Monitoring the Laryngeal Nerves During Thyroidectomy. Initial 115 Cases Experience

Area of Science:

• Otorhinolaryngology
• Surgical Anatomy
• Neurosurgery

Background:

• Laryngeal nerve injury is a severe complication of thyroidectomy.
• Recurrent laryngeal nerve (RLN) visualization is standard, but anatomical variations pose challenges.
• Intraoperative neuro monitoring (IONM) is an emerging tool for nerve identification.

Purpose of the Study:

• To assess traditional landmarks for RLN identification.
• To evaluate high-risk anatomical situations during thyroidectomy.
• To present initial experience with IONM for RLN monitoring.

Main Methods:

• Retrospective analysis of 222 thyroidectomy cases.
• Identification of Zuckerkandl tubercle and RLN position relative to it.
• Application and analysis of IONM data for RLN integrity.

Main Results:

• Zuckerkandl tubercle identified in 72.97% of cases, aiding RLN localization.
• Non-recurrent laryngeal nerves found in 2 cases (right side).
• Extralaryngeal branching of RLN occurred in 23.8%, with the anterior branch carrying motor fibers.
• IONM confirmed RLN integrity in 96.84% of visually identified nerves, with few false negatives.

Conclusions:

• The Zuckerkandl tubercle is a reliable landmark for RLN identification.
• Extralaryngeal branching is common and requires careful surgical attention.
• IONM is a safe and effective tool for confirming RLN integrity during thyroidectomy.
• Further studies are needed to confirm IONM's impact on reducing iatrogenic RLN injury.