Deniwar Ahmed, Kandil Emad, Randolph Gregory
1 Department of Surgery, School of Medicine, Tulane University, New Orleans, USA ; 2 Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, USA.
Gland Surg. 2015 Oct;4(5):368-75. doi: 10.3978/j.issn.2227-684X.2015.04.04.
Recurrent laryngeal nerve (RLN) injury is one of the most common complications of thyroid surgery. RLN injury can cause vocal cord paralysis, affecting the patient's voice and the quality of life. Injury of the external branch of the superior laryngeal nerve (EBSLN) can cause cricothyroid muscle denervation affecting high vocal tones. Thus, securing the laryngeal nerves in these surgeries is of utmost importance. Visual identification of the nerves has long been the standard method for this precaution. Intraoperative neuromonitoring (IONM) has been introduced as a novel technology to improve the protection of the laryngeal nerves and reduce the rate of RLN injury. The aim of this article is to provide a brief description of the technique and review the literature to illustrate the value of IONM. IONM can provide early identification of anatomical variations and unusual nerve routes, which carry a higher risk of injury if not detected. IONM helps in prognosticating postoperative nerve function. Moreover, by detecting nerve injury intraoperatively, it aids in staging bilateral surgeries to avoid bilateral vocal cord paralysis and tracheostomy. The article will discuss the value of continuous IONM (C-IOMN) that may prevent nerve injury by detecting EMG waveform changes indicating impending nerve injury. Herein, we are also discussing anatomy of laryngeal nerves and aspects of its injury.
喉返神经（RLN）损伤是甲状腺手术最常见的并发症之一。喉返神经损伤可导致声带麻痹，影响患者的嗓音和生活质量。喉上神经外支（EBSLN）损伤可导致环甲肌失神经支配，影响高音调。因此，在这些手术中保护喉神经至关重要。长期以来，直视下识别神经一直是这种预防措施的标准方法。术中神经监测（IONM）作为一种新技术被引入，以改善喉神经的保护并降低喉返神经损伤率。本文旨在简要描述该技术并回顾文献以阐明术中神经监测的价值。术中神经监测可早期识别解剖变异和异常神经走行，如果未被发现，这些情况会带来更高的损伤风险。术中神经监测有助于预测术后神经功能。此外，通过术中检测神经损伤，它有助于安排双侧手术分期，以避免双侧声带麻痹和气管切开术。本文将讨论连续术中神经监测（C-IOMN）的价值，其可通过检测表明即将发生神经损伤的肌电图波形变化来预防神经损伤。在此，我们还将讨论喉神经的解剖结构及其损伤的相关方面。
