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：

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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.	孙辉, 侯信明, 付言涛, 等. 甲状腺手术中喉返神经的显露保护技巧. 中国地方病防治杂志, 2009, 37(6):469-471.
2.	孙辉, 刘晓莉. 甲状腺手术中喉返神经和喉上神经的保护. 中国实用外科杂志, 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.	孙辉. 中国医师协会外科医师分会甲状腺外科医师委员会. 甲状腺及甲状旁腺手术中神经电生理监测临床指南(中国版). 中国实用外科杂志, 2013, 33(6):470-474.
6.	刘晓莉, 孙辉. 喉返神经监测技术原理与临床应用. 中国实用外科杂志, 2012, 32(5):409-411.
7.	孙辉, 刘晓莉, 张大奇, 等. 甲状腺手术中喉返神经保护及监测的临床应用. 中国普外基础与临床杂志, 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.	刘春萍, 黄韬. 甲状腺手术喉返神经损伤的原因及处理探讨. 中国普外基础与临床杂志, 2008, 15(5):314-317.
13.	魏涛, 李志辉, 朱精强. 喉返神经探测仪实时监测在再次甲状腺手术中的应用. 中国普外基础与临床杂志, 2010, 17(8):772-774.
14.	申曦, 李晓毅, 刘跃武, 等. 非返性喉返神经的解剖特点及术中损伤的预防. 中国普外基础与临床杂志, 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.	周龙翔, 俞冬, 徐军, 等. 采用精细化被膜解剖+喉返神经显露法行甲状腺腺叶切除452例临床分析. 中国普外基础与临床杂志, 2013, 20(6):638-642.
17.	秦坚, 徐晓波, 周致圆, 等. 甲状腺手术方式和喉返神经损伤的关系. 中国普外基础与临床杂志, 2014, 21(9):1149-1151.
18.	赵诣深. 甲状腺手术中喉返神经损伤机制及神经监测技术的应用研究. 长春:吉林大学,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.	孙辉, 刘晓莉, 付言涛, 等. 术中神经监测技术在复杂甲状腺手术中的应用. 中国实用外科杂志, 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. 孙辉, 侯信明, 付言涛, 等. 甲状腺手术中喉返神经的显露保护技巧. 中国地方病防治杂志, 2009, 37(6):469-471.
2. 孙辉, 刘晓莉. 甲状腺手术中喉返神经和喉上神经的保护. 中国实用外科杂志, 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. 孙辉. 中国医师协会外科医师分会甲状腺外科医师委员会. 甲状腺及甲状旁腺手术中神经电生理监测临床指南(中国版). 中国实用外科杂志, 2013, 33(6):470-474.
6. 刘晓莉, 孙辉. 喉返神经监测技术原理与临床应用. 中国实用外科杂志, 2012, 32(5):409-411.
7. 孙辉, 刘晓莉, 张大奇, 等. 甲状腺手术中喉返神经保护及监测的临床应用. 中国普外基础与临床杂志, 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. 刘春萍, 黄韬. 甲状腺手术喉返神经损伤的原因及处理探讨. 中国普外基础与临床杂志, 2008, 15(5):314-317.
13. 魏涛, 李志辉, 朱精强. 喉返神经探测仪实时监测在再次甲状腺手术中的应用. 中国普外基础与临床杂志, 2010, 17(8):772-774.
14. 申曦, 李晓毅, 刘跃武, 等. 非返性喉返神经的解剖特点及术中损伤的预防. 中国普外基础与临床杂志, 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. 周龙翔, 俞冬, 徐军, 等. 采用精细化被膜解剖+喉返神经显露法行甲状腺腺叶切除452例临床分析. 中国普外基础与临床杂志, 2013, 20(6):638-642.
17. 秦坚, 徐晓波, 周致圆, 等. 甲状腺手术方式和喉返神经损伤的关系. 中国普外基础与临床杂志, 2014, 21(9):1149-1151.
18. 赵诣深. 甲状腺手术中喉返神经损伤机制及神经监测技术的应用研究. 长春:吉林大学,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. 孙辉, 刘晓莉, 付言涛, 等. 术中神经监测技术在复杂甲状腺手术中的应用. 中国实用外科杂志, 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

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