Uludag Mehmet, Yetkin Gurkan, Oran Ebru S, Aygun Nurcihan, Celayir Fevzi, Kartal Abdulcabbar, Isgor Adnan
, Atakent Mahallesi. 3. Etap. Manolya çıkmazı. No: 2E/1 Blok: D21/1 Daire:1, Kucukcekmece, 34303, Istanbul, Turkey.
Department of General Surgery, Sisli Etfal Training and Research Hospital, Halaskargazi caddesi Etfal sokak. Sisli, 34820, Istanbul, Turkey.
Surg Today. 2015 Nov;45(11):1436-41. doi: 10.1007/s00595-014-1039-5. Epub 2014 Oct 19.
Our aim was to evaluate the findings of intraoperative nerve monitoring (IONM) in two cases with preoperative vocal cord palsy. Case 1: a 61-year-old female with recurrent goiter underwent secondary thyroidectomy. The preoperative evaluation of the vocal cords revealed right vocal cord paralyses without atrophy. The right recurrent laryngeal nerve (RLN) was found to be anatomically intact and preserved. The electrical responses of the vocal cords were elicited via IONM. Case 2: a 26-year-old male, who presented with preoperative right vocal cord palsy with atrophy, underwent completion thyroidectomy secondary to papillary carcinoma. The right RLN was explored and found to be tied and interrupted. There was no signal from the RLN with IONM.
Even in cases with vocal cord palsy detected preoperatively, the nerve should be explored intraoperatively, and should never be sacrificed before an evaluation by nerve monitoring. A palsied RLN which has electrical activity should be protected to maintain the vocal cord's neural tone and to prevent its atrophy.
我们的目的是评估两例术前声带麻痹患者的术中神经监测（IONM）结果。病例1：一名61岁患有复发性甲状腺肿的女性接受了二次甲状腺切除术。术前对声带的评估显示右侧声带麻痹且无萎缩。发现右侧喉返神经（RLN）在解剖学上完整并得以保留。通过IONM引出了声带的电反应。病例2：一名26岁男性，术前表现为右侧声带麻痹伴萎缩，因乳头状癌接受了甲状腺全切术。探查右侧RLN发现其被结扎并中断。IONM未检测到来自RLN的信号。
即使在术前已检测到声带麻痹的病例中，术中也应探查神经，且在通过神经监测进行评估之前绝不应牺牲神经。具有电活动的麻痹性RLN应予以保护，以维持声带的神经张力并防止其萎缩。
