title: Prospective analysis of the efficacy of continuous intraoperative nerve monitoring during thyroidectomy, parathyroidectomy, and parotidectomy.
abstract: OBJECTIVE
  Continuous intraoperative electromyographic monitoring was prospectively performed in all parotidectomies, thyroidectomies, and parathyroidectomies over approximately 5 years to assess the efficacy of this technology.
  
  
  METHODS
  Continuous intraoperative nerve monitoring with perioperative nerve assessment was performed. The postresection minimal stimulation level of the nerves was determined to evaluate if this level would predict nerve function postoperatively.
  
  
  RESULTS
  Forty-four parotidectomies and 70 thyroid/parathyroid operations were performed with 140 nerves at risk (44 facial, 96 recurrent laryngeal). The incidence of temporary facial paralysis was 15.9% (7 of 44) and the incidence of permanent paralysis was 0%. The incidence of temporary recurrent laryngeal nerve paralysis in terms of nerves at risk was 1.0% (1 of 96), and the incidence of permanent recurrent laryngeal nerve paralysis was 0%. All patients with normally functioning facial and recurrent laryngeal nerves postoperatively had minimal stimulation levels less than or equal to 0.4 mA.
  
  
  CONCLUSIONS
  Continuous intraoperative nerve monitoring was associated with extremely low rates of temporary and permanent nerve paralysis in our series of 140 nerves at risk as compared to the rates documented in the literature.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Wilford Hall Medical Center, Lackland Air Force Base, Texas 78236-5300, USA. Joseph.Brennan@59MDW.WHMC.AF.MIL
authors.forename: J
authors.initials: J
authors.lastname: Brennan
authors.forename: E J
authors.initials: EJ
authors.lastname: Moore
authors.forename: K J
authors.initials: KJ
authors.lastname: Shuler
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D004576:Electromyography; D005154:Facial Nerve; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000601:surgery; D007049:Iatrogenic Disease / Q000517:prevention & control; D007823:Laryngeal Nerves; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D016105:Parathyroidectomy / Q000009:adverse effects; D010305:Parotid Diseases / Q000601:surgery*; D011446:Prospective Studies; D013959:Thyroid Diseases / Q000601:surgery; D013964:Thyroid Neoplasms / Q000601:surgery; D013965:Thyroidectomy / Q000009:adverse effects; D014826:Vocal Cord Paralysis / Q000209:etiology / Q000517:prevention & control