Utilizing Surgeon-Performed Intraoperative Translaryngeal Ultrasound for Verifying Vocal Fold Function: A...

Area of Science:

• Otolaryngology
• Surgical Monitoring
• Medical Imaging

Background:

• Assessing vocal fold (VF) mobility during thyroid and parathyroid surgery is crucial.
• Transcutaneous laryngeal ultrasonography (TLUS) offers a potential method for real-time VF assessment.
• Its utility in scenarios with recurrent laryngeal nerve (RLN) signal loss requires investigation.

Purpose of the Study:

• To evaluate the precision and utility of TLUS for monitoring VF mobility during neck surgeries.
• To compare TLUS performance against established neuromonitoring techniques.
• To assess TLUS effectiveness in managing RLN signal loss during surgery.

Main Methods:

• A prospective study involving 443 vocal fold evaluations between October 2020 and January 2023.
• Concurrent use of TLUS, Doppler sonography, laryngeal twitch response (LTR) palpation, and electromyography (EMG).
• Postoperative verification of VF activity using fiberoptic video laryngoscopy (FL).

Main Results:

• TLUS demonstrated 97.8% agreement with EMG for VF mobility assessment.
• TLUS showed superior diagnostic accuracy (99.7%) compared to EMG (98.2%).
• TLUS was significantly more cost-effective ($68 vs $300) than EMG for comparable operative durations.

Conclusions:

• TLUS is a highly accurate and cost-effective method for intraoperative neuromonitoring of VF mobility.
• It rivals EMG in accuracy and outperforms LTR, proving particularly valuable in signal loss situations.
• TLUS can help prevent additional surgeries by reliably assessing nerve function during neck procedures.