromonitoring of the external branch of the superior laryngeal nerve in thyroidectomy: A review and meta‐analysis study

Naytah, Mai; Ibrahim, Iman; Silva, Sabrina da

doi:10.1002/hed.25669

Cited by 21 publications

(7 citation statements)

References 37 publications

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“…IOMN has always been recommend in thyroid surgery for navigation and confirmation of the functional integrity of the RLN during both OT (18) and TOETVA (19). We highly recommend the use of IONM in cases like these.…”

Section: Other Discussionmentioning

confidence: 93%

Transoral endoscopic thyroidectomy vestibular approach in a patient with Class III goitre (operative steps and video)

Liu

Peng

et al. 2020

Gland Surg

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Transoral endoscopic thyroidectomy vestibular approach (TOETVA) has recently become a hot research topic due to the advantage of leaving no scar, but, according to most centers, its indication is restricted to the size of thyroid gland. Here we report a case of a female patient with Class III goitre who successfully underwent TOETVA (video attached). A 53-year-old woman with a previous history of chest keloidosis presented with a history of neck swelling for 3 years and was diagnosed as Hashimoto's thyroiditis with no nodules. The patient insisted that she undergo a TOETVA procedure in our hospital.Compared to the traditional TOETVA, several techniques were applied in this operation to ensure the resection and removal of the thyroid gland: with the dissection of the mental nerve and using the lateral approach to the thyroid gland. The total volume of thyroid gland was 205 mL. The operating time was 195 min. No complications were incurred. The numbness of the lip and chin was measured by the "two-points discrimination" method with several aspects (touch, pain, temperature) at different times to evaluate mental nerve injury. She felt the numbness during the first operative day but it was almost completely relieved in the third postoperative month. To our knowledge, this is the largest thyroid gland reported removed with TOETVA procedure. By carefully designing the operative steps, it is feasible to use the transoral approach in patients who have a benign thyroid disease with a Class III goitre if the patient strongly desires that operation.

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Section: Other Discussionmentioning

confidence: 93%

Transoral endoscopic thyroidectomy vestibular approach in a patient with Class III goitre (operative steps and video)

Liu

Peng

et al. 2020

Gland Surg

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“…The electromyography of the cricothyroid muscle is the gold standard to ensure the proper functioning of the ipsilateral EBULN. However, this difficult-to-access technique is invasive and EBULN neuromonitoring at 1 mA, according to the scientific literature, is reliable for highlighting a complete nerve injury [7,22]. But enough for a slight impairment?…”

Section: Discussionmentioning

confidence: 99%

Assessment of Voice Changes of Patients after Thyroidectomy Without Inferior and Superior Laryngeal Nerves Injury According to the Intraoperative Neuromonitoring

Buiret¹,

Guillemaud²,

Fieux³

et al. 2021

JCO

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Objectives: to assess voice changes of patients after thyroidectomy without inferior and superior laryngeal nerves injury according to the intraoperative neuromonitoring. Material and methods: This monocentric study included all patients who underwent thyroidectomy with laryngeal nerves neuromonitoring between September, 2018 and December, 2019. The voice assessment was performed 1 month before and 3 months after surgery. It was both subjective (with Voice Handicap Index 10 and GRBAS scale) and objective (Dysphonia Severity Index). Voice was considered impaired if there was an increase ≥ 4 points of the Voice Handicap Index 10 score or ≥ 1 point of the GRBAS scale score or a decrease ≥ 2 points of the Dysphonia Severity Index score between the two vocal assessments. A composite score was created, combining both subjective and objective scores. Predictive factors of altered voice were seek. Results: Fifty-nine patients were analyzed. Mean Voice Handicap Index 10 varied from 3.39 ± 5.40 to 2.90 ± 5.29 (p = 0.62) before and after the surgery respectively, mean GRBAS from 0.64 ± 0.76 to 0.73 ± 0.85 (p = 0.57) and mean Dysphonia Severity Index from 8.47 ± 1.15 to 8.31 ± 1.03 (p = 0.42). Voice impairment composite score identified 14 patients with an impaired voice (23.7%). Age ≥65 years, preoperative Voice Handicap Index 10 score ≥ 3 and thyroidectomy past history were independent risk factors of voice impairment. Conclusions: the voice quality 3 months after thyroidectomy was not significantly subjectively and objectively changed compared to before thyroidectomy. When grouping voice impairment scores, age ≥65 years, preoperative Voice Handicap Index 10 score ≥ 3 and thyroidectomy past history were independent risk factors of voice impairment.

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“…Moreover, if necessary, the sternothyroid muscle is cut off, and the blood vessels of the superior thyroid pole are ossified such that damage to the type II b external branch can be prevented. Subsequently, IONM is used to observe cricothyroid muscle tremors or electromyography (EMG) signals and accurately grasp the approximate positions of nerve fibers coursing along the surface of the muscle or within the muscle, which prevents damage to the external branch (44). In the case of unilateral EBSLN damage, neurotrophic and hormonal drugs are administered.…”

Section: Ebsln Injurymentioning

confidence: 99%

Narrative review of management of thyroid surgery complications

Jin¹,

Sugitani²

2021

Gland Surg

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Currently, thyroid surgery is the most common and safe operation worldwide. However, thyroidectomy is still not free from the risks of complications and death due to the anatomical structure and physiological function particularity of the thyroid gland. Postoperative complications affect the life quality and life safety of patients after surgery. The common complications include hypoparathyroidism (HP), recurrent laryngeal nerve (RLN) injury, injury to the external branch of the superior laryngeal nerve (EBSLN), postoperative bleeding (PB), thoracic duct injury, laryngeal edema, tracheospasm, tracheal injury, and esophageal injury. A severe complication, such as dyspnea, asphyxia, or thyroid crisis, might cause the death of the patient. Therefore, every thyroid surgeon's responsibility is to remain alert and aware of the occurrence of various intraoperative and postoperative complications and exercise effective prevention and treatment. This is closely related to the advancement in thyroid disease research, the increase in local anatomy knowledge, the standardization of surgical approaches, the improvement in operating skills, the application of new technologies, and the emphasis on specialty training. In addition, many complications that effect patients are much better tolerated if the patient has appropriate expectations of what the complications are and how to treat them. Open communication between surgeon and patient optimizes the potential negative effects that complications may have on patients' quality of life. This paper discusses the prevention, recognition and therapy of intraoperative and postoperative complications in thyroid surgery.

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Importance of incorporating intraoperative neuromonitoring of the external branch of the superior laryngeal nerve in thyroidectomy: A review and meta‐analysis study

Cited by 21 publications

References 37 publications

Transoral endoscopic thyroidectomy vestibular approach in a patient with Class III goitre (operative steps and video)

Transoral endoscopic thyroidectomy vestibular approach in a patient with Class III goitre (operative steps and video)

Assessment of Voice Changes of Patients after Thyroidectomy Without Inferior and Superior Laryngeal Nerves Injury According to the Intraoperative Neuromonitoring

Narrative review of management of thyroid surgery complications

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