The advantages and disadvantages of nerve monitoring during thyroid surgery in childhood.

BACKGROUND

Intraoperative damage of the recurrent laryngeal nerve (RLN) and the external branch of the superior laryngeal nerve (EBSLN) are common and cause complications in thyroid surgery. The method of intraoperative electrophysiological neuromonitoring (IONM) of the RLN and the EBSLN has been used in adults for several years. The question is whether IONM can be used in paediatric surgery for the identification and functional control of the RLN and the EBSLN, and what the advantages and disadvantages of using it are.

METHODS

Surgical treatment of benign (n = 9) and malign (n = 2) thyroid diseases was carried out in eleven children (median age: 13 years) with a total of 18 nerves at risk (NAR). The function of the vocal cord was monitored in all children before and after surgery. Intraoperative identification and functional control of RLN and EBSLN was performed using the Neurosign 100. All results before and after resection of the thyroid gland were documented.

RESULTS

A clear and reliable identification of the RLN and the EBSLN was possible in all cases. All NAR showed a constant physiological nerve signal before and after surgical resection of the thyroid gland. However, in one young patient the postoperative examination of the vocal cord revealed a partial paralysis on the left side after thyroidectomy, despite the constant intraoperative signal of the RLN. After a period of six months, normal functioning had resumed.

CONCLUSION

The IONM of both RLN and EBSLN in adult surgery could be used successfully in paediatric surgery. In this study a clear and positive identification of both nerves was possible in all patients. Therefore the IONM of the RLN and EBSLN could develop into a successful and easy method for the prevention of intraoperative nerve damage during thyroid surgery in childhood and young adolescence. Assuming that a constant IONM signal represents a normal vocal cord, our evaluation showed that there is a small percentage of false negative and positive results.