European Archives of Oto-Rhino-Laryngology

, Volume 270, Issue 9, pp 2383–2395 | Cite as

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

  • Alvaro Sanabria
  • Carl E. Silver
  • Carlos Suárez
  • Ashok Shaha
  • Avi Khafif
  • Randall P. Owen
  • Alessandra Rinaldo
  • Alfio Ferlito
Review Article


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.


Thyroid gland Laryngeal nerve injuries Neuromuscular monitoring Thyroidectomy Tracheostomy 


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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Alvaro Sanabria
    • 1
  • Carl E. Silver
    • 2
  • Carlos Suárez
    • 3
    • 4
  • Ashok Shaha
    • 5
  • Avi Khafif
    • 6
  • Randall P. Owen
    • 7
  • Alessandra Rinaldo
    • 8
  • Alfio Ferlito
    • 8
  1. 1.Department of SurgeryUniversidad de Antioquia, Universidad de La Sabana-Oncology Unit, Hospital Pablo Tobón UribeMedellínColombia
  2. 2.Departments of Surgery and Otolaryngology-Head and Neck SurgeryAlbert Einstein College of Medicine, Montefiore Medical CenterBronxUSA
  3. 3.Department of OtolaryngologyHospital Universitario Central de AsturiasOviedoSpain
  4. 4.Instituto Universitario de Oncología Del Principado de AsturiasOviedoSpain
  5. 5.Head and Neck ServiceMemorial Sloan-Kettering Cancer CenterNew YorkUSA
  6. 6.Head and Neck Surgery and Oncology UnitA.R.M. Center for Advanced Otolaryngology Head and Neck Surgery, Assuta Medical CenterTel AvivIsrael
  7. 7.Division of Metabolic, Endocrine and Minimally Invasive Surgery, Department of SurgeryMount Sinai School of MedicineNew YorkUSA
  8. 8.ENT ClinicUniversity of UdineUdineItaly

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