1. Intraoperative neuromonitoring by vagus nerve stimulation in thyroid surgery: Clinical assessment of recurrent and superior laryngeal nerves
- Author
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M.-D. Dubois, Yann Lelonge, Marie Gavid, Jean-Michel Prades, and B. Farizon
- Subjects
medicine.medical_specialty ,Cricothyroid ligament ,Intraoperative Neurophysiological Monitoring ,Vagus Nerve Stimulation ,medicine.medical_treatment ,03 medical and health sciences ,Superior laryngeal nerve ,0302 clinical medicine ,medicine.ligament ,medicine ,Recurrent laryngeal nerve ,Humans ,Thyroarytenoid muscle ,030223 otorhinolaryngology ,Recurrent Laryngeal Nerve ,business.industry ,Laryngeal Nerves ,Cricothyroid muscle ,respiratory system ,Vagus nerve ,Surgery ,Otorhinolaryngology ,030220 oncology & carcinogenesis ,Laryngeal Muscle ,Thyroidectomy ,business ,Vagus nerve stimulation - Abstract
Intraoperative neuromonitoring of the laryngeal nerves during thyroidectomy is a reliable method to assess nerve function. After identification of the cricothyroid ligament, a bipolar electrode is selectively inserted through the ligament into the thyroarytenoid muscle (TAM) and cricothyroid muscle (CTM). Vagus nerve stimulation then allows precise monitoring of the recurrent laryngeal nerve and the external branch of the superior laryngeal nerve (EBSLN) in the TAM and CTM, respectively. A significant muscle response (greater than 100 μV) is 100% predictive of preserved laryngeal mobility, while the absence of a muscle response is 70% predictive of vocal fold paralysis with 100% sensitivity and 98% specificity. A significant thyroarytenoid muscle response is only recorded ipsilateral to the stimulation with a shorter latency on the right side. A concomitant TAM and CTM response to vagus nerve stimulation or EBSLN stimulation is observed in more than 70% of cases.
- Published
- 2020