Normative Intra-operative Electrophysiologic Waveform Analysis of Superior Laryngeal Nerve External Branch and Recurrent Laryngeal Nerve in Patients Undergoing Thyroid Surgery

Normative Intra-operative Electrophysiologic Waveform Analysis of Superior Laryngeal Nerve External Branch and Recurrent Laryngeal Nerve in Patients Undergoing Thyroid Surgery

Background Injury to the external branch of the superior laryngeal nerve (EBSLN) can occur during superior pole dissection in thyroid surgery; the EBSLN injury rate is reported as high as 28 % (Cernea et al., Head Neck 14:380–383, 1992 ). Injury to the EBSLN leads to variable symptoms that may be ov...

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Bibliographic Details
Published in:World journal of surgery Vol. 37; no. 10; pp. 2336 - 2342
Main Authors: Potenza, Andre S., Phelan, Eimear A., Cernea, Claudio R., Slough, Cristian M., Kamani, Dipti V., Darr, Ashlie, Zurakowski, David, Randolph, Gregory W.
Format: Journal Article
Language:English
Published: Boston Springer US 01-10-2013
Springer Nature B.V
Subjects:
Abdominal Surgery
Adult
Aged
Aged, 80 and over
Anatomic Landmarks
Cardiac Surgery
Electrodiagnosis - methods
Female
General Surgery
Humans
Intraoperative Complications - prevention & control
Laryngeal Nerve Injuries - etiology
Laryngeal Nerve Injuries - prevention & control
Laryngeal Nerves - physiology
Male
Medicine
Medicine & Public Health
Middle Aged
Monitoring, Intraoperative - methods
Neural Stimulation
Outcome Assessment (Health Care)
Prospective Studies
Recurrent Laryngeal Nerve
Recurrent Laryngeal Nerve - physiology
Sternothyroid Muscle
Superior Pole
Surgery
Thoracic Surgery
Thyroidectomy
Vascular Surgery
Vocal Fold
Sternothyroid Muscle
Superior Pole
Vocal Fold
Neural Stimulation
Recurrent Laryngeal Nerve
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Summary:Background Injury to the external branch of the superior laryngeal nerve (EBSLN) can occur during superior pole dissection in thyroid surgery; the EBSLN injury rate is reported as high as 28 % (Cernea et al., Head Neck 14:380–383, 1992 ). Injury to the EBSLN leads to variable symptoms that may be overlooked, but that can be significant, especially to professional speakers and singers. Intraoperative nerve monitoring (IONM) is employed widely to aid in nerve identification. We report on normative electroneuromyography (EMG) data on EBSLN-IONM and cricothyroid muscle (CTM) twitch response during stimulation as an aid to EBSLN identification. Methods A prospective study of the SLN and the recurrent laryngeal nerve (RLN) IONM data in 72 consecutive thyroid surgeries was carried out. All patients underwent preoperative and postoperative laryngeal exams, and patients with abnormal preoperative laryngeal function were excluded. Normative EMG data and CTM twitch response during EBSLN stimulation were recorded and analyzed. Results Stimulation of the EBSLN resulted in a positive CTM twitch response in 100 %, whereas EMG response was recordable in 80 %. Electromyographic amplitude was ~1/3 of ipsilateral RLN amplitude and did not change through the case with multiple stimulations. Stimulation of the EBSLN was similar for men and women and at 1 and 2 mA stimulation levels. Conclusions Intraoperative nerve monitoring of the EBSLN aids in EBSLN identification and provides electroneuromyographic information in 80 % of cases. The laryngeal head of the sternothyroid muscle is a useful landmark to locate EBSLN.
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ISSN:0364-2313
1432-2323
DOI:10.1007/s00268-013-2148-9