Recent Modalities In Monitoring Of the Recurrent Laryngeal Nerve in Various Neck Operations

Abstract

Anatomic and functional preservation of the recurrent laryngeal nerve (RLN) is the gold standard in thyroid and various neck surgery. Visual identification of RLN has decreased the rates of permanent RLN palsy during thyroid and parathyroid operations. However, unexpected RLN palsy still occurs. This is one of the most frequent causes of medicolegal litigation after thyroid and parathyroid surgery. In addition, most nerve injuries are not recognized intraoperatively and visualization of the nerve is insufficient to assess nerve damage. Intraoperative neuro-monitoring (IONM) of the RLN represents an adjunct to routine visual identification of the nerve during surgery and provides a broader vision of surgical anatomy incorporating new clinical neurophysiologic and functional patterns to surgical practice.

The lack of standardized procedures for nerve monitoring during thyroid and parathyroid operations has led to variable and disparate results. A review of the relevant medical literature on RLN monitoring over the last 10 years shows that IONM was performed in an unstandardized way and, thus, it is difficult to compare studies and obtain a concurred opinion on IONM.

KEYWORDS:Recurrent laryngeal nerve - Intraoperative neuromonitoring - various neck surgery - thyroid and parathyroid.