title: Supramaximal neurostimulation with laryngeal palpation to predict postoperative vocal fold mobility.
abstract: Recurrent laryngeal nerve (RLN) injury during thyroidectomy or parathyroidectomy is a challenging issue and causes significant morbidity. We adopted the supramaximal stimulation protocol for neurostimulation with laryngeal palpation (NSLP) and tried to evaluate the predictive values of supramaximal NSLP for immediate postoperative vocal fold (VF) mobility.
  
  
  
  Prospective cohort study.
  
  
  
  Prospectively, 293 patients who underwent thyroid and parathyroid surgery and 542 RLNs at risk were enrolled in this study. During NSLP, the current was escalated to 3 mA until definite laryngeal twitch was observed. Immediate postoperative VF mobility was evaluated using flexible laryngoscopy.
  
  
  
  Diagnostic accuracy of NSLP is calculated according to cutoff values of minimal current intensity (1 mA, 1.5 mA, and 2 mA). At 2mA, sensitivity was 81.82%, specificity 100%, positive predictive value 100%, and negative predictive value 99.62%.
  
  
  
  Supramaximal NSLP might be a simple and reliable method to predict immediate postoperative VF mobility in open thyroid and parathyroid surgeries when intraoperative neuromonitoring is unavailable.
  
  
  
  4. Laryngoscope, 126:2863-2868, 2016.
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery and Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea.|Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Pusan National University, Yangsan, South Korea.
authors.forename: Wonjae
authors.initials: W
authors.lastname: Cha
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery and Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea.
authors.forename: Ilyoung
authors.initials: I
authors.lastname: Cho
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery and Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea.
authors.forename: Jeon Yeob
authors.initials: JY
authors.lastname: Jang
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Inje University Ilsan Paik Hospital and Inje University School of Medicine, Goyang, South Korea.
authors.forename: Jae-Keun
authors.initials: JK
authors.lastname: Cho
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery and Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea.|Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Pusan National University, Yangsan, South Korea.
authors.forename: Soo-Geun
authors.initials: SG
authors.lastname: Wang
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery and Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea.
authors.forename: Ji-Hwan
authors.initials: JH
authors.lastname: Park
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004558:Electric Stimulation / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016105:Parathyroidectomy / Q000009:adverse effects*; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012009:Recurrent Laryngeal Nerve / Q000502:physiology; D061226:Recurrent Laryngeal Nerve Injuries / Q000175:diagnosis / Q000209:etiology*; D013965:Thyroidectomy / Q000009:adverse effects*; D014826:Vocal Cord Paralysis / Q000175:diagnosis / Q000209:etiology*
keywords: Supramaximal neurostimulation; predictive value; recurrent laryngeal nerve; thyroid surgery; vocal fold palsy