Normative Intra‐operative Electrophysiologic Waveform Analysis of Superior Laryngeal Nerve External Branch and Recurrent Laryngeal Nerve in Patients Undergoing Thyroid Surgery

作者：André S. Potenza, Eimear Phelan, Cláudio Roberto Cernea, Cristian M. Slough, Dipti Kamani, Ashlie Darr, David Zurakowski, Gregory William Randolph · 发表于：World Journal of Surgery · 年份：2013 · DOI：10.1007/s00268-013-2148-9 · 被引用次数：75 · 研究领域：Thyroid and Parathyroid Surgery、Voice and Speech Disorders、Nerve Injury and Rehabilitation

BACKGROUND: Injury to the external branch of the superior laryngeal nerve (EBSLN) can occur during superior pole dissection in thyroid surgery; the EBSLN injury rate is reported as high as 28 % (Cernea et al., Head Neck 14:380-383, 1992). Injury to the EBSLN leads to variable symptoms that may be overlooked, but that can be significant, especially to professional speakers and singers. Intraoperative nerve monitoring (IONM) is employed widely to aid in nerve identification. We report on normative electroneuromyography (EMG) data on EBSLN-IONM and cricothyroid muscle (CTM) twitch response during stimulation as an aid to EBSLN identification. METHODS: A prospective study of the SLN and the recurrent laryngeal nerve (RLN) IONM data in 72 consecutive thyroid surgeries was carried out. All patients underwent preoperative and postoperative laryngeal exams, and patients with abnormal preoperative laryngeal function were excluded. Normative EMG data and CTM twitch response during EBSLN stimulation were recorded and analyzed. RESULTS: Stimulation of the EBSLN resulted in a positive CTM twitch response in 100 %, whereas EMG response was recordable in 80 %. Electromyographic amplitude was ~1/3 of ipsilateral RLN amplitude and did not change through the case with multiple stimulations. Stimulation of the EBSLN was similar for men and women and at 1 and 2 mA stimulation levels. CONCLUSIONS: Intraoperative nerve monitoring of the EBSLN aids in EBSLN identification and provides electroneurom...