title: Monitoring of the posterior cricoarytenoid muscle represents another option for neural monitoring during thyroid surgery: Normative vagal and recurrent laryngeal nerve posterior cricoarytenoid muscle electromyographic data.
abstract: Intraoperative neural monitoring (IONM) of laryngeal nerves using electromyography (EMG) is routinely performed using endotracheal tube surface electrodes adjacent to the vocalis muscles. Other laryngeal muscles such as the posterior cricoarytenoid muscle (PCA) are indirectly monitored. The PCA may be directly and reliably monitored through an electrode placed in the postcricoid region. Herein, we describe the method and normative data for IONM using PCA EMG.
  
  
  
  Retrospective review.
  
  
  
  Data were reviewed retrospectively for thyroid and parathyroid surgery patients with IONM of laryngeal nerves from January to August 2016. Recordings of vocalis and PCA EMG amplitudes and latencies with stimulation of laryngeal nerves were obtained using endotracheal (ET) tube-based and postcricoid surface electrodes.
  
  
  
  Data comprised EMG responses in vocalis and PCA recording channels with stimulation of the vagus, recurrent laryngeal nerve (RLN), and external branch of the superior laryngeal nerve from 20 subjects (11 left, 9 right), as well as PCA EMG threshold data with RLN stimulation from 17 subjects. Mean EMG amplitude was 725.69 ± 108.58 microvolts (µV) for the ipsilateral vocalis and 329.44 ± 34.12 µV for the PCA with vagal stimulation, and 1,059.75 ± 140.40 µV for the ipsilateral vocalis and 563.88 ± 116.08 µV for the PCA with RLN stimulation. There were no statistically significant differences in mean latency. For threshold cutoffs of the PCA with RLN stimulation, mean minimum and maximum threshold intensities were 0.37 milliamperes (mA) and 0.84 mA, respectively.
  
  
  
  This study shows robust and reliable PCA EMG waveforms with direct nerve stimulation. Further studies will evaluate feasibility and application of the PCA electrode as a complementary quantitative tool in IONM.
  
  
  
  4. Laryngoscope, 128:283-289, 2018.
authors.affiliation: Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A.|Department of Otology and Laryngology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A.
authors.forename: Whitney
authors.initials: W
authors.lastname: Liddy
authors.affiliation: Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A.
authors.forename: Samuel R
authors.initials: SR
authors.lastname: Barber
authors.affiliation: Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A.|Department of Otology and Laryngology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A.
authors.forename: Brian M
authors.initials: BM
authors.lastname: Lin
authors.affiliation: Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A.|Department of Otology and Laryngology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A.
authors.forename: Dipti
authors.initials: D
authors.lastname: Kamani
authors.affiliation: Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A.
authors.forename: Natalia
authors.initials: N
authors.lastname: Kyriazidis
authors.affiliation: Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A.|Department of Otology and Laryngology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A.
authors.forename: Bradley
authors.initials: B
authors.lastname: Lawson
authors.affiliation: Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A.|Department of Otology and Laryngology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A.|Division of Surgical Oncology Endocrine Surgical Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A.
authors.forename: Gregory W
authors.initials: GW
authors.lastname: Randolph
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004576:Electromyography; D005260:Female; D006801:Humans; D007821:Laryngeal Muscles / Q000294:innervation*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D037981:Neck Dissection; D010279:Parathyroid Diseases / Q000601:surgery*; D016105:Parathyroidectomy; D012009:Recurrent Laryngeal Nerve / Q000502:physiology*; D012189:Retrospective Studies; D013959:Thyroid Diseases / Q000601:surgery*; D013965:Thyroidectomy; D014630:Vagus Nerve / Q000502:physiology*
keywords: Thyroid and parathyroid surgery; electromyography; intraoperative neural monitoring; posterior cricoarytenoid; recurrent laryngeal nerve