The authors have no funding, financial relationships, or conflicts of interest to disclose.
Recurrent laryngeal nerve monitoring versus identification alone on post-thyroidectomy true vocal fold palsy: A meta-analysis†
Version of Record online: 25 APR 2011
Copyright © 2011 The American Laryngological, Rhinological, and Otological Society, Inc.
Volume 121, Issue 5, pages 1009–1017, May 2011
How to Cite
Higgins, T. S., Gupta, R., Ketcham, A. S., Sataloff, R. T., Wadsworth, J. T. and Sinacori, J. T. (2011), Recurrent laryngeal nerve monitoring versus identification alone on post-thyroidectomy true vocal fold palsy: A meta-analysis. The Laryngoscope, 121: 1009–1017. doi: 10.1002/lary.21578
- Issue online: 25 APR 2011
- Version of Record online: 25 APR 2011
- Accepted manuscript online: 3 MAR 2011 03:46PM EST
- Manuscript Accepted: 17 NOV 2010
- Manuscript Revised: 14 NOV 2010
- Manuscript Received: 18 JUL 2010
- recurrent laryngeal nerve;
- vocal fold;
- vocal cord;
- Level of Evidence: 2a.
To compare by meta-analysis the effect of recurrent laryngeal nerve (RLN) monitoring versus RLN identification alone on true vocal fold palsy rates after thyroidectomy.
Systematic review and meta-analysis.
A search of MEDLINE (1966–July 2008), EMBASE (1980–July 2008), Cochrane Central Register of Clinical Trials (CENTRAL), Cochrane Database of Systematic Reviews, clinicaltrials.gov, and The National Guideline Clearinghouse databases was performed. References from retrieved articles, presentation data, and correspondence with experts was also included. All authors used a detailed list of inclusion/exclusion criteria to determine articles eligible for final inclusion. Two authors independently extracted data including study criteria, methods of vocal fold function assessment, laryngeal nerve monitor type, and surgical procedure. Odds ratios (OR) were pooled using a random-effects model. Associations with patient and operative characteristics were tested in subgroups.
One randomized clinical trial, seven comparative trials, and 34 case series evaluating 64,699 nerves-at-risk were included. The overall incidence of true vocal fold palsy (TVFP) was 3.52% for intraoperative nerve monitoring (IONM) versus 3.12% for nerve identification alone (ID) (OR 0.93; 95% confidence interval [CI], 0.76-1.12]. No statistically significant difference in transient TVFP (2.74% IONM vs. 2.49% ID [OR 1.07, 95% CI, 0.95-1.20]), persistent TVFP (0.75% IONM vs. 0.58% ID [OR 0.99, 95% CI, 0.79-1.23]), or unintentional RLN injury (0.12% IONM vs. 0.33% ID [OR 0.50, 95% CI, 0.15-1.75]) was found.
This meta-analysis demonstrates no statistically significant difference in the rate of true vocal fold palsy after using intraoperative neuromonitoring versus recurrent laryngeal nerve identification alone during thyroidectomy.