title: Continuous laryngeal nerve integrity monitoring during thyroidectomy: does it reduce risk of injury?
abstract: OBJECTIVE
  To determine if continuous laryngeal nerve integrity monitoring (NIM) during thyroidectomy is associated with a decreased risk of postoperative recurrent laryngeal nerve (RLN) injury.
  
  
  METHODS
  Retrospective cohort study of 165 patients who underwent thyroidectomy at a resident teaching institution between 1999 and 2002. The control group had 120 nerves at risk (NAR) whereas the NIM group consisted of 116 NAR. Primary outcome measures included postoperative RLN paralysis, paresis, and total injury rates.
  
  
  RESULTS
  RLN paralysis occurred in 2.54% NAR in the control group and 0.86% in the NIM group [relative risk (RR) = 0.34, 95% confidence interval (CI95) = 0.04-3.27, P = 0.62]. Temporary RLN paresis occurred in 4.24% NAR in the control group and 3.45% in the NIM group (RR = 0.9, CI95 = 0.23-3.55, P = 0.89). Total RLN injury occurred in 6.78% NAR in the control group and 4.31% in the NIM group (RR = 0.66, CI95 = 0.21-2.09, P = 0.48). When compared to all other NAR, advanced T-stage malignancy was associated with a significantly increased risk of RLN paresis (T4 RR = 9.0, CI95 = 2.56-31.67, P = 0.0006; T3+T4 RR = 7.5, CI95 = 2.17-25.86, P = 0.0001) but not paralysis. NIM did not significantly reduce the risk of RLN paresis in the advanced T-stage subset (T3+T4 RR = 0.36, CI95 = 0.04-3.0, P = 0.59).
  
  
  CONCLUSIONS
  There were no statistically significant differences in RLN paralysis, paresis, or total injury rates between control and NIM groups, even in subsets with advanced T-stage and increased baseline risk. Advanced T-stage is a significant predictor of RLN paresis in this cohort.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, OH 45267-0528, USA.
authors.forename: Matt L
authors.initials: ML
authors.lastname: Robertson
authors.forename: David L
authors.initials: DL
authors.lastname: Steward
authors.forename: Jack L
authors.initials: JL
authors.lastname: Gluckman
authors.forename: Jeff
authors.initials: J
authors.lastname: Welge
mesh_terms: D000328:Adult; D015331:Cohort Studies; D020209:Cranial Nerve Injuries / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D009367:Neoplasm Staging; D061226:Recurrent Laryngeal Nerve Injuries; D012189:Retrospective Studies; D013959:Thyroid Diseases / Q000601:surgery; D013964:Thyroid Neoplasms / Q000473:pathology / Q000601:surgery; D013965:Thyroidectomy / Q000009:adverse effects*; D014826:Vocal Cord Paralysis / Q000517:prevention & control*