Thong Gerard, Brophy Catherine, Sheahan Patrick
Department of Otolaryngology - Head and Neck Surgery, South Infirmary Victoria University Hospital, Cork, Ireland.
Ear Nose Throat and Oral (ENTO) Research Institute, University College Cork, Cork, Ireland.
Head Neck. 2021 Jan;43(1):7-14. doi: 10.1002/hed.26440. Epub 2020 Aug 30.
The benefits of intraoperative neural monitoring (IONM) of recurrent laryngeal nerve (RLN) on post-thyroidectomy vocal cord palsy (VCP) rates are contentious. We wished to study impact of IONM on permanent VCP after thyroidectomy.
Retrospective review of prospective series of 1011 (1539 nerves-at-risk) patients undergoing thyroidectomy without (418, group 1) and with (583, group 2) IONM.
There were three recognized nerve injuries in group 1, vs one in group 2 (P = .3). There were no differences in overall VCP rates. However, patients in group 2 with immediate postoperative VCP had higher likelihood of full recovery than patients in group 1 (55 of 56 vs 23 of 29 patients, P = .01), and lower incidence of total permanent VCP (2 of 917 vs 9 of 647 patients, P = .01).
Among patients with immediate postoperative VCP after thyroidectomy, IONM is associated with a higher likelihood of regaining normal vocal function. This may be related to better identification of RLN branching in IONM cases.
术中喉返神经（RLN）监测（IONM）对甲状腺切除术后声带麻痹（VCP）发生率的益处存在争议。我们希望研究IONM对甲状腺切除术后永久性VCP的影响。
对1011例（1539条有风险神经）接受甲状腺切除术的患者进行回顾性研究，其中418例（第1组）未进行IONM，583例（第2组）进行了IONM。
第1组有3例公认的神经损伤，第2组有1例（P = 0.3）。总体VCP发生率无差异。然而，术后即刻发生VCP的第2组患者完全恢复的可能性高于第1组患者（56例中的55例对29例中的23例，P = 0.01），且永久性VCP的总发生率较低（917例中的2例对647例中的9例，P = 0.01）。
在甲状腺切除术后即刻发生VCP的患者中，IONM与恢复正常发声功能的可能性较高相关。这可能与IONM病例中对RLN分支的更好识别有关。
