Injury to the Recurrent Laryngeal Nerve (RLN) is a worrisome complication of a thyroidectomy. Intra-operative nerve monitoring (IONM) of the RLN has gained prevalence as an aid to prevent injury. We reviewed our serie...Injury to the Recurrent Laryngeal Nerve (RLN) is a worrisome complication of a thyroidectomy. Intra-operative nerve monitoring (IONM) of the RLN has gained prevalence as an aid to prevent injury. We reviewed our series and other studies in literature for insight. A chart review was carried out to identify all patients who underwent a thyroidectomy between 2005 and 2010. IONM was implemented by the Otolaryngology service in 2007. All identified patients were separated into three groups: 1) Otolaryngology service with IONM, 2) Otolaryngology service without IONM, and 3) General Surgery service without IONM. Several factors were noted, including age, sex, thyroid disease, extent of thyroidectomy, and RLN injury along with recovery. 230 patients underwent thyroidectomy from 2005-2010. 60 patients were isolated in the IONM-Otolaryngology group with 3 patients suffering injury. 109 patients underwent a thyroidectomy by the Otolaryngology service without IONM with 8 patients suffering nerve damage. In the third group, 61 patients underwent a thyroidectomy by General Surgery without IONM with 4 patients suffering damage. Of the thyroid pathology, 10 patients had Multinodular Goiter while 4 had Papillary Cancer and 1 had a Follicular Adenoma. The most severe complication of a thyroidectomy is RLN injury. In order to further decrease the risk of RLN injury, IONM has been employed. From our review and other studies, there does not appear to be a significant difference in rates of RLN injury with or without use of nerve monitoring. An interesting note is the increased prevalence of nerve injuries in Multinodular Goiter—a finding that merits further study to evaluate the role of IONM.展开更多
Intraoperative nerve monitoring(IONM)has evolved into an objective tool not only for the identification but also for the preservation and prognostication of function of the recurrent laryngeal nerve in thyroid surgeri...Intraoperative nerve monitoring(IONM)has evolved into an objective tool not only for the identification but also for the preservation and prognostication of function of the recurrent laryngeal nerve in thyroid surgeries.Technical improvements have resulted in the increasing incorporation of IONM into operating rooms around the world.The importance of adherence to recommended standards is also recognized as being vital in optimizing the efficacy of IONM.The advent of continuous IONM has made real-time nerve monitoring possible,thus providing the surgeon with an ally in difficult surgeries.Additionally,as thyroid surgeries are evolving into remote access and minimally invasive procedures,so also is the applicability of IONM.This review focuses on the use of IONM for nerve monitoring in thyroidectomies for neoplastic conditions while discussing the rationale,technique,and interpretation of findings and their implications.展开更多
文摘Injury to the Recurrent Laryngeal Nerve (RLN) is a worrisome complication of a thyroidectomy. Intra-operative nerve monitoring (IONM) of the RLN has gained prevalence as an aid to prevent injury. We reviewed our series and other studies in literature for insight. A chart review was carried out to identify all patients who underwent a thyroidectomy between 2005 and 2010. IONM was implemented by the Otolaryngology service in 2007. All identified patients were separated into three groups: 1) Otolaryngology service with IONM, 2) Otolaryngology service without IONM, and 3) General Surgery service without IONM. Several factors were noted, including age, sex, thyroid disease, extent of thyroidectomy, and RLN injury along with recovery. 230 patients underwent thyroidectomy from 2005-2010. 60 patients were isolated in the IONM-Otolaryngology group with 3 patients suffering injury. 109 patients underwent a thyroidectomy by the Otolaryngology service without IONM with 8 patients suffering nerve damage. In the third group, 61 patients underwent a thyroidectomy by General Surgery without IONM with 4 patients suffering damage. Of the thyroid pathology, 10 patients had Multinodular Goiter while 4 had Papillary Cancer and 1 had a Follicular Adenoma. The most severe complication of a thyroidectomy is RLN injury. In order to further decrease the risk of RLN injury, IONM has been employed. From our review and other studies, there does not appear to be a significant difference in rates of RLN injury with or without use of nerve monitoring. An interesting note is the increased prevalence of nerve injuries in Multinodular Goiter—a finding that merits further study to evaluate the role of IONM.
文摘Intraoperative nerve monitoring(IONM)has evolved into an objective tool not only for the identification but also for the preservation and prognostication of function of the recurrent laryngeal nerve in thyroid surgeries.Technical improvements have resulted in the increasing incorporation of IONM into operating rooms around the world.The importance of adherence to recommended standards is also recognized as being vital in optimizing the efficacy of IONM.The advent of continuous IONM has made real-time nerve monitoring possible,thus providing the surgeon with an ally in difficult surgeries.Additionally,as thyroid surgeries are evolving into remote access and minimally invasive procedures,so also is the applicability of IONM.This review focuses on the use of IONM for nerve monitoring in thyroidectomies for neoplastic conditions while discussing the rationale,technique,and interpretation of findings and their implications.
