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Neuromonitoring of the external branch of the superior laryngeal nerve during minimally invasive thyroid surgery under local anesthesia: A prospective study of 10 patients
Author(s) -
Inabnet William B.,
Murry Thomas,
Dhiman Shamly,
Aviv Jonathan,
Lifante JeanChristophe
Publication year - 2009
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.20071
Subject(s) - medicine , superior laryngeal nerve , thyroidectomy , anesthesia , recurrent laryngeal nerve , surgery , laryngoscopy , perioperative , thyroid , prospective cohort study , local anesthesia , larynx , intubation
Objectives/Hypothesis: Avoiding alterations of the voice is a challenge in thyroid surgery. Identification and preservation of the external branch of the superior laryngeal nerve (EBSLN) is paramount for normal vocal function preservation after thyroidectomy. Conventional nerve monitoring requires a general anesthesia and placement of a special endotracheal tube equipped with electrodes to evoke the laryngeal nerves. This study aims to assess feasibility and efficacy of a novel technique of neuromonitoring of the EBSLN under local anesthesia during minimally invasive thyroidectomy. Study Design; Prospective Study: This study is a prospective trial to evaluate the efficacy of nerve monitoring of the EBSLN during minimally invasive thyroidectomy under local anesthesia. Patient self‐assessment of changes in perceived voice severity prior to and 3 weeks after surgery was assessed with the Voice Handicap Index‐10 (VHI‐10). Results: Thyroidectomy was successfully completed under local anesthesia in all cases. The recurrent laryngeal nerve(s) was identified and preserved in each patient as demonstrated by normal perioperative transnasal flexible laryngoscopy. A total of 15 EBSLNs were at risk, but only 8 EBSLNs (53%) were definitively identified. Neuromonitoring demonstrated preservation of the EBSLN in 100% of cases. The analysis of the results of the VHI‐10 questionnaire before and 3 weeks after surgery indicated no significant change in patients' perception of voice severity. Conclusion: Monitoring of the EBSLN during thyroidectomy under local anesthesia is a feasible alternative to conventional nerve monitoring under general anesthesia. This technique may be useful for the preservation of voice quality during a minimally invasive thyroidectomy under local anesthesia. Laryngoscope, 2009