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Vol. 63. Issue 5.
Pages 355-363 (September - October 2012)
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Vol. 63. Issue 5.
Pages 355-363 (September - October 2012)
Original article
DOI: 10.1016/j.otoeng.2012.09.007
Usefulness of Neuromonitoring in Thyroid Surgery
Utilidad de la neuromonitorización en cirugía tiroidea
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José Luis Pardal-Refoyo
Sección de Cirugía Tiroidea y Paratiroidea, Servicio de Otorrinolaringología, Hospital Virgen de La Concha, Zamora, Spain
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Tables (5)
Table 1. Neuromonitoring in Thyroid Surgery. Sample Distribution.
Table 2. Neuromonitoring in Thyroid Surgery. Interpretation of the Signal.
Table 3. Neuromonitoring in Thyroid Surgery. Incidences During Neuromonitoring.
Table 4. Neuromonitoring in Thyroid Surgery. Location and Identification of Recurrent Laryngeal Nerve.
Table 5. Validity of Neuromonitoring.
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Abstract
Introduction

Identifying the recurrent laryngeal nerve is the gold standard for reducing injury in thyroidectomy.

Objective

To evaluate the usefulness of neuromonitoring in identifying the recurrent laryngeal nerve.

Methods

This was a study of 259 recurrent laryngeal nerves at risk during thyroidectomy performed with neuromonitoring (group A: 129 nerves) and without neuromonitoring (control group B: 130 nerves).

Results

The percentage of visually unidentified nerves was 18% in group A and 20% in group B, with no statistical difference. From the moment of non-identification, identification with neuromonitoring was achieved in group A in 100% of cases. The difference was statistically significant. The positive and negative predictive values of neuromonitoring were 100%.

Conclusions

Neuromonitoring helps to identify the recurrent laryngeal nerve and increases the security of the surgeon in the technique. It is advisable to perform neuromonitoring routinely in thyroid surgery.

Keywords:
Thyroid
Thyroidectomy
Surgery
Recurrent laryngeal nerve
Intraoperative nerve monitoring
Complications
Vocal cord
Harmonic
Resumen
Introducción

La identificación del nervio laríngeo recurrente es el patrón de referencia para reducir su lesión en la tiroidectomía.

Objetivo

Evaluar la utilidad de la neuromonitorización en la identificación del nervio laríngeo recurrente.

Métodos

Estudio de 259 nervios laríngeos recurrentes en riesgo durante la tiroidectomía realizada con neuromonitorización (grupo A: 129 nervios), y sin neuromonitorización (grupo B de control: 130 nervios).

Resultados

El porcentaje de nervios no identificados visualmente es del 18% en el grupo A y del 20% en el grupo B, sin diferencia estadística. A partir del momento de no identificación, en el grupo A, con neuromonitorización se consigue la identificación en el 100% de los casos. La diferencia es estadísticamente significativa. El valor predictivo positivo y negativo de la neuromonitorización es del 100%.

Conclusiones

La neuromonitorización ayuda en la identificación del nervio laríngeo recurrente, incrementa la seguridad del cirujano en la técnica y es recomendable realizarla sistemáticamente en la cirugía tiroidea.

Palabras clave:
Tiroides
Tiroidectomía
Cirugía
Nervio laríngeo recurrente
Neuromonitorización intraoperatoria
Complicaciones
Cuerda vocal
Armónico

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