• Clin Otolaryngol · Nov 2019

    Continuous versus intermittent intraoperative neuromonitoring in complex benign thyroid surgery: A retrospective analysis and prospective follow-up.

    • Anke Sedlmaier, Thomas Steinmüller, Mechthild Hermanns, Tadeus Nawka, Sebastian Weikert, Benedikt Sedlmaier, and Philipp P Caffier.
    • Department of Surgery, DRK Kliniken Berlin Westend, Berlin, Germany.
    • Clin Otolaryngol. 2019 Nov 1; 44 (6): 1071-1079.

    ObjectivesTo compare continuous (C-IONM) vs intermittent intraoperative neuromonitoring (I-IONM) in complex benign thyroid surgery, and to follow up patients with loss of signal (LOS) or unilateral vocal fold paralysis (UVFP).DesignRetrospective clinical study, prospective case series.SettingUniversity hospital and academic teaching hospital of Charité-University Medicine Berlin, Germany.ParticipantsC-IONM- and I-IONM-assisted thyroid surgery was conducted in 357 patients diagnosed with recurrent goitre, Graves' disease, complex hyperparathyroidism, cervical preoperation (anterior access) and LOS in primary operation (2-stage thyroidectomy).Main Outcome MeasuresTo evaluate the incidence of early postoperative and permanent UVFP, and to report the results of phonosurgical therapy in patients suffering from persisting dysphonia.ResultsIn 346 patients enrolled (81.8% female, 18.2% male) with 613 nerves at risk (NAR) being monitored (409 I-IONM vs 204 C-IONM), early postoperative UVFP was observed in 10.5% of I-IONM vs 4.9% of C-IONM group (P < .05), permanent paralysis in 1.5% of I-IONM vs 1.0% of C-IONM group (P = .619). In total, 72 patients (21%) experienced pathological events (19 LOS < 100 μV, 53 transient or permanent UVFP). Three patients with permanent UVFP and persisting dysphonia received phonosurgery with stable improvements of all acoustic-aerodynamic parameters.ConclusionCompared to I-IONM, C-IONM-application in complex benign thyroid surgery shows a significant reduction of transient UVFP and a non-significant trend in preventing permanent UVFP. In persistent UVFP with dysphonia, endolaryngeal phonomicrosurgery and transcervical laryngeal framework surgery are long-term effective treatment approaches to improve vocal function.© 2019 John Wiley & Sons Ltd.

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