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Neuromonitoring of the laryngeal nerves in thyroid surgery: a critical appraisal of the literature

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Abstract

One of the most significant complication of thyroid surgery is injury of the recurrent laryngeal nerve. Injury of the external branch of the superior laryngeal nerve is a less obvious but occasionally significant problem. Recently, neuromonitoring during thyroidectomy has received considerable attention because of literature encouraging its use, but there is no consensus about its advantages and utility. A critical assessment of the literature on neuromonitoring was conducted in order to define its effectiveness, safety, cost-effectiveness and medical-legal impact. Available data does not show results superior to those obtained by traditional anatomical methods of nerve identification during thyroid surgery. Data about cost-effectiveness is scarce. The literature shows inconsistencies in methodology, patient selection and randomization in various published studies which may confound the conclusions of individual investigations. The current recommendation for use in “high risk” patients should be assessed because definition heterogeneity makes identification of these patients difficult. As routine use of neuromonitoring varies according to geography, its use should not be considered to be the standard of care.

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Authors and Affiliations

  1. Department of Surgery, Universidad de Antioquia, Universidad de La Sabana-Oncology Unit, Hospital Pablo Tobón Uribe, Medellín, Colombia

    Alvaro Sanabria

  2. Departments of Surgery and Otolaryngology-Head and Neck Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA

    Carl E. Silver

  3. Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain

    Carlos Suárez

  4. Instituto Universitario de Oncología Del Principado de Asturias, Oviedo, Spain

    Carlos Suárez

  5. Head and Neck Service, Memorial Sloan-Kettering Cancer Center, New York, USA

    Ashok Shaha

  6. Head and Neck Surgery and Oncology Unit, A.R.M. Center for Advanced Otolaryngology Head and Neck Surgery, Assuta Medical Center, Tel Aviv, Israel

    Avi Khafif

  7. Division of Metabolic, Endocrine and Minimally Invasive Surgery, Department of Surgery, Mount Sinai School of Medicine, New York, USA

    Randall P. Owen

  8. ENT Clinic, University of Udine, Piazzale S. Maria Della Misericordia, 33100, Udine, Italy

    Alessandra Rinaldo & Alfio Ferlito

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  1. Alvaro Sanabria
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  2. Carl E. Silver
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  3. Carlos Suárez
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  4. Ashok Shaha
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  5. Avi Khafif
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  6. Randall P. Owen
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  7. Alessandra Rinaldo
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  8. Alfio Ferlito
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Correspondence to Alfio Ferlito.

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This paper was written by members of the International Head and Neck Scientific Group (www.IHNSG.com).

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Sanabria, A., Silver, C.E., Suárez, C. et al. Neuromonitoring of the laryngeal nerves in thyroid surgery: a critical appraisal of the literature. Eur Arch Otorhinolaryngol 270, 2383–2395 (2013). https://doi.org/10.1007/s00405-013-2558-1

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