title: Protective effect of intraoperative nerve monitoring against recurrent laryngeal nerve injury during re-exploration of the thyroid.
abstract: BACKGROUND
  Previous thyroid or parathyroid surgery induces scarring or distorts anatomy, and increases the risk of recurrent laryngeal nerve (RLN) injury for a reoperation. The benefit of intraoperative nerve monitoring (IONM) for re-exploration (a second nerve exploration) and reoperation has not been established.
  
  
  METHODS
  Two hundred and ten patients were given a thyroid or parathyroid reoperation at our hospital between 2001 and 2010. Using IONM, we re-explored 56 patients who had been operated on before June 2007. The injury rate in these patients was compared with that of the 15 patients re-explored without IONM between 2001 and 2006.
  
  
  RESULTS
  Of the 70 nerves that were re-explored using IONM, only one was incidentally injured, significantly fewer than the three injured in the 15 nerves re-explored without using IONM (1.43% vs. 20%, P = 0.0164).
  
  
  CONCLUSIONS
  IONM helped prevent RLN damage when re-exploring nerves during thyroid and parathyroid surgery. We recommend the routine use of IONM in thyroid and parathyroid reoperations.
authors.affiliation: Department of Surgery, National Cheng Kung University Hospital, Tainan 704, Taiwan.
authors.forename: Yu-Chuan
authors.initials: YC
authors.lastname: Chuang
authors.forename: Shih-Ming
authors.initials: SM
authors.lastname: Huang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004576:Electromyography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D009364:Neoplasm Recurrence, Local / Q000209:etiology / Q000473:pathology / Q000517:prevention & control*; D009367:Neoplasm Staging; D011379:Prognosis; D061226:Recurrent Laryngeal Nerve Injuries / Q000209:etiology / Q000517:prevention & control*; D012086:Reoperation; D013959:Thyroid Diseases / Q000473:pathology / Q000601:surgery*; D013965:Thyroidectomy / Q000009:adverse effects*; D055815:Young Adult