Filippo Carta, Valeria Marrosu, Valeria Pinto, Melania Tatti, Bontempi Mauro, Cinzia Mariani, Roberto Puxeddu
Unit of Otorhinolaryngology, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari University of Cagliari Cagliari Italy.
Clin Case Rep. 2022 Jul 25;10(7):e6137. doi: 10.1002/ccr3.6137. eCollection 2022 Jul.
The most common surgical risk after total thyroidectomy remains the recurrent laryngeal nerve (RLN) injury. Nowadays, the use of intraoperative nerve monitoring systems (IONM) such as the endotracheal tube-based is recommended to prevent RLN palsy. The use of the nerve monitoring is standardized by dedicated guidelines on the basis of a normal laryngeal anatomy, but previous head and neck surgical procedures may complicate its application. The authors herewith present a case of a non-conventional use of endotracheal tube-based IONM in a 72-year-old patient who underwent to a second-stage total thyroidectomy for metastatic papillary cancer incidentally detected after an open partial horizontal laryngectomy (OPHL) extended to one arytenoid (Type IIa + ary left) for squamous cell carcinoma. The use of the endotracheal tube-based IONM in such particular case where the function of the only remaining arytenoid had to be absolutely preserved was effective in avoiding the RLN accidental injury. The authors reviewed the non-traditional use of IONM and described the procedure in case of thyroidectomy in patients previously treated by OPHL.
全甲状腺切除术后最常见的手术风险仍然是喉返神经（RLN）损伤。如今，建议使用基于气管插管的术中神经监测系统（IONM）来预防RLN麻痹。基于正常的喉部解剖结构，通过专门的指南对神经监测的使用进行了规范，但既往的头颈外科手术可能会使其应用变得复杂。作者在此介绍了一例72岁患者非传统使用基于气管插管的IONM的病例，该患者因鳞状细胞癌行扩大至一侧杓状软骨（IIa型+左侧杓状软骨）的开放性部分水平喉切除术（OPHL）后偶然发现转移性乳头状癌，接受了二期全甲状腺切除术。在这种必须绝对保留唯一剩余杓状软骨功能的特殊情况下，使用基于气管插管的IONM有效地避免了RLN意外损伤。作者回顾了IONM的非传统使用情况，并描述了曾接受OPHL治疗的患者行甲状腺切除术时的操作过程。
