Archives of Head and Neck Surgery
Archives of Head and Neck Surgery
Original Article Thyroid diseases and tumors

Effectiveness of intraoperative neuromonitoring of the recurrent laryngeal nerve with intermittent vagal nerve stimulation

Marco Aurélio Vamondes Kulcsar, Felipe Toyama Aires, Danielli Matsuura, Lenine Garcia Brandão, Claudio Roberto Cernea

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Introduction: Vocal fold paralysis due to recurrent laryngeal nerve (RLN) injury during thyroidectomy occurs in 1-5% of patients, but it can reach up to 15% in reoperations. Intraoperative neuromonitoring (IONM) during thyroidectomy was first described in 1970, and has been widely used by surgeons. However, data on the IONM capacity to predict inferior laryngeal nerve function are still lacking. Objective: To evaluate the effectiveness of IONM of the RLN using intermittent stimulation of the vagus nerve during thyroidectomy to predict post-operative vocal fold function. Methods: Retrospective cohort analysis of 104 patients undergoing thyroidectomy with IONM of the RLN through intermittent vagal nerve stimulation. IONM response and vocal fold mobility were evaluated utilizing the McNemar’s test associated with the Kappa agreement coefficient. Results: The final response of RLN stimulation showed 69.23% sensitivity and 93.79% specificity (p=0.180). Conclusion: IONM of the RLN through intermittent vagal nerve stimulation during thyroidectomy is effective to predict post-operative vocal fold function.


intraoperative neuromonitoring; laryngoscopy; thyroidectomy.


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