title: External branch of the superior laryngeal nerve monitoring during thyroid and parathyroid surgery: International Neural Monitoring Study Group standards guideline statement.
abstract: Intraoperative neural monitoring (IONM) during thyroid surgery has gained widespread acceptance as an adjunct to the gold standard of visual identification of the recurrent laryngeal nerve (RLN). Contrary to routine dissection of the RLN, most surgeons tend to avoid rather than routinely expose and identify the external branch of the superior laryngeal nerve (EBSLN) during thyroidectomy or parathyroidectomy. IONM has the potential to be utilized for identification of the EBSLN and functional assessment of its integrity; therefore, IONM might contribute to voice preservation following thyroidectomy or parathyroidectomy. We reviewed the literature and the cumulative experience of the multidisciplinary International Neural Monitoring Study Group (INMSG) with IONM of the EBSLN. A systematic search of the MEDLINE database (from 1950 to the present) with predefined search terms (EBSLN, superior laryngeal nerve, stimulation, neuromonitoring, identification) was undertaken and supplemented by personal communication between members of the INMSG to identify relevant publications in the field. The hypothesis explored in this review is that the use of a standardized approach to the functional preservation of the EBSLN can be facilitated by application of IONM resulting in improved preservation of voice following thyroidectomy or parathyroidectomy. These guidelines are intended to improve the practice of neural monitoring of the EBSLN during thyroidectomy or parathyroidectomy and to optimize clinical utility of this technique based on available evidence and consensus of experts.
  
  
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authors.affiliation: Department of Endocrine Surgery, Third Chair of General Surgery, Jagiellonian University Medical College, Kraków, Poland.
authors.forename: Marcin
authors.initials: M
authors.lastname: Barczyński
authors.forename: Gregory W
authors.initials: GW
authors.lastname: Randolph
authors.forename: Claudio R
authors.initials: CR
authors.lastname: Cernea
authors.forename: Henning
authors.initials: H
authors.lastname: Dralle
authors.forename: Gianlorenzo
authors.initials: G
authors.lastname: Dionigi
authors.forename: Piero F
authors.initials: PF
authors.lastname: Alesina
authors.forename: Radu
authors.initials: R
authors.lastname: Mihai
authors.forename: Camille
authors.initials: C
authors.lastname: Finck
authors.forename: Davide
authors.initials: D
authors.lastname: Lombardi
authors.forename: Dana M
authors.initials: DM
authors.lastname: Hartl
authors.forename: Akira
authors.initials: A
authors.lastname: Miyauchi
authors.forename: Jonathan
authors.initials: J
authors.lastname: Serpell
authors.forename: Samuel
authors.initials: S
authors.lastname: Snyder
authors.forename: Erivelto
authors.initials: E
authors.lastname: Volpi
authors.forename: Gayle
authors.initials: G
authors.lastname: Woodson
authors.forename: Jean Louis
authors.initials: JL
authors.lastname: Kraimps
authors.forename: Abdullah N
authors.initials: AN
authors.lastname: Hisham
mesh_terms: D004576:Electromyography; D006801:Humans; D007821:Laryngeal Muscles / Q000502:physiology; D007823:Laryngeal Nerves / Q000033:anatomy & histology / Q000502:physiology*; D016343:Monitoring, Intraoperative / Q000592:standards*; D016105:Parathyroidectomy; D011183:Postoperative Complications / Q000517:prevention & control; D013961:Thyroid Gland / Q000294:innervation; D013965:Thyroidectomy; D014826:Vocal Cord Paralysis / Q000517:prevention & control; D014832:Voice Disorders / Q000503:physiopathology / Q000517:prevention & control
keywords: Superior laryngeal nerve; external branch of the superior laryngeal nerve; nerve identification; nerve monitoring; nerve stimulation; thyroid and parathyroid surgery