Neuromonitoring of the external branch of the superior laryngeal nerve during minimally invasive thyroid surgery under local anesthesia: A prospective study of 10 patients
Article first published online: 21 JAN 2009
Copyright © 2009 The American Laryngological, Rhinological, and Otological Society, Inc.
Volume 119, Issue 3, pages 597–601, March 2009
How to Cite
Inabnet, W. B., Murry, T., Dhiman, S., Aviv, J. and Lifante, J.-C. (2009), Neuromonitoring of the external branch of the superior laryngeal nerve during minimally invasive thyroid surgery under local anesthesia: A prospective study of 10 patients. The Laryngoscope, 119: 597–601. doi: 10.1002/lary.20071
- Issue published online: 20 FEB 2009
- Article first published online: 21 JAN 2009
- Manuscript Accepted: 25 SEP 2008
- Nerve monitoring;
- voice change;
- local anesthesia;
Avoiding alterations of the voice is a challenge in thyroid surgery. Identification and preservation of the external branch of the superior laryngeal nerve (EBSLN) is paramount for normal vocal function preservation after thyroidectomy. Conventional nerve monitoring requires a general anesthesia and placement of a special endotracheal tube equipped with electrodes to evoke the laryngeal nerves. This study aims to assess feasibility and efficacy of a novel technique of neuromonitoring of the EBSLN under local anesthesia during minimally invasive thyroidectomy.
Study Design; Prospective Study:
This study is a prospective trial to evaluate the efficacy of nerve monitoring of the EBSLN during minimally invasive thyroidectomy under local anesthesia. Patient self-assessment of changes in perceived voice severity prior to and 3 weeks after surgery was assessed with the Voice Handicap Index-10 (VHI-10).
Thyroidectomy was successfully completed under local anesthesia in all cases. The recurrent laryngeal nerve(s) was identified and preserved in each patient as demonstrated by normal perioperative transnasal flexible laryngoscopy. A total of 15 EBSLNs were at risk, but only 8 EBSLNs (53%) were definitively identified. Neuromonitoring demonstrated preservation of the EBSLN in 100% of cases. The analysis of the results of the VHI-10 questionnaire before and 3 weeks after surgery indicated no significant change in patients' perception of voice severity.
Monitoring of the EBSLN during thyroidectomy under local anesthesia is a feasible alternative to conventional nerve monitoring under general anesthesia. This technique may be useful for the preservation of voice quality during a minimally invasive thyroidectomy under local anesthesia. Laryngoscope, 2009