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Title
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Intra-operative vagal neuromonitoring predicts non-recurrent laryngeal nerves : technical notes and review of the recent literature
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Author
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Abstract
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| Background: During thyroid surgery, extreme caution must be taken not to harm the recurrent laryngeal nerve to avoid vocal cord palsy. A non-recurrent laryngeal nerve (NRLN) is a rare anatomical variation that is extremely vulnerable during thyroid surgery. Methods: Description of two NRLN during thyroid surgery discovered early by using continuous intra-operative vagal nerve neuromonitoring and review of the literature. Results: During thyroid surgery, we use continuous intra-operative vagal nerve neuromonitoring starting with checking vagal nerve signals. It is essential to start stimulation in the most proximal portion of the carotid sheath. An absent pre-dissection signal on the right vagal nerve with a positive signal on the left vagal nerve indicates a non-recurrent course of the right laryngeal nerve. Post-operatively computed tomography scan (CT-scan) was performed and showed an associated extra-anatomical course of the subclavian artery also known as an arteria lusoria. Conclusion: The NRLN is an important surgical challenge because unilateral palsy can lead to permanent hoarseness. This anomaly emphasizes the importance of a thorough surgical dissection and the use of intra-operative vagal nerve neuromonitoring. Our method of continuous intra-operative vagal nerve monitoring makes it possible to predict a non-recurrent laryngeal nerve in an early stage during surgery. |
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Language
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English
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Source (journal)
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Acta chirurgica Belgica. - Brussel, 1946 - 1996
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Publication
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Abingdon
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Taylor & francis ltd
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2021
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ISSN
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0001-5458
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DOI
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10.1080/00015458.2020.1722931
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Volume/pages
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121
:4
(2021)
, p. 248-253
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ISI
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000512887100001
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Pubmed ID
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31986987
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Full text (Publisher's DOI)
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