Intraoperative Neural Injury Management: Neuropraxic Non-transection Injury

  • Gianlorenzo DionigiEmail author
  • Gregory W. Randolph
  • Per Mattsson


During thyroid surgery, the macroscopically intact recurrent laryngeal nerve (RLN) may cease to function, even though it is not transected. Traction, cautery, pressure, crush, or being tied in surrounding tissue are some causes of impaired function during surgery. Invisible RLN injuries (such as thermal, traction, compression, contusion, or pressure) are not detected by the surgeon’s eye; only a functional assessment of the RLN with intraoperative nerve monitoring (IONM) can detect such insults. With the application of IONM, we appreciate that traction is the major cause of RLN injury during thyroid surgery.


Recurrent laryngeal nerve Superior laryngeal nerve Mechanism of injury Neurobiology Neurophysiology Management Intraoperative corticosteroids Neuromonitoring 

Supplementary material

Video 20.1

RLN segmental type 1 injury due to traction. Nerve injury is neither appreciated by surgeon eye nor by high definition endoscopy magnification. By means of IONM, the surgeon identifies the site of injury: the RLN loses stimulation proximal to the point of traction injury and retains nerve stimulation distal to the point of traction injury. Subsequent VN stimulation is negative (AVI 37675 kb)


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Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • Gianlorenzo Dionigi
    • 1
    Email author
  • Gregory W. Randolph
    • 2
    • 3
    • 4
  • Per Mattsson
    • 5
  1. 1.1st Division of Surgery, Department of Surgical Sciences and Human MorphologyUniversity of InsubriaVareseItaly
  2. 2.The Claire and John Bertucci Endowed Chair in Thyroid Surgery OncologyHarvard Medical SchoolBostonUSA
  3. 3.Division of Thyroid and Parathyroid Endocrine SurgeryDepartment of Otolaryngology—Head and Neck Surgery, Massachusetts Eye and Ear InfirmaryBostonUSA
  4. 4.Department of Surgery, Endocrine Surgery ServiceMassachusetts General HospitalBostonUSA
  5. 5.Department of Endocrine/Sarcoma Surgery/Institution of Clinical NeuroscienceKarolinska University Hospital/Karolinska InstitutetStockholmSweden

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