Role of intraoperative neuromonitoring of the recurrent laryngeal nerve in high-risk thyroid surgery.
BACKGROUND
Thyroid surgeries associated with an elevated incidence of recurrent laryngeal nerve (RLN) injury are considered high-risk thyroidectomies. These high-risk operations include surgery for thyroid cancer, Graves disease, and recurrent goitre. In addition, the size of the goitre is an important risk factor for RLN injury.


OBJECTIVE
In our retrospective study, we tried to evaluate the role of intraoperative neuromonitoring of RLN specifically in high-risk thyroid surgery with 421 nerves at risk.


METHODS
Thyroid surgeries in our study were done by experienced surgeons in a high-volume provider centre.The overall percentage of RLN injury was 8.8% in the monitored group in comparison with 9.1% in the unmonitored group. The percentage of permanent nerve palsy in the monitored group was 3.9% of nerves at risk in comparison with 3.8% in the unmonitored group. No statistically significant difference was found between groups.


CONCLUSIONS
Routine visual identification of the nerve by meticulous dissection is the best method to avoid RLN injury. The benefit of RLN neuromonitoring could be further assessed by performing a multicentre prospective study to compare the role of RLN neuromonitoring in high-risk thyroid surgeries.
Atallah
Ihab
I
Department of Otolaryngology and Head and Neck Surgery, Hautepierre Hospital, Strasbourg, France. Ihab.ATALLAH@free.fr
Dupret
Agnàs
A
Carpentier
Anne-Sophie
AS
Weingertner
Anne Sophie
AS
Volkmar
Pierre-Philippe
PP
Rodier
Jean-François
JF
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020209:Cranial Nerve Injuries / Q000517:prevention & control*; D004576:Electromyography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D012009:Recurrent Laryngeal Nerve / Q000503:physiopathology*; D012189:Retrospective Studies; D012307:Risk Factors; D013959:Thyroid Diseases / Q000601:surgery*; D013965:Thyroidectomy / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult