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Recurrent Laryngeal Nerve Injury in Thyroid Surgery with Intraoperative Nerve Monitoring

  • Emin Gürleyik
  • Günay Gürleyik
Chapter

Abstract

IONM assesses the motor function of the recurrent laryngeal nerve (RLN) while exposing the anatomical integrity, which does not always ensure the normal function. However, despite its advantages, IONM cannot always prevent injury to the nerve. Nevertheless, nerve monitoring can still play an important role in case of an inadvertent nerve injury. We present a case of an RLN injury in thyroid surgery performed under the guidance of IONM.

We planned for total thyroidectomy for the surgical treatment of papillary cancer under the guidance of IONM. We first dissected the right lobe harboring the malignant solid nodule. Pre-dissection sound signals (V1 and R1) after vagus nerve (VN) and RLN stimulations were obtained from the device while recording the wave amplitude. The right RLN was isolated and completely exposed. In the end, post-dissection stimulation (R2) of the anatomically intact RLN determined the loss of signal (LOS) without a recordable waveform amplitude. Post-dissection stimulation of the right VN confirmed the LOS, revealing the transient or permanent injury to the nerve. Electrophysiological monitoring of the RLN detected a segmental (type 1) injury. The resection of the left lobe was abandoned after right hemithyroidectomy. Postoperative laryngoscopy showed unilateral right VC palsy. The final pathological diagnosis was papillary thyroid cancer in the right lobe. The normal function of the right VC was recovered in the third postoperative month. Completion left lobe excision was performed under the guidance of IONM as a delayed procedure after 4 months of primary surgery. Postoperative laryngoscopy confirmed the normal function of both VCs.

IONM assesses and confirms the functional integrity of the laryngeal nerves. Intraoperative LOS indicates an injury to the nerve and the presence of palsy. In case of unfavorable complications, IONM detects the type of injury to the RLN. IONM establishes the outcome of the neural palsy, affects the surgical decision-making, and prevents the risk of bilateral palsy.

Keywords

Vocal cord palsy Staged thyroidectomy Nerve injury 

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  • Emin Gürleyik
    • 1
  • Günay Gürleyik
    • 2
  1. 1.Department of SurgeryDüzce UniversityDüzceTurkey
  2. 2.Department of SurgeryHaydarpaşa Numune Training and Research HospitalIstanbulTurkey

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