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IONM of the Recurrent Laryngeal Nerve

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The Recurrent and Superior Laryngeal Nerves

Abstract

Thyroid surgery can pose risk to both the right and the left recurrent laryngeal nerves (RLN) in a single surgical procedure. Unilateral vocal cord palsy (VCP) can lead to morbidity related to changes in voice, especially in professional voice users, as well as potential dysphagia and aspiration, while bilateral VCP may require tracheostomy. Visualization of the RLN during surgery has been considered the gold standard for preventing injury to the RLN; however, an intraoperatively visualized and structurally intact nerve does not necessarily represent a postoperatively functioning nerve. Neural monitoring has increasingly gained the attention of surgeons performing thyroid and parathyroid surgeries around the world. Current studies suggest that a majority of general and head and neck surgeons use neural monitoring in at least some of their thyroid surgical cases. This chapter presents a historical overview and usage patterns of intraoperative neural monitoring (IONM) of the RLN and discusses its impact on surgical practice, including intraoperative applications of IONM, medicolegal aspects and standards of IONM, normative data, as well as current advances in IONM such as continuous IONM.

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Authors and Affiliations

  1. 1st Division of Surgery, Department of Surgical Sciences and Human Morphology, University of Insubria, Viale Guicciardini 9, Varese, 21100, Italy

    Gianlorenzo Dionigi M.D., F.A.C.S., Ph.D.

  2. Department of General, Visceral and Vascular Surgery, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany

    Henning Dralle M.D., Ph.D.

  3. Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology—Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA

    Whitney Liddy M.D., Dipti Kamani M.D. & Natalia Kyriazidis M.S.

  4. The Claire and John Bertucci Endowed Chair in Thyroid Surgery Oncology, Harvard Medical School, Boston, MA, USA

    Gregory W. Randolph M.D.

  5. Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology—Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA, USA

    Gregory W. Randolph M.D.

  6. Department of Surgery, Endocrine Surgery Service, Massachusetts General Hospital, Boston, MA, USA

    Gregory W. Randolph M.D.

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  1. Gianlorenzo Dionigi M.D., F.A.C.S., Ph.D.
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  2. Henning Dralle M.D., Ph.D.
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  3. Whitney Liddy M.D.
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  4. Dipti Kamani M.D.
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  5. Natalia Kyriazidis M.S.
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  6. Gregory W. Randolph M.D.
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Correspondence to Gianlorenzo Dionigi M.D., F.A.C.S., Ph.D. .

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  1. The Claire and John Bertucci Endowed Cha, Harvard Medical School, Boston, Massachusetts, USA

    Gregory W. Randolph

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Dionigi, G., Dralle, H., Liddy, W., Kamani, D., Kyriazidis, N., Randolph, G.W. (2016). IONM of the Recurrent Laryngeal Nerve. In: Randolph, G. (eds) The Recurrent and Superior Laryngeal Nerves. Springer, Cham. https://doi.org/10.1007/978-3-319-27727-1_14

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  • DOI: https://doi.org/10.1007/978-3-319-27727-1_14

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