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Updated: Dec 15, 2025
Intra-Operative Neural Monitoring of Thyroid Surgery in a Porcine Model
Published on: February 11, 2019
Recurrent laryngeal nerve monitoring in children using cricothyroid membrane needle electrodes
1Otolaryngology-Head and Neck Surgery Department, Hôpital Robert Debré, 48, Boulevard Sérurier, 75019 Paris, France.
Insights
This study presents a safe and effective method for monitoring recurrent laryngeal nerves (RLN) during pediatric thyroid surgery. The technique ensures RLN identification and stimulation in children, reducing the risk of vocal cord paralysis.
Area of Science:
- Pediatric Surgery
- Otolaryngology
- Endocrinology
Background:
- Thyroid pathology is uncommon in children, but malignancy rates are higher than in adults.
- Pediatric thyroid surgery carries a significant risk of recurrent laryngeal nerve (RLN) palsies.
- Standard RLN monitoring techniques are often unsuitable for pediatric patients due to endotracheal tube size limitations.
Purpose of the Study:
- To introduce a simple, effective, and age-appropriate method for intraoperative recurrent laryngeal nerve monitoring in pediatric thyroid surgery.
- To address the challenges of RLN monitoring in children, particularly neonates.
Main Methods:
- A retrospective review of pediatric cases undergoing thyroid surgery with a novel RLN monitoring technique.
- Utilized double-needle electrodes (NIM 3.0) inserted via the cricothyroid membrane, maintaining a submucosal position near the vocal folds.
- Involved vagal nerve stimulation prior to RLN identification and periodic RLN stimulation checks throughout the surgery.
Main Results:
- The study included nine children, involving 15 nerves.
- Successful identification and stimulation of the recurrent laryngeal nerve were achieved in all cases.
- Post-operative voice quality was assessed as a key outcome.
Conclusions:
- The described electrode placement technique is safe and feasible for pediatric patients of all ages, including neonates.
- The electrode's position within the surgical field allows for easy monitoring and control.
- This method provides reliable intraoperative recurrent laryngeal nerve monitoring during pediatric thyroid surgery.
Aims:
Thyroid pathology is rare in children and the rate of malignancy is higher than in adults. Thyroid surgery in children is therefore particularly at risk of causing recurrent laryngeal nerve (RLN) palsies. The classical technique for monitoring the RLN is not always adapted to children due to the large size of the dedicated endotracheal tubes.
Material And Methods:
Double-needle electrodes (NIM 3.0) were placed medially or paramedially through the cricothyroid membrane and carefully kept submucosal just below the level of the vocal folds. Before identification of the RLN, the vagal nerve was dissected on the side of the concerned lobe and stimulated. The thyroid surgery was then performed with the routine identification of the RLN. The response of the RLN is periodically checked using a stimulating probe. The main outcomes were the identification and stimulation of the RLN, quality of the voice in post-operative time.
Objective:
The main objective of our study is to present a simple and efficient method, available for children of all ages, in order to perform monitoring of the recurrent laryngeal nerves during thyroid surgery.
Results:
We present the results of our retrospective series, in a tertiary-care university pediatric hospital. We included nine children, corresponding to 15 nerves. In all cases, the RLN was identified, stimulated and a positive response was obtained via monitoring.
Conclusions:
This technique of monitoring is safe, feasible at any age, even in neonates, and, as the electrode stays in the operation field, its position is easily controlled.
