Recurrent laryngeal nerve monitoring during thyroidectomy and related cervical procedures in the pediatric population.
OBJECTIVE
To gather data on, and assess the applicability of, intraoperative recurrent laryngeal nerve (RLN) monitoring during thyroidectomy and related cervical procedures in children and adolescents. Recurrent laryngeal nerve trauma is one of the most serious complications of surgery in the anterior neck compartment. Numerous studies have demonstrated the utility of intraoperative monitoring of the RLN in adult thyroid surgery to prevent such injury. Although the risk of RLN injury is reportedly higher in the pediatric population, little data exist regarding the use of intraoperative RLN monitoring in children and adolescents.


METHODS
Retrospective case series review.


METHODS
A pediatric otolaryngology practice in a tertiary care hospital.


METHODS
Five patients undergoing surgical excision of thyroid neoplasms or branchial pouch anomalies.


METHODS
During surgical excision, intraoperative RLN monitoring was performed with use of the Xomed NIM II monitor and Xomed RLN monitoring endotracheal tube, which allow for both passive and stimulation-evoked electromyographic monitoring of the thyroarytenoid muscle.


METHODS
True vocal fold mobility as assessed by postoperative flexible laryngoscopy.


RESULTS
Intraoperative RLN monitoring was performed successfully for up to 4 hours. Such monitoring facilitated the identification of the RLN and was predictive of the subsequent presence or absence of postoperative RLN paresis.


CONCLUSIONS
Intraoperative RLN monitoring can be a useful tool during cervical procedures that place the RLN at risk in children and adolescents. As has been demonstrated in adults, it is a safe and reliable technique that can be predictive of and may lessen the risk of RLN morbidity in this younger patient population.
White
W Matthew
WM
Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, and Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts 02114, USA.
Randolph
Gregory W
GW
Hartnick
Christopher J
CJ
Cunningham
Michael J
MJ
D000293:Adolescent; D001934:Branchial Region / Q000002:abnormalities / Q000601:surgery; D002648:Child; D004576:Electromyography / Q000295:instrumentation; D006801:Humans; D007821:Laryngeal Muscles / Q000294:innervation*; D007828:Laryngoscopy / Q000379:methods*; D008297:Male; D016343:Monitoring, Intraoperative; D010036:Otolaryngology / Q000379:methods; D011183:Postoperative Complications; D012009:Recurrent Laryngeal Nerve / Q000502:physiology*; D012189:Retrospective Studies; D013964:Thyroid Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D013965:Thyroidectomy / Q000379:methods*; D014057:Tomography, X-Ray Computed; D014826:Vocal Cord Paralysis / Q000209:etiology* / Q000517:prevention & control*