TY - JOUR
T1 - Prospective study of vocal fold function after loss of the neuromonitoring signal in thyroid surgery
T2 - The International Neural Monitoring Study Group's POLT study
AU - Schneider, Rick
AU - Randolph, Gregory
AU - Dionigi, Gianlorenzo
AU - Barczyński, Marcin
AU - Chiang, Feng Yu
AU - Triponez, Frédéric
AU - Vamvakidis, Kyriakos
AU - Brauckhoff, Katrin
AU - Musholt, Thomas J.
AU - Almquist, Martin
AU - Innaro, Nadia
AU - Jimenez-Garcia, Antonio
AU - Kraimps, Jean Louis
AU - Miyauchi, Akira
AU - Wojtczak, Beata
AU - Donatini, Gianluca
AU - Lombardi, Davide
AU - Müller, Uwe
AU - Pezzullo, Luciano
AU - Ratia, Tomas
AU - Van Slycke, Sam
AU - Nguyen Thanh, Phuong
AU - Lorenz, Kerstin
AU - Sekulla, Carsten
AU - Machens, Andreas
AU - Dralle, Henning
PY - 2016
Y1 - 2016
N2 - Objectives/Hypothesis: Intraoperative neuromonitoring identifies recurrent laryngeal nerve (RLN) injury and gives prognostic information regarding postoperative glottic function. Loss of the neuromonitoring signal (LOS) signifies segmental type 1 or global type 2 RLN injury. This study aimed at identifying risk factors for RLN injury and determining vocal fold (VF) function initially and 6 months after definitive LOS. Study Design: Prospective study encompassing 21 hospitals from 13 countries. Methods: Included in this study were patients with persistent intraoperative LOS. Results: At first postoperative laryngoscopy, early VF palsy was present in 94 of all 115 patients with LOS (81.7%): in 53 of 56 patients (94.6%) with type 1 injury and 41 of 59 patients (69.5%) with type 2 injury. In LOS type 1, women outnumbered men >5-fold. Traction produced LOS type 1 in 38 of 56 patients (67.9%) and LOS type 2 in 54 of 59 patients (91.5%). Course of the RLN posterior and/or anterior to the inferior thyroid artery, extralaryngeal branching, or tuberculum of Zuckerkandl did not increase VF palsy rates. Permanent VF palsy rates were also lower (P = .661) after LOS type 2 than after LOS type 1: 6.8% (four of 59 patients) versus 10.7% (six of 56 patients). Intraoperative administration of steroids did not diminish postoperative VF palsy rates. Conclusions: LOS type 1 entails more severe nerve damage than LOS type 2, affecting women disproportionately. Both LOS types, being primarily associated with traction injury, are unaffected by variant neck anatomy in expert hands and unresponsive to steroids.
AB - Objectives/Hypothesis: Intraoperative neuromonitoring identifies recurrent laryngeal nerve (RLN) injury and gives prognostic information regarding postoperative glottic function. Loss of the neuromonitoring signal (LOS) signifies segmental type 1 or global type 2 RLN injury. This study aimed at identifying risk factors for RLN injury and determining vocal fold (VF) function initially and 6 months after definitive LOS. Study Design: Prospective study encompassing 21 hospitals from 13 countries. Methods: Included in this study were patients with persistent intraoperative LOS. Results: At first postoperative laryngoscopy, early VF palsy was present in 94 of all 115 patients with LOS (81.7%): in 53 of 56 patients (94.6%) with type 1 injury and 41 of 59 patients (69.5%) with type 2 injury. In LOS type 1, women outnumbered men >5-fold. Traction produced LOS type 1 in 38 of 56 patients (67.9%) and LOS type 2 in 54 of 59 patients (91.5%). Course of the RLN posterior and/or anterior to the inferior thyroid artery, extralaryngeal branching, or tuberculum of Zuckerkandl did not increase VF palsy rates. Permanent VF palsy rates were also lower (P = .661) after LOS type 2 than after LOS type 1: 6.8% (four of 59 patients) versus 10.7% (six of 56 patients). Intraoperative administration of steroids did not diminish postoperative VF palsy rates. Conclusions: LOS type 1 entails more severe nerve damage than LOS type 2, affecting women disproportionately. Both LOS types, being primarily associated with traction injury, are unaffected by variant neck anatomy in expert hands and unresponsive to steroids.
KW - Intraoperative neuromonitoring
KW - Loss of signal
KW - Recurrent laryngeal nerve injury
KW - Transient and permanent vocal fold palsy
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U2 - 10.1002/lary.25807
DO - 10.1002/lary.25807
M3 - Article
AN - SCOPUS:84951060696
JO - Laryngoscope
JF - Laryngoscope
SN - 0023-852X
ER -