Puram Sidharth V, Chow Harold, Wu Che-Wei, Heaton James T, Kamani Dipti, Gorti Gautham, Chiang Feng Yu, Dionigi Gianlorenzo, Barczynski Marcin, Schneider Rick, Dralle Henning, Lorenz Kerstin, Randolph Gregory W
Division of Thyroid and Parathyroid Surgery, Department of Otolaryngology, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston, Massachusetts, U.S.A.
Department of Otorhinolaryngology-Head and Neck Surgery, Kaohsiung Medical University Hospital; Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
Laryngoscope. 2016 Dec;126(12):2744-2751. doi: 10.1002/lary.25967. Epub 2016 Apr 26.
OBJECTIVES/HYPOTHESIS: Injury to the recurrent laryngeal nerve (RLN) is a dreaded complication of endocrine surgery. Intraoperative neural monitoring (IONM) has been increasingly utilized to assess the functional status of the RLN. Although the posterior cricoarytenoid muscle (PCA) is innervated by the RLN as the abductor of the larynx, PCA electromyography (EMG) is infrequently recorded during IONM and PCA activity after RLN compressive injury remains poorly characterized.
Single-subject prospective animal study.
We employed a canine model to identify postcricoid EMG correlates of postoperative vocal cord paralysis (VCP). Postcricoid electrode recordings were obtained before and after compressive RLN injury associated with VCP.
Normative postcricoid recordings revealed mean amplitude of 1288 microvolt (μV) and latency of 8.2 millisecond (ms) with maximum (1 milliamp [mA]) vagal stimulation, and mean amplitude of 1807 μV and latency of 3.5 ms with maximum (1 mA) RLN stimulation. Following injury that was associated with VCP, there was 62.1% decrement in postcricoid EMG amplitude with maximum vagal stimulation and 80% decrement with maximum RLN stimulation. Threshold stimulation of the vagus increased by 23%, and there was a corresponding 42% decrease in amplitude. For RLN stimulation, latency increased by 17.3% following injury, whereas threshold stimulation increased by 61% with 35.5% decrement in EMG amplitude. Thus, if RLN amplitude decreases by ≥ 80%, with absolute amplitude of ≤ 300 μV or less and latency increase of ≥ 10%, RLN injury is likely associated with VCP.
Our results predict postoperative VCP based on postcricoid electromyographic IONM and may guide surgical decision making.
NA Laryngoscope, 126:2744-2751, 2016.
目的/假设：喉返神经（RLN）损伤是内分泌手术中令人恐惧的并发症。术中神经监测（IONM）已越来越多地用于评估RLN的功能状态。尽管环杓后肌（PCA）作为喉部外展肌由RLN支配，但在IONM期间很少记录PCA肌电图（EMG），并且RLN受压损伤后PCA的活动仍缺乏充分的特征描述。
单受试者前瞻性动物研究。
我们采用犬模型来确定环状软骨后EMG与术后声带麻痹（VCP）的相关性。在与VCP相关的RLN受压损伤前后获取环状软骨后电极记录。
正常的环状软骨后记录显示，最大（1毫安 [mA]）迷走神经刺激时平均振幅为1288微伏（μV），潜伏期为8.2毫秒（ms）；最大（1 mA）RLN刺激时平均振幅为1807 μV，潜伏期为3.5 ms。在与VCP相关的损伤后，最大迷走神经刺激时环状软骨后EMG振幅下降62.1%，最大RLN刺激时下降80%。迷走神经的阈值刺激增加了23%，相应地振幅下降了42%。对于RLN刺激，损伤后潜伏期增加了17.3%，而阈值刺激增加了61%，EMG振幅下降了35.5%。因此，如果RLN振幅下降≥80%，绝对振幅≤300 μV或更低，且潜伏期增加≥10%，则RLN损伤可能与VCP相关。
我们的结果基于环状软骨后肌电图IONM预测术后VCP，并可能指导手术决策。
NA 《喉镜》，126:2744 - 2751，2016年。
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