value of recurrent laryngeal nerve identification and stimulation by usig intraoperative disposable nerve stimulator during thyoid operation

ABSTRACT

Recurrent laryngeal nerve [RLN] iatrogenic injury is one of the most serious complications in thyroid surgery. Paralysis of vocal cords can repesents a srious complication inducing, when bilateral, serious functional sequelae such as phonatory, respiratory and psychological problems that limit working capacities and social relationships of patients. This work is to study the importance of searching, identification and exposure of the RLN surgically and confirming this by using a disposable nerve stimulator to avoid its injury.Design: prospective study. Patients and Records of forty patients who underwent thyroidectomy by the authers at several Hospitals were reviewed for RLN paralysis between January2001 and December 2003. Intraoperative determination of RLN function was evaluated with a disposable nerve stimulator [Xomed, Jacksonville, Florida] set at 0.5 milliamper [mA]. Without the use of neuromuscular blockade during anesthesia, RLN function was assessed by palpating of the cricoarytenoid joint and posterior cricoaryteniod muscle while the stimulus was applied directly to nerve after identificantion. Postoperative, assessment of RLN integrity was determined by using flexible nasolaryngoscopy 7 days after the procedure to visualize the vocal cord mobility. RLNs were identified and stimulated intraoperatively in all patients. Concerning the postoperative results, flexible nasolaryngoscopy was utilized in all patients one week after the procedure. All patients had bilateral mobile vocal cords after the first week postoperatively. Conclusions: The authors concluded that iatrogenic injury to the RLN or to its branches could be avoided by searching, identifying, and exposing the nerve itself and by following its course with care. In addition, using intraoperative disposable nerve stimulator is very helpful in confirming the location and function of the RLN