The Function of Recurrent Laryngeal Nerve and Movement of Vocal Cords in Thyroid Surgery_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 ZHAOYi-shen , LIUXiao-li , WANGTie , XINJing-wei , ZHAOLi-na , LIJing-ting ,  SUNHui

Department of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Key Laboratory of Surgical Translational Medicine of Jilin Province, Thyroid Disease Multidisciplinary Treatment Center of Jilin Province, Changchun 130033, Jilin Province, China;

Corresponding?author：

SUNHui, Email: sunhui1229@163.com

Keywords：

Intraoperative neuromonitoring; Recurrent laryngeal nerve function; Vocal cord movement; Thyroid surgery; Recurrent laryngeal nerve injury

DOI：

10.7507/1007-9424.20150205

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To research the relevancy between the amplitudes of EMG signal of recurrent laryngeal nerve (RLN) during thyroidectemy with the movement of vocal cords after operation by applying the intraoperative neuromonitoring (IONM) and verify the proper warning criterion. Methods From April 2013 to October 2013, 130 patients (214 nerves at risk) underwent complex thyroidectomy with the application of IONM. According to the degree of amplitude changing on different sites of RLN (proximal site and distal site) before closing incision, all the patients were divided into 10 groups. Every patient's vocal cords movement after operation by laryngoscopy and simulated the neural function in real time were compared. Results Seven patients got abnormal movement of vocal cords, the corresponding amplitudes of the EMG signal of RLN were in the range between 0 to 50%, 1 case from Group 6 (40%≤Rp/Rd<50%), 1 case from Group 8 (20%≤Rp/Rd<30%), 1 case from Group 9 (10%≤Rp/Rd<20%), 4 cases from Group 10 (0≤Rp/Rd<10%), and there's no permanent RLN palsy. Conclusion The final amplitude of RLN decrease below 50%R1 would probably lead to vocal cords' abnormal movement, and when it decrease below 30%R1, the possibility of abnormal movement would increase; 50% decrease of EMG amplitude can be used as a warning criterion to prevent nerve function damage.

Citation： ZHAOYi-shen, LIUXiao-li, WANGTie, XINJing-wei, ZHAOLi-na, LIJing-ting, SUNHui. The Function of Recurrent Laryngeal Nerve and Movement of Vocal Cords in Thyroid Surgery. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2015, 22(7): 784-787. doi: 10.7507/1007-9424.20150205 Copy

