Utilizing Surgeon-Performed Intraoperative Translaryngeal Ultrasound for Verifying Vocal Fold Function: A Troubleshooting Approach for Intraoperative Neuromonitoring in Neck Surgery

• Published in: Journal of voice
• Main Authors: Balbaloglu, Hakan, Karadeniz, Emre, Erkek, Ahmet, Yilmaz, Cem, Ugurlu, Mustafa Umit, Cakmak, Guldeniz Karadeniz
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 15-03-2024
• Subjects: Intraoperative ultrasound; Recurrent laryngeal nerve; Signal loss; Thyroid; Vocal fold; Vocal fold; Intraoperative ultrasound; Signal loss; Thyroid; Recurrent laryngeal nerve
• ISSN: 0892-1997; 1873-4588
• DOI: 10.1016/j.jvoice.2024.02.022

We investigated transcutaneous laryngeal ultrasonography (TLUS) for assessing vocal fold (VF) mobility during thyroid and parathyroid surgeries, emphasizing its precision and utility in signal loss scenarios.
Between October 2020 and January 2023, we performed TLUS, Doppler sonography, laryngeal twitch response (LTR) palpation, and electromyography (EMG) to monitor recurrent laryngeal nerve function during neck surgeries. Postoperatively, the VF activity was verified using fiberoptic video laryngoscopy (FL). Concordance with FL was categorized based on VF activity.
Of the 443 VF evaluations, no instances of permanent bilateral paralysis were noted. Temporary unilateral palsy was found in 3.38% and permanent in 0.45%. TLUS displayed 97.8% agreement with EMG and was diagnostically superior (99.7% vs 98.2%) and more affordable ($68 vs $300) compared to analogous operative durations.
TLUS rivals EMG in terms of intraoperative neuromonitoring accuracy and outperforms LTR. Being cost-effective, TLUS can effectively address signal loss situations, thereby averting additional surgeries.