Intraoperative nerve monitoring (IONM) is an essential
technique for detecting Recurrent Laryngeal Nerve (RLN) function during thyroid
surgery, significantly reducing the risk of nerve damage. IONM involves
attaching sensors to the endotracheal tube, which stimulates the RLN and
detects vocal cord motion. The study aims to determine whether IONM improves
outcomes in thyroid surgery, particularly in preserving vocal cord function.
Post-surgical voice function is assessed using tools like the GRBAS scale, CAPE-V,
and the Voice Handicap Index (VHI), which evaluate dysphonia severity and its
impact on daily life. This prospective randomized controlled study was
conducted from January 2023 to May 2024 at PGIMER Chandigarh, involving 100
patients undergoing thyroidectomy. Surgical techniques involved using an NIM
FLEX endotracheal tube for IONM in Group 1 and a standard Portex tube for Group
2. Nerve stimulation was performed using a monopolar stimulator probe, with
real-time monitoring of amplitude and latency. In the preoperative 90-degree
endoscopy, 96% of patients in the test group had bilateral true vocal cord
(TVC) mobility, while 4% had left TVC palsy. In the control group, 100% had
bilateral TVC mobility. In the test group, 86% of patients had bilateral TVC mobility,
while 2% had right TVC palsy, 6% had left TVC palsy (2 of which were
preoperative), 4% had right TVC paresis, and 2% had left TVC paresis. In the
control group, 74% had bilateral TVC mobility, 2% had left TVC palsy, 14% had
right TVC paresis, and 10% had left TVC paresis. There were no significant
differences observed in GRBAS, VHI, CAPE-V, or MPD scores between the two
groups on preoperative day, postoperative day 1, and postoperative day 10. The
study highlighted that while IONM did not lead to a significant reduction in
the overall incidence of RLN injury, it did aid in the preservation of vocal
cord function. Transient nerve paresis was observed in the test group,
specifically following repeated nerve stimulation, which was managed effectively
with steroid therapy. Patients in the test group showed higher rates of
bilateral true vocal cord mobility and less deviation from preoperative voice
quality parameters, such as GRBAS scores and VHI, highlighting IONM’s role in
reducing nerve injury severity and improving patient outcomes.
Author(s) Details
Shivam Saxena
Department of Otorhinolaryngology and Head and Neck Surgery, PGIMER,
Chandigarh, India.
Jaimanti Bakshi
Department of Otorhinolaryngology and Head and Neck Surgery, PGIMER,
Chandigarh, India.
Naresh Panda
Department of Otorhinolaryngology and Head and Neck Surgery, PGIMER,
Chandigarh, India.
Rijuneeta Gupta
Department of Otorhinolaryngology and Head and Neck Surgery, PGIMER,
Chandigarh, India.
Sourabha Patro
Department of Otorhinolaryngology and Head and Neck Surgery, PGIMER,
Chandigarh, India.
Sanjay Munjal
Department of Speech and Audiometry, PGIMER, Chandigarh, India.
Tanvir Samra
Department of Anesthesia, PGIMER, Chandigarh, India.
Please see the book here :- https://doi.org/10.9734/bpi/msraa/v11/6136
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