Abstract
Background: Intraoperative damage of the recurrent laryngeal nerve (RLN) and the external branch
of the superior laryngeal nerve (EBSLN) are common and cause complications in thyroid
surgery. The method of intraoperative electrophysiological neuromonitoring (IONM)
of the RLN and the EBSLN has been used in adults for several years. The question is
whether IONM can be used in paediatric surgery for the identification and functional
control of the RLN and the EBSLN, and what the advantages and disadvantages of using
it are. Methods: Surgical treatment of benign (n = 9) and malign (n = 2) thyroid diseases was carried
out in eleven children (median age: 13 years) with a total of 18 nerves at risk (NAR).
The function of the vocal cord was monitored in all children before and after surgery.
Intraoperative identification and functional control of RLN and EBSLN was performed
using the Neurosign 100®. All results before and after resection of the thyroid gland
were documented. Results: A clear and reliable identification of the RLN and the EBSLN was possible in all
cases. All NAR showed a constant physiological nerve signal before and after surgical
resection of the thyroid gland. However, in one young patient the postoperative examination
of the vocal cord revealed a partial paralysis on the left side after thyroidectomy,
despite the constant intraoperative signal of the RLN. After a period of six months,
normal functioning had resumed. Conclusion: The IONM of both RLN and EBSLN in adult surgery could be used successfully in paediatric
surgery. In this study a clear and positive identification of both nerves was possible
in all patients. Therefore the IONM of the RLN and EBSLN could develop into a successful
and easy method for the prevention of intraoperative nerve damage during thyroid surgery
in childhood and young adolescence. Assuming that a constant IONM signal represents
a normal vocal cord, our evaluation showed that there is a small percentage of false
negative and positive results.
Key words
Recurrent laryngeal nerve - intraoperative monitoring - thyroid surgery - childhood
References
- 1
Beldi G, Kinsbergen T, Schlumpf R.
Evaluation of intraoperative recurrent nerve monitoring in thyroid surgery.
World J Surg.
2004;
28
589-591
- 2
Brauckhoff M, Gimm O, Thanh P N, Brauckhoff K, Ukkat J, Thomusch O, Dralle H.
First experiences in intraoperative neurostimulation of the recurrent laryngeal nerve
during thyroid surgery of children and adolescents.
J Pediatr Surg.
2002;
37
1414-1418
- 3
Eisele D W.
Intraoperative electrophysiologic monitoring of the recurrent laryngeal nerve.
Laryngoscope.
1996;
106
443-449
- 4
Hamelmann W, Meyer T, Timm S, Timmermann W.
Kritische Beurteilung und Fehlermöglichkeiten des intraoperativen Neuromonitoring
(IONM) bei Operationen an der Schilddrüse.
Zentralbl Chir.
2002;
127
409-413
- 5
Hermann M, Hellebart C, Freissmuth M.
Neuromonitoring in thyroid surgery: prospective evaluation of intraoperative electrophysiological
responses for the prediction of recurrent laryngeal nerve injury.
Ann Surg.
2004;
240
9-17
- 6
Jonas J, Bähr R.
Die intraoperative elektrophysiologische Identifikation des Nervus laryngeus recurrens.
Chirurg.
2000;
71
534-538
- 7
Meyer T, Hamelmann W, Hoppe F, Timmermann W.
Intraoperatives Neuromonitoring des Nervus laryngeus recurrens.
Chir Praxis.
2002;
60
615-622
- 8
Meyer T, Hamelmann W, Schramm C, Hoppe F, Thiede A, Timmermann W.
Is there a high risk for damaging the external branch of the superior laryngeal nerve
during thyroid surgery?.
Eur Surg.
2003;
35
202-205
- 9 Møller A R.
Basis of intraoperative neurophysiologic monitoring. Møller AR Intraoperative Neurophysiologic Monitoring. New York; Harwood Academic
Publishers GmbH 1995: 1-15
- 10
Thomusch O, Sekulla C, Machens A, Neumann H J, Timmermann W, Dralle H.
Validity of intra-operative neuromonitoring signals in thyroid surgery.
Langenbecks Arch Surg.
2004;
389
499-503
- 11
Timmermann W, Dralle H, Hamelmann W, Thomusch O, Sekulla C, Meyer T, Timm S, Thiede A.
Reduziert das intraoperative Neuromonitoring die Recurrensparese bei Schildddrüsenoperationen?.
Zentralbl Chir.
2002;
127
395-399
- 12
Timmermann W, Hamelmann W, Meyer T, Timm S, Schramm C, Hoppe F, Thiede A.
Der Ramus externus des Nervus laryngeus superior (RELS): Ein Stiefkind in der Schilddrüsenchirurgie.
Zentralbl Chir.
2002;
127
425-428
- 13
Timmermann W, Hamelmann W H, Thiede A.
Schilddrüsenchirurgie: Neuromonitoring zur Schonung des Nervus recurrens.
Dtsch Ärztebl.
2004;
101
1341-1345
Dr. med. T. Meyer
Paediatric Surgery Unit
Department of General Surgery
Zentrum Operative Medizin (ZOM)
Oberdürrbacher Straße 6
97080 Würzburg
Germany
Email: Meyer_t@chirurgie.uni-wuerzburg.de