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Recurrent Laryngeal Nerve Monitoring in Thyroid Surgery
Neuromonitoring is advocated for rapid, reliable identification of the recurrent laryngeal nerve and for predicting postoperative vocal cord mobility. Neuromonitoring helps identify the recurrent laryngeal nerve, particularly when the anatomic situation is complicated by previous neck surgery, significant scarring, a large thyroid goiter, or an aberrant nerve course. A special electrode is embedded in the endotracheal tube and positioned over the vocal cord, then connected to an EMG monitor. Using a probe, the surgeon can continuously monitor the nerve during a surgical procedure.
This is a screenshot of a response from the Recurrent Laryngeal nerve. The amplitude of this waveform is high and can be easily seen on the graph at 3 ms; the nerve was stimulated at 1 mA
This is a screenshot of a response from the External Branch of the Superior Laryngeal nerve. This low-amplitude waveform is small because only a branch of the nerve is being stimulated. Like the recurrent Laryngeal nerve response, the action potential can be seen at 3 ms, and the nerve was stimulated at 1 mA
External Branch of the Superior Laryngeal Nerve Monitoring in Thyroid Surgery
The external branch of the superior laryngeal nerve (EBSLN) is responsible for a high-pitched voice and voice projection. This is especially important for singers, teachers, and public speakers. Monitoring of the external branch of the superior laryngeal nerve is performed during minimally invasive thyroid surgery under general anesthesia. Special electrodes are used to stimulate the cricothyroid muscle and see a response. Monitoring the external branch of the superior laryngeal nerve helps the surgeon localize and preserve it.
Nerve anatomy.
Endotracheal (ET) tube with sensor for nerve monitoring during thyroid surgery.
