Recurrent laryngeal nerve location in thyroidectomy and parathyroidectomy: Use of an indwelling laryngeal surface electrode with evoked electromyography

Injury to vital neural structures remains a source of major morbidity in head and neck surgery. Electromyographic (EMG) monitoring has been successfully used during otologic and parotid surgery. However, its use in thyroid and parathyroid surgery has been less than routine even though preservation of recurrent laryngeal nerve function is essential to voice and airway. We describe our technique with the use of a postcricoid surface electrode for evoked EMG monitoring in thyroid and parathyroid surgeries. Technique of insertion of the electrode is described. Operative thyroidectomy is described for either close-capsular dissection or initial nerve location. Equipment required and monitoring technique is described for both methods and outcomes are briefly discussed. These results support evoked EMG by postcricoid surface electrode as a useful practical tool in identification of recurrent nerve in thyroid and parathyroid surgery.