title: Does intraoperative nerve monitoring reliably aid in staging of total thyroidectomies?
abstract: OBJECTIVE
  Demonstrate whether intraoperative nerve monitoring is an effective tool in staging bilateral thyroid and neck surgeries in cases of intraoperative injury to the recurrent laryngeal nerve on the side of initial dissection. We hypothesized that IONM provides reliable and appropriate feedback on the functional status of the RLN on side of initial dissection during total thyroidectomy and central neck surgery.
  
  
  METHODS
  Case series with planned data collection.
  
  
  METHODS
  All patients receiving total thyroidectomies or central neck surgeries were reviewed. The outcomes of patients treated whose procedures were staged based on intraoperative nerve monitoring are described.
  
  
  RESULTS
  Ten (4.9%) of 206 procedures were staged based on unfavorable signal change including six patients with thyroid cancers and four with compressive substernal goiters. The overall signal drop in the 10 patients with unfavorable signal change was 63%. Three patients had complete loss of signal. In the other seven patients, the signal dropped by a mean of 48%. In the eight patients with laryngoscopy-proven vocal fold paresis, the signal dropped by a mean of 68%.
  
  
  CONCLUSIONS
  Intraoperative nerve monitoring results accurately indicated postoperative ipsilateral vocal cord dysfunction with high reliability. Intraoperative nerve monitoring is a reliable tool in staging thyroid surgery.
  
  
  METHODS
  4.
authors.affiliation: Department of Surgery, School of Medicine, Tulane University, New Orleans, Louisiana, U.S.A.
authors.forename: Tatyana E
authors.initials: TE
authors.lastname: Fontenot
authors.affiliation: Division of Thyroid and Parathyroid Surgery, Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A.
authors.forename: Gregory W
authors.initials: GW
authors.lastname: Randolph
authors.affiliation: Department of Surgery, School of Medicine, Tulane University, New Orleans, Louisiana, U.S.A.
authors.forename: Tedhar E
authors.initials: TE
authors.lastname: Setton
authors.affiliation: Department of Surgery, School of Medicine, Tulane University, New Orleans, Louisiana, U.S.A.
authors.forename: Nuha
authors.initials: N
authors.lastname: Alsaleh
authors.affiliation: Department of Surgery, School of Medicine, Tulane University, New Orleans, Louisiana, U.S.A.
authors.forename: Emad
authors.initials: E
authors.lastname: Kandil
mesh_terms: D000328:Adult; D004576:Electromyography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D009367:Neoplasm Staging / Q000379:methods*; D012009:Recurrent Laryngeal Nerve / Q000502:physiology*; D061226:Recurrent Laryngeal Nerve Injuries / Q000517:prevention & control*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013964:Thyroid Neoplasms / Q000175:diagnosis / Q000601:surgery*; D013965:Thyroidectomy / Q000379:methods*
keywords: Thyroid cancer; complications of thyroid surgery; intraoperative neuromonitoring; patient outcomes; recurrent laryngeal nerve injury