The mechanism of recurrent laryngeal nerve injury during thyroid surgery—The application of intraoperative neuromonitoring

Chiang, Feng‐Yu; Lu, I-Chen; Kuo, Wen‐Rei; Lee, Ka–Wo; Chang, Ning-Chia

doi:10.1016/j.surg.2008.02.006

Cited by 330 publications

(390 citation statements)

References 19 publications

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“…The most frequent cause of RLN paralysis is traction trauma. The power of traction due to traction of the thyroid lobe is reflected to the RLN in different proportions (16). Diminished diameter due to branching is an important risk factor for injury related to dissection and/or traction.…”

Section: Discussionmentioning

confidence: 99%

Extralaryngeal division of the recurrent laryngeal nerve: A common and asymmetric anatomical variant

et al. 2017

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Results: A total of 161 recurrent laryngeal nerves were examined (82 right, 79 left). Overall, 77 (47.8%) of 161 recurrent laryngeal nerves were bifurcated before entering the larynx. There were 36 (43.9%) branching nerves on the right and 41 (51.9%) branching nerves on the left, and there was no significant difference between the sides in terms of branching (p=0.471). Among 67 patients who underwent bilateral exploration, 28.4% were found to have bilateral branching, 40.3% had unilateral branching, and the remaining 31.3% had no branching. The median branching distance was 15 mm (5-60mm). Conclusion:Extralaryngeal division of recurrent laryngeal nerve is a common and asymmetric anatomical variant. These variations can be easily recognized if the recurrent laryngeal nerve is identified at the level of the inferior thyroid artery and then dissected totally to the entry point of the larynx. Inadvertent division of a branch may lead to vocal cord palsy postoperatively, even when the surgeon believes the integrity of the nerve has been preserved.

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Section: Discussionmentioning

confidence: 99%

Extralaryngeal division of the recurrent laryngeal nerve: A common and asymmetric anatomical variant

et al. 2017

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“…There are several technical issues that increase the risk of nerve injury. It may be due to unintentional stretching, thermal injury, entrapment by a ligature, excessive use of suction near the nerve, aggressive surgical dissection or ischemic injury [7,9,21]. Tumor factors include extra-thyroidal extension, substernal extension of enlarged thyroid, recurrent disease, enlarged central compartment lymph node.…”

Section: Discussionmentioning

confidence: 99%

Enlargement of “SHENOY Node”: A Risk Factor for Temporary Recurrent Laryngeal Nerve Paralysis after Thyroid Surgery

Dev¹,

Gurawalia²,

A³

et al. 2016

Head Neck Cancer Res

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“…During surgery, methods such as the palpation of cricothyroid muscle synchronous with the nerve impulse, observation of the movement of vocal cords by using direct or fiberoptic nasopharyngoscopy, measurement of the pressure on the endotracheal tube exerted by the movement of vocal cords, placement of electrodes on the vocal cord muscles, and formation of contact between the vocal cord mucosa and the electrodes placed on the surface of the endotracheal tube are performed [7][8][9][10]. Visual identification of RLN during thyroid surgery has been associated with low rates of permanent RLN paralysis and also has been considered as gold standard for the prevention of RLN injury in most studies [1,3,[20][21][22]. Jatzko et al [22] have reevaluated ten studies covering 12,211 thyroid operations and demonstrated that there is a lower rate of RLN paralysis in the group with nerve identification compared to the group without (2.7 vs. 7.9 % for temporary paralysis; 1.2 vs. 5.2 % for permanent paralysis).…”

Section: Discussionmentioning

confidence: 99%

“…At the end of the study, there was no significant difference between the groups. Without any doubt, RLN paralysis can occur in routine identifications of RLN, even in combination with IONM, but in most cases only temporarily [21]. Most studies have shown that although surgeons ascertain the integrity of the RLN by visual inspection in most cases, they are not aware of the injury to the nerve [25][26][27].…”

Section: Discussionmentioning

confidence: 99%

Is Nerve Monitoring Required in Total Thyroidectomy? Cerrahpasa Experience

et al. 2013

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Thyroidectomy is an elective operation performed in an anatomically complex region in which certain structures are responsible for vital functions and special senses. This study aims to compare the effects of two different technical approaches-nerve dissection combined with intraoperative nerve monitoring (IONM) and no nerve identification-on recurrent laryngeal nerve (RLN) damage in total thyroidectomy. One hundred and sixty-one consecutive cases that underwent total thyroidectomy and 322 RLN under risk were evaluated. In group 1 (n=162), nerve dissection combined with IONM was performed, whereas no RLN identification was performed in group 2 (n=160). While the duration of operation in group 1 (34.23±12.21 min) was statistically shorter than that in group 2 (36.98±16.79 min, p=0.017), there was no significant difference between groups related to RLN palsy (group 1 n=10, group 2 n=7). Use of IONM was found only to shorten the duration of operation. According to our presented experience, there is no benefit of IONMcombined routine dissection of RLN during total thyroidectomy on the prevention of RLN palsy.

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The mechanism of recurrent laryngeal nerve injury during thyroid surgery—The application of intraoperative neuromonitoring

Cited by 330 publications

References 19 publications

Extralaryngeal division of the recurrent laryngeal nerve: A common and asymmetric anatomical variant

Extralaryngeal division of the recurrent laryngeal nerve: A common and asymmetric anatomical variant

Enlargement of “SHENOY Node”: A Risk Factor for Temporary Recurrent Laryngeal Nerve Paralysis after Thyroid Surgery

Is Nerve Monitoring Required in Total Thyroidectomy? Cerrahpasa Experience

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