INTRAOPERATIVE NEUROMONITORING IN LARYNGEAL NERVE INJURIES PREVENTION
DOI:
https://doi.org/10.11603/1811-2471.2022.v.i2.13148Keywords:
thyroid gland, rotary nerve, violation of phonation, traumaAbstract
SUMMARY. The aim – to analyze the results of the application of intraoperative neuromonitoring of the laryngeal nerves in thyroid surgeries.
Material and Methods. A comparative assessment of the number and nature of laryngeal nerve injuries and phonation disorders caused by them after surgical treatment of goiter patients was performed on our own clinical material. Group 1 consisted of 208 patients who underwent only visual identification of the recurrent laryngeal nerves during thyroid surgery. In order to prevent injuries of the external branch of the superior laryngeal nerve, the method of gradual and separate ligation of the superior thyroid artery and its branches on the capsule of the thyroid was used. Group 2 included 201 patients who underwent surgery using intraoperative neuromonitoring of the recurrent laryngeal nerve and the external branch of the superior laryngeal nerve by the author's method.
Results. Peculiarities of monitoring the recurrent nerves and the external branch of the superior laryngeal nerve and options for evaluating its results are presented. Analysis of the number of injuries based on our own clinical material showed that in the group of patients who used intraoperative neuromonitoring, they were almost 2.5 times less than in the group of patients who underwent surgery for visual identification of nerves. It is established that the use of intraoperative neuromonitoring allows increasing the number of identified laryngeal nerves and reducing the frequency of their injuries, laryngeal paresis and phonation disorders. It is emphasized that intraoperative neuromonitoring does not replace the visual identification of laryngeal nerves, but complements it. In complex cases, its results are crucial for making a technical decision during the surgery.
Conclusions. In different clinical forms of goiter, the topographic and anatomical proportions of the organs of the anterior triangle are changed compared to normal anatomy. Such clinical situations create conditions for intraoperative injuries of the rotary and external branches of the superior nerves of the larynx and disorders of its phonatory function. To prevent intraoperative injuries of the laryngeal nerves, we consider it appropriate to perform surgical treatment of goiter with the use of intraoperative neuromonitoring.
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