Value of Neurostimulation Plus Laryngeal Palpation to Predict Postoperative Vocal Fold Motility

• Published in: The Journal of surgical research 2021-11, Vol.267, p.506-511
• Main Authors: Cipolla, Calogero, Vieni, Salvatore, Genova, Pietro, Contino, Silvia, Latteri, Mario, Graceffa, Giuseppa
• Format: Article
• Language: English
• Subjects: Humans; Intraoperative nerve monitoring; Laryngeal palpation; Nerve injury; Palpation; Recurrent Laryngeal Nerve; Recurrent Laryngeal Nerve Injuries - diagnosis; Recurrent Laryngeal Nerve Injuries - etiology; Reproducibility of Results; Retrospective Studies; Thyroidectomy; Thyroidectomy - adverse effects; Thyroidectomy - methods; Vocal Cord Paralysis - diagnosis; Vocal Cord Paralysis - etiology; Vocal Cord Paralysis - physiopathology; Vocal Cords - physiopathology
• ISSN: 0022-4804; 1095-8673
• DOI: 10.1016/j.jss.2021.06.003

•Intraoperative neuromonitoring of recurrent laryngeal nerve integrates visual identification providing valuable information on their functional integrity.•The aim of this study was to evaluate the reliability of intermittent intraoperative neuromonitoring in addition to laryngeal palpation in predicting postoperative vocal cord palsy.•High sensitivity and specificity confirm the validity of IONM with simultaneous laryngeal palpation in predicting the regular functioning of the RLN and therefore of the vocal cord. The aim of this study was to evaluate the reliability of intraoperative neuromonitoring through recurrent laryngeal nerve stimulation and simultaneous laryngeal palpation (NSLP) in predicting postoperative vocal cord palsy and in providing useful information in the decision to perform a staged surgery in initially planned total thyroidectomy. A retrospective review was performed involving 552 patients for whom a total thyroidectomy was planned. In all patients, preoperative and postoperative laryngoscopy was performed. The incidence of vocal cord palsy was calculated on 1104 nerves at risk. Sensitivity and specificity of NSLP were 0.9411 and 0.9925 respectively. The positive predictive value was 0.7804, the negative predictive value was 0.9981, the false positive rate was 0.8%. In 41 patients (7.4%) the initial surgical strategy was changed into a staged procedure. Nine patients (21.9%) were false positive, 32 patients (78.1%) were true positive. Finally, a two-stage thyroidectomy was performed in 27 of 41 patients. High sensitivity and specificity confirm the validity of NSLP in predicting postoperative vocal cord palsy and in driving a possible staged thyroidectomy, both in benign thyroid disease and in differentiated thyroid carcinoma.