[Intraoperative neurophysiological monitoring (IONM) of the recurrent laryngeal nerve and microdissection. Surgical techniques for decreasing the risk of recurrent laryngeal nerve paralysis].
BACKGROUND
Frequently numerous recurrent laryngeal nerve injuries occur after operations on the thyroid glands. Compared with postoperative permanent hypocalcemia, unilateral and especially double-side recurrent paresis pose serious complication. As early as 1938 specialists [1] pleaded for a routine visualisation of the nervus recurrens in operations of the thyroid gland, to reduce the risk of permanently recurring paresis. In controversial discussions of the matter specialists have opted for a demonstration of the nerve also under medico-legal aspects. Implementing functionally-critical operational strategies requires the choice of an anatomically suitable operative procedure for the removal of morphological, functional and oncological changes, as well as the avoidance of complications.


METHODS
Intra-operative Monitoring is highly recommendable as a neurophysiological method of supervision combined with microdissection to ensure the safe handling of recurrent laryngeal nerve.


CONCLUSIONS
The rate of permanent paresis on the recurrent nerve can be lowered to less than 1 per cent when this is used as a routine procedure for all operations and the treatment of the thyroid gland diseases.
Neumann
H J
HJ
Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie Städtisches Krankenhaus Martha-Maria Halle-Dölau gGmbH, Akademisches Lehrkrankenhaus, Medizinischen Fakultät, Martin-Luther-Universität Halle-Wittenberg. 03455590-0007@t-online.de
D004558:Electric Stimulation / Q000295:instrumentation; D004567:Electrodes, Implanted; D004576:Electromyography / Q000295:instrumentation; D004867:Equipment Design; D006801:Humans; D007431:Intraoperative Complications / Q000175:diagnosis / Q000503:physiopathology / Q000517:prevention & control*; D008866:Microsurgery / Q000295:instrumentation*; D016343:Monitoring, Intraoperative / Q000295:instrumentation*; D012009:Recurrent Laryngeal Nerve / Q000503:physiopathology; D061226:Recurrent Laryngeal Nerve Injuries; D012307:Risk Factors; D013965:Thyroidectomy / Q000295:instrumentation*; D014826:Vocal Cord Paralysis / Q000175:diagnosis / Q000503:physiopathology / Q000517:prevention & control*