Presented as a poster at the Triological Society in Chicago, IL, April 18–22, 2011.
The role of nerve monitoring to predict postoperative recurrent laryngeal nerve function in thyroid and parathyroid surgery
Article first published online: 5 AUG 2013
Copyright © 2013 The American Laryngological, Rhinological and Otological Society, Inc.
Volume 123, Issue 10, pages 2583–2586, October 2013
How to Cite
Eid, I., Miller, F. R., Rowan, S. and Otto, R. A. (2013), The role of nerve monitoring to predict postoperative recurrent laryngeal nerve function in thyroid and parathyroid surgery. The Laryngoscope, 123: 2583–2586. doi: 10.1002/lary.23946
The authors have no funding, financial relationships, or conflicts of interest to disclose.
- Issue published online: 23 SEP 2013
- Article first published online: 5 AUG 2013
- Manuscript Accepted: 27 NOV 2012
- Manuscript Revised: 12 OCT 2012
- Manuscript Received: 31 MAR 2012
- Nerve monitoring;
- thyroid surgery;
- parathyroid surgery;
- recurrent laryngeal nerve
To determine the role and efficacy of intraoperative recurrent laryngeal nerve (RLN) stimulation in the prediction of early and permanent postoperative nerve function in thyroid and parathyroid surgery.
A retrospective review of thyroid and parathyroid surgeries was performed with calculation of sensitivity and specificity of the response of intraoperative stimulation for different pathological groups.
Normal electromyography (EMG) response with 0.5 mAmp stimulation was considered a positive stimulation response with postoperative function determined by laryngoscopy. No EMG response at >1–2 mAmps was considered a negative response. The rates of early and permanent paralysis, as well as sensitivity, specificity, and positive and negative predictive values for postoperative nerve function were calculated for separate pathological groups.
The number of nerves at risk analyzed was 909. The overall early and permanent paralysis rates were 3.1% and 1.2%, respectively, with the highest rate being for Grave's disease cases. The overall sensitivity was 98.4%. The specificity was lower at 62.5% but acceptable in thyroid carcinoma and Grave's disease patients. The majority of nerves with a positive stimulation result and postoperative paralysis on laryngoscopy recovered function in 3 to 12 weeks, showing positive stimulation to be a good predictor of eventual recovery.
Stimulation of the RLN during thyroid and parathyroid surgery is a useful tool in predicting postoperative RLN function. The sensitivity of stimulation is high, showing positive stimulation to be an excellent predictor of normal nerve function. Negative stimulation is more predictive of paralysis in cases of thyroid carcinoma and Grave's disease.
Level of Evidence
2b. Laryngoscope, 123:2584–2587, 2013