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World J Exp Med. May 20, 2015; 5(2): 120-123
Published online May 20, 2015. doi: 10.5493/wjem.v5.i2.120
Electrophysiological neuromonitoring of the laryngeal nerves in thyroid and parathyroid surgery: A review
Ahmed Deniwar, Parisha Bhatia, Emad Kandil
Ahmed Deniwar, Parisha Bhatia, Emad Kandil, Division of Endocrine and Oncologic Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, LA 70112, United States
Author contributions: Deniwar A performed research, analyzed data and wrote the paper; Bhatia P revised data analysis and revised the paper; Kandil E revised research, analyzed data and revised the paper.
Conflict-of-interest: The authors declare that they have no competing interests.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Emad Kandil, MD, FACS, FACE, Chair, Chief, Division of Endocrine and Oncologic Surgery, Department of Surgery, Tulane University School of Medicine, 1430 Tulane Avenue, Room 8510 (Box SL-22), New Orleans, LA 70112, United States. ekandil@tulane.edu
Telephone: +1-504-9887520 Fax: +1-504-9884762
Received: August 26, 2014
Peer-review started: August 26, 2014
First decision: November 14, 2014
Revised: December 20, 2014
Accepted: February 4, 2015
Article in press: February 9, 2015
Published online: May 20, 2015
Abstract

Recurrent laryngeal nerve (RLN) injury is one of the most common complications of thyroid surgery. Injury to the external branch of the superior laryngeal nerve is less obvious and affects the voice variably; however, it can be of great significance to professional voice users. Recent literature has led to an increase in the use of neuromonitoring as an adjunct to visual nerve identification during thyroid surgery. In our review of the literature, we discuss the application, efficacy and safety of neuromonitoring in thyroid surgery. Although intraoperative neuromonitoring (IONM) contributes to the prevention of laryngeal nerves injury, there was no significant difference in the incidence of RLN injury in thyroid surgery when IONM was used compared with visual identification alone. IONM use is recommended in high risk patients; however, there are no clear identification criteria for what constitutes “high risk”. There is no clear evidence that IONM decreases the risk of laryngeal nerve injury in thyroid surgery. However, continuous IONM provides a promising tool that can prevent imminent nerve traction injury by detecting decreased amplitude combined with increased latency.

Keywords: Neuromonitoring, Superior laryngeal nerve, Recurrent laryngeal nerve, Thyroid surgery

Core tip: As recurrent laryngeal nerve injury is one of the most common causes of medicolegal litigation after thyroid and parathyroid surgery, securing the nerve is an increasing demand in these surgeries. Although visual identification has been used as the gold standard and had been proved to reduce the rate of laryngeal nerves injury, intertwining with inferior thyroid vessels and unusual course of the nerve may be challenging. Neromonitoring has been introduced as a novel technique to help identifying the nerve and prevent misidentification of any cord-like structure as a nerve, the thing that can reduce rate of laryngeal nerves injury.