Clinical Professor, Department of Otolaryngology, SUNY Downstate Medical Center, Brooklyn, NY 11203, USAUnited States
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Interventions during surgical procedures are hotly debated for many years. Interven-tions of benefit to patients stand the test of time and become accepted by the surgical communi-ty at large after a period of several years. The benefit conferred by the intervention is inversely proportional to the time taken for acceptance by the surgical community.
OTOLARYNGOLOGY ISSN 2470-4059 http://dx.doi.org/10.17140/OTLOJ-1-e002 Open Journal Editorial In Support of Nerve Monitoring During * *Corresponding author Thyroid Surgery Krishnamurthi Sundaram, MD, FACS Clinical Professor Department of Otolaryngology * SUNY Downstate Medical Center Krishnamurthi Sundaram Brooklyn, NY 11203, USA Tel. 718-270-1638 Clinical Professor, Department of Otolaryngology, SUNY Downstate Medical Center, Fax: 718-270-3924 Brooklyn, NY 11203, USA E-mail: krishsun@aol.com Volume 1 : Issue 1 Interventions during surgical procedures are hotly debated for many years. Interven- Article Ref. #: 1000OTLOJ1e002 tions of benefit to patients stand the test of time and become accepted by the surgical communi- ty at large after a period of several years. The benefit conferred by the intervention is inversely proportional to the time taken for acceptance by the surgical community. After acceptance by Article History th the surgical community the intervention becomes accepted as the standard of care. In Otolaryn- Received: October 12 , 2015 th gology, laryngeal nerve monitoring during thyroid surgery and image guided sinus surgery are Accepted: October 12 , 2015 th two such interventions.
Published: October 12 , 2015 The benefits of Laryngeal Nerve Monitoring (LNM) in thyroid surgery are in the de- Citation bate stage. As a surgeon who uses LNM in every thyroidectomy and parathyroidectomy over Sundaram K. In support of nerve the last eight years, I have greatly benefitted from it. My patient outcomes have improved with monitoring during thyroid surgery.
regard to nerve function both temporary and permanent. I would like to take this opportunity to Otolaryngol Open J. 2015; 1(1): e3- e4. doi: 10.17140/OTLOJ-1-e002 write in support of the technique.
The technique is described by Randolph GW, Dralle H, with the International Intra- operative Monitoring Study Group.1 Largely because of its ease of use and reliability, I have been using an endotracheal tube with surface Electromyography electrodes (EMG-ET), which directly contact the vocal cords.
Dralle has calculated that a randomized controlled trial will need at least 40,000 pa- tients per arm for adequate statistical power and may not be feasible to study these techniques.1 So, we looked at 119 consecutive thyroidectomies/parathyroidectomies where residents were involved and I was the attending surgeon, to study the incidence of Recurrent Laryngeal Nerve (RLN) paralysis.2 One patient developed a permanent vocal fold paralysis (1/119 or 0.84%). Another patient had a vocal fold paresis which recovered in 4 weeks (1/119 or 0.84%). This is an acceptable morbidity rate.
Anatomic variations are seen in the Laryngeal nerves which cannot be predicted pre- 3-5 6 operatively.3-5 LNM aids in these cases. LNM has its pitfalls and a learning curve.6 Improper positioning of the EMG-ET can give rise to complications7 which are treatable.
We performed a survey of the American Head and Neck Society (AHNS) members and found the following: The response rate was 18%. The most commonly cited reasons for using LNM were medical-legal protection and increased confidence. Younger surgeons were more likely to use LNM.8 The results suggest that LNM use has become more widespread and Copyright may eventually become routine practice.
©2015 Sundaram K. This is an open access article distributed un- REFERENCES der the Creative Commons Attribu- tion 4.0 International License (CC 1. Randolph GW, Dralle H, Abdullah H, et al. Electrophysiologic recurrent laryngeal nerve BY 4.0), which permits unrestricted use, distribution, and reproduction monitoring during thyroid and parathyroid surgery: International standards guideline state- in any medium, provided the origi- ment. Laryngoscope. 2011; 121(Suppl 1): S1-S16. doi: 10.1002/lary.21119 nal work is properly cited.
OTOLARYNGOLOGY ISSN 2470-4059 http://dx.doi.org/10.17140/OTLOJ-1-e002 Open Journal 2. Aynehchi BB, Sundaram K, Aynehchi BB. Teaching recurrent laryngeal nerve dissection to residents in head and neck endocrine surgery. Int J Head and Neck Surg. 2012; 3(1): 5-7. doi: 10.5005/jp-journals-10001-1080 3. Cernea CR, Ferraz AR, Nishio S, et al. Surgical anatomy of the external branch of the superior laryngeal nerve. Head Neck. 1992: 14(5): 380-383.
4. Randolph GW. Surgical anatomy and Monitoring of the recurrent laryngeal nerve. In: Randolph GW, ed. Chapter 33. 2013: 306- 340.
5. Yalcin B, Tugcu H, Canturk N, et al. Laryngeal branching pattern of the inferior laryngeal nerve, before entering the larynx. Surg Radiol Anat. 2006; 28: 339-342. doi: 10.1007/s00276-006-0118-8 6. Snyder SK, Hendricks JC. Intraoperative neurophysiology testing of the recurrent laryngeal nerve: Plaudits and pitfalls. Surgery. 2005; 138: 1183-1192. doi: 10.1016/j.surg.2005.08.027 7. Sundaram K. Prevention of main-stem bronchus intubation with the EMG endotracheal tube. Letters to the editor. Otol Head Neck Surg. 2010; 142: 152. doi: 10.1016/j.otohns.2009.10.012 8. Singer MC, Rosenfeld RM, Sundaram K.
Laryngeal nerve monitoring: current utilization among head and neck surgeons. Otol Head Neck Surg. 2012; 146(6): 895-899. doi: 10.1177/0194599812439278