1.	?孫輝, 侯信明, 付言濤, 等. 甲狀腺手術中喉返神經的顯露保護技巧. 中國地方病防治雜志, 2009, 37(6):469-471.
2.	孫輝, 劉曉莉. 甲狀腺手術中喉返神經和喉上神經的保護. 中國實用外科雜志, 2012, 32 (5):356-359.
3.	Gremillion G, Fatakia A, Dornelles A, et al. Intraoperative recurrent laryngeal nerve monitoring in thyroid surgery:is it worth the cost? Ochsner J, 2012, 12(4):363-366.
4.	Dionigi G, Bacuzzi A, Boni L, et al. Visualization versus neuromonitoring of recurrent laryngeal nerves during thyroidectomy:what about the costs? World J Surg, 2012, 36(4):748-754.
5.	孫輝. 中國醫師協會外科醫師分會甲狀腺外科醫師委員會. 甲狀腺及甲狀旁腺手術中神經電生理監測臨床指南(中國版). 中國實用外科雜志, 2013, 33(6):470-474.
6.	劉曉莉, 孫輝. 喉返神經監測技術原理與臨床應用. 中國實用外科雜志, 2012, 32(5):409-411.
7.	孫輝, 劉曉莉, 張大奇, 等. 甲狀腺手術中喉返神經保護及監測的臨床應用. 中國普外基礎與臨床雜志, 2010, 17(8):768-771.
8.	Randolph GW, Dralle H, International Intraoperative Monitoring Study Group, et al. Electrophysiologic recurrent laryngeal nerve monitoring during thyroid and parathyroid surgery:international standards guideline statement. Laryngoscope, 2011, 121 Suppl 1:S1-S16.
9.	Chiang FY, Lee KW, Chen HC, et al. Standardization of intraoperative neuromonitoring of recurrent laryngeal nerve in thyroid operation. World J Surg, 2010, 34(2):223-229.
10.	Barczyński M, Konturek A, Stopa M, et al. Clinical value of intraoperative neuromonitoring of the recurrent laryngeal nerves in improving outcomes of surgery for well-differentiated thyroid cancer. Pol Przegl Chir, 2011, 83(4):196-203.
11.	Duclos A, Lifante JC, Ducarroz S, et al. Influence of intraoperative neuromonitoring on surgeons' technique during thyroidectomy. World J Surg, 2011, 35(4):773-778.
12.	劉春萍, 黃韜. 甲狀腺手術喉返神經損傷的原因及處理探討. 中國普外基礎與臨床雜志, 2008, 15(5):314-317.
13.	魏濤, 李志輝, 朱精強. 喉返神經探測儀實時監測在再次甲狀腺手術中的應用. 中國普外基礎與臨床雜志, 2010, 17(8):772-774.
14.	申曦, 李曉毅, 劉躍武, 等. 非返性喉返神經的解剖特點及術中損傷的預防. 中國普外基礎與臨床雜志, 2013, 20(1):71-76.
15.	Chuang YC, Huang SM. Protective effect of intraoperative nerve monitoring against recurrent laryngeal nerve injury during re-exploration of the thyroid. World J Surg Oncol, 2013, 11(1):94.
16.	周龍翔, 俞冬, 徐軍, 等. 采用精細化被膜解剖+喉返神經顯露法行甲狀腺腺葉切除452例臨床分析. 中國普外基礎與臨床雜志, 2013, 20(6):638-642.
17.	秦堅, 徐曉波, 周致圓, 等. 甲狀腺手術方式和喉返神經損傷的關系. 中國普外基礎與臨床雜志, 2014, 21(9):1149-1151.
18.	趙詣深. 甲狀腺手術中喉返神經損傷機制及神經監測技術的應用研究. 長春:吉林大學,2014.
19.	Phelan E, Schneider R, Lorenz K, et al. Continuous vagal IONM prevents recurrent laryngeal nerve paralysis by revealing initial EMG changes of impending neuropraxic injury:a prospective, multicenter study. Laryngoscope, 2014, 124(6):1498-1505.
20.	Hayward NJ, Grodski S, Yeung M, et al. Recurrent laryngeal nerve injury in thyroid surgery:a review. ANZ J Surg, 2013, 83(1-2):15-21.
21.	孫輝, 劉曉莉, 付言濤, 等. 術中神經監測技術在復雜甲狀腺手術中的應用. 中國實用外科雜志, 2010, 30(1):66-68.
22.	Tsai CJ, Tseng KY, Wang FY, et al. Electromyographic endotracheal tube placement during thyroid surgery in neuromonitoring of recurrent laryngeal nerve. Kaohsiung J Med Sci, 2011, 27(3):96-101.
23.	Friedrich C, Ulmer C, Rieber F, et al. Safety analysis of vagal nerve stimulation for continuous nerve monitoring during thyroid surgery. Laryngoscope, 2012, 122(9):1979-1987.
24.	Schneider R, Randolph GW, Sekulla C, et al. Continuous intraoperative vagus nerve stimulation for identification of imminent recurrent laryngeal nerve injury. Head Neck, 2013, 35(11):1591-1598.
25.	Wu CW, Dionigi G, Chiang FY, et al. Intraoperative neuromonitoring for the early detection and prevention of RLN traction injury in thyroid surgery:a porcine model. Surergy, 2014, 155(2):329-339.

