Wen Liang Joel Lau, Che-Wei Wu, Man Hon Tang, Han Boon Oh, Wei Keat Cheah, Moon Young Oh, Young Jun Chai
{"title":"Feasibility of Cricothyroid Muscle Needle Electrode for Monitored Thyroidectomy.","authors":"Wen Liang Joel Lau, Che-Wei Wu, Man Hon Tang, Han Boon Oh, Wei Keat Cheah, Moon Young Oh, Young Jun Chai","doi":"10.1002/lary.32051","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>Preservation of the recurrent laryngeal nerve (RLN) and external branch of the superior laryngeal nerve (EBSLN) is essential to maintain voice function after thyroidectomy. Intraoperative neuromonitoring (IONM) assists in nerve preservation. This study compares three IONM modalities, endotracheal surface electrode (ETSE), thyroid cartilage needle electrodes (TCNE), and cricothyroid muscle needle electrode (CTNE), in their monitoring of laryngeal muscle electromyographic (EMG) amplitude.</p><p><strong>Methods: </strong>An observational prospective cohort study included 29 patients (21F:8M) undergoing thyroidectomy for Bethesda III-VI nodules or benign nodules >4 cm. EMG amplitudes were recorded via ETSE, TCNE, and CTNE following stimulation of the EBSLN, RLN, and vagus nerve (VN).</p><p><strong>Results: </strong>A total of 105 nerves at risk were assessed, including 35 EBSLNs, 35 VNs, and 35 RLNs. The recorded amplitudes at S1 for the ETSE, TCNE, and CTNE were 45.6 ± 60.7 μV, 403.7 ± 865.4 μV, and 3049.4 ± 2749.8 μV. The CTNE demonstrate significantly