Vocal cord paralysis predicted by neural monitoring electrophysiologic changes with recurrent laryngeal nerve compressive neuropraxic injury in a canine model. (8th September 2015)

• Record Type: Journal Article
• Authors: Puram, Sidharth V.; Chow, Harold; Wu, Che‐Wei; Heaton, James T.; Kamani, Dipti; Gorti, Gautham; Chiang, Feng Yu; Dionigi, Gianlorenzo; Barczyński, Marcin; Schneider, Rick; Dralle, Henning; Lorenz, Kerstin; Randolph, Gregory W.
• Is Part Of: Head & neck. Volume 38(2016)Supplement 1
• Page Start: E1341
• Page End: E1350
• Publication Date: 2015-09-08
• Subjects: recurrent laryngeal nerve -- injury -- endocrine -- thyroid surgery -- vocal cord palsy -- intraoperative nerve monitoring (IONM); Head -- Diseases -- Periodicals; Neck -- Diseases -- Periodicals; Head -- Periodicals; Neck -- Periodicals; Face -- Periodicals; 617.51059
• DOI: 10.1002/hed.24225
• Languages: English
• ISSNs: 1043-3074

Abstract

Abstract: Background: Recurrent laryngeal nerve (RLN) injury is a known complication of thyroid/parathyroid surgery. Intraoperative nerve monitoring (IONM) has been used to gain more information regarding the functional status of the RLN intraoperatively; however, the electromyography (EMG) parameters of RLN after nontransection neuropraxic compressive injury remain unknown. Methods: We developed a canine model to identify IONM EMG correlates of postoperative vocal cord paralysis (VCP) using a standardized method to simulate surgical RLN compression sufficient to cause VCP. Results: Compression nerve injury decreased EMG amplitude and increased EMG latency, with a 60% increase in RLN threshold stimulation compared to preinjury values. If RLN amplitude decreases by 80% with an absolute amplitude of 300 μV or less in combination with a latency increase of 10% or more, then nerve injury and associated VCP is likely. Conclusion: These results may help surgeons to prognosticate postoperative neural function and intraoperative decision‐making regarding contralateral thyroid surgery. © 2015 Wiley Periodicals, Inc. Head Neck 38 : E1341–E1350, 2016