1. ?孫輝, 侯信明, 付言濤, 等. 甲狀腺手術中喉返神經的顯露保護技巧. 中國地方病防治雜志, 2009, 37(6):469-471.
2. 孫輝, 劉曉莉. 甲狀腺手術中喉返神經和喉上神經的保護. 中國實用外科雜志, 2012, 32 (5):356-359.
3. Gremillion G, Fatakia A, Dornelles A, et al. Intraoperative recurrent laryngeal nerve monitoring in thyroid surgery:is it worth the cost? Ochsner J, 2012, 12(4):363-366.
4. Dionigi G, Bacuzzi A, Boni L, et al. Visualization versus neuromonitoring of recurrent laryngeal nerves during thyroidectomy:what about the costs? World J Surg, 2012, 36(4):748-754.
5. 孫輝. 中國醫師協會外科醫師分會甲狀腺外科醫師委員會. 甲狀腺及甲狀旁腺手術中神經電生理監測臨床指南(中國版). 中國實用外科雜志, 2013, 33(6):470-474.
6. 劉曉莉, 孫輝. 喉返神經監測技術原理與臨床應用. 中國實用外科雜志, 2012, 32(5):409-411.
7. 孫輝, 劉曉莉, 張大奇, 等. 甲狀腺手術中喉返神經保護及監測的臨床應用. 中國普外基礎與臨床雜志, 2010, 17(8):768-771.
8. Randolph GW, Dralle H, International Intraoperative Monitoring Study Group, et al. Electrophysiologic recurrent laryngeal nerve monitoring during thyroid and parathyroid surgery:international standards guideline statement. Laryngoscope, 2011, 121 Suppl 1:S1-S16.
9. Chiang FY, Lee KW, Chen HC, et al. Standardization of intraoperative neuromonitoring of recurrent laryngeal nerve in thyroid operation. World J Surg, 2010, 34(2):223-229.
10. Barczyński M, Konturek A, Stopa M, et al. Clinical value of intraoperative neuromonitoring of the recurrent laryngeal nerves in improving outcomes of surgery for well-differentiated thyroid cancer. Pol Przegl Chir, 2011, 83(4):196-203.
11. Duclos A, Lifante JC, Ducarroz S, et al. Influence of intraoperative neuromonitoring on surgeons' technique during thyroidectomy. World J Surg, 2011, 35(4):773-778.
12. 劉春萍, 黃韜. 甲狀腺手術喉返神經損傷的原因及處理探討. 中國普外基礎與臨床雜志, 2008, 15(5):314-317.
13. 魏濤, 李志輝, 朱精強. 喉返神經探測儀實時監測在再次甲狀腺手術中的應用. 中國普外基礎與臨床雜志, 2010, 17(8):772-774.
14. 申曦, 李曉毅, 劉躍武, 等. 非返性喉返神經的解剖特點及術中損傷的預防. 中國普外基礎與臨床雜志, 2013, 20(1):71-76.
15. Chuang YC, Huang SM. Protective effect of intraoperative nerve monitoring against recurrent laryngeal nerve injury during re-exploration of the thyroid. World J Surg Oncol, 2013, 11(1):94.
16. 周龍翔, 俞冬, 徐軍, 等. 采用精細化被膜解剖+喉返神經顯露法行甲狀腺腺葉切除452例臨床分析. 中國普外基礎與臨床雜志, 2013, 20(6):638-642.
17. 秦堅, 徐曉波, 周致圓, 等. 甲狀腺手術方式和喉返神經損傷的關系. 中國普外基礎與臨床雜志, 2014, 21(9):1149-1151.
18. 趙詣深. 甲狀腺手術中喉返神經損傷機制及神經監測技術的應用研究. 長春:吉林大學,2014.
19. Phelan E, Schneider R, Lorenz K, et al. Continuous vagal IONM prevents recurrent laryngeal nerve paralysis by revealing initial EMG changes of impending neuropraxic injury:a prospective, multicenter study. Laryngoscope, 2014, 124(6):1498-1505.
20. Hayward NJ, Grodski S, Yeung M, et al. Recurrent laryngeal nerve injury in thyroid surgery:a review. ANZ J Surg, 2013, 83(1-2):15-21.
21. 孫輝, 劉曉莉, 付言濤, 等. 術中神經監測技術在復雜甲狀腺手術中的應用. 中國實用外科雜志, 2010, 30(1):66-68.
22. Tsai CJ, Tseng KY, Wang FY, et al. Electromyographic endotracheal tube placement during thyroid surgery in neuromonitoring of recurrent laryngeal nerve. Kaohsiung J Med Sci, 2011, 27(3):96-101.
23. Friedrich C, Ulmer C, Rieber F, et al. Safety analysis of vagal nerve stimulation for continuous nerve monitoring during thyroid surgery. Laryngoscope, 2012, 122(9):1979-1987.
24. Schneider R, Randolph GW, Sekulla C, et al. Continuous intraoperative vagus nerve stimulation for identification of imminent recurrent laryngeal nerve injury. Head Neck, 2013, 35(11):1591-1598.
25. Wu CW, Dionigi G, Chiang FY, et al. Intraoperative neuromonitoring for the early detection and prevention of RLN traction injury in thyroid surgery:a porcine model. Surergy, 2014, 155(2):329-339.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

The Function of Recurrent Laryngeal Nerve and Movement of Vocal Cords in Thyroid Surgery

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content