title: Intraoperative electromyographic monitoring of the recurrent laryngeal nerve in reoperative thyroid and parathyroid surgery.
abstract: BACKGROUND
  Injury to the recurrent laryngeal nerve (RLN) is a rare complication of initial thyroid and parathyroid surgery, but the prevalence is much higher in the reoperative setting. The use of continuous, intraoperative electromyographic monitoring of the RLN has been suggested to improve the safety of cervical explorations.
  
  
  METHODS
  Outcomes of a group of reoperative thyroid and parathyroid cases that used EMG monitoring with endoscopically applied hook-wire electrodes were compared with a group of cervical reoperations without monitoring. Office laryngoscopy (indirect or fiberoptic) was used to evaluate and follow suspected RLN complications.
  
  
  RESULTS
  Electromyography was used in 52 cervical reexploration procedures. Patients averaged 1.8 previous explorations (range, 1-7 explorations) and underwent procedures for parathyroid (31%) and/or thyroid (77%) disease (overall, 72% malignant). The non-monitored group had 59 patients with similar characteristics. Only 1 permanent nerve complication in each group was unintended (electromyography, 1.9%; non-electromyography, 1.7%). Seven false-negative and 2 false-positive electromyographic findings occurred. No complications resulted from placement of the electromyography electrodes.
  
  
  CONCLUSIONS
  Intraoperative electromyographic monitoring of the RLN in reoperative neck surgery can be performed safely but did not decrease RLN complications in this study. Experience and routine nerve exposure remain crucial to the minimization of RLN complications.
authors.affiliation: Department of Surgery, College of Medicine, Mayo Clinic, Mayo Building W6, 200 First Street SW, Rochester, MN 55905, USA.
authors.forename: Donald E
authors.initials: DE
authors.lastname: Yarbrough
authors.forename: Geoffrey B
authors.initials: GB
authors.lastname: Thompson
authors.forename: Jan L
authors.initials: JL
authors.lastname: Kasperbauer
authors.forename: C Michel
authors.initials: CM
authors.lastname: Harper
authors.forename: Clive S
authors.initials: CS
authors.lastname: Grant
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D004576:Electromyography / Q000379:methods*; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D016105:Parathyroidectomy / Q000009:adverse effects*; D012009:Recurrent Laryngeal Nerve / Q000502:physiology; D061226:Recurrent Laryngeal Nerve Injuries; D012086:Reoperation; D013965:Thyroidectomy / Q000009:adverse effects*; D020196:Trauma, Nervous System / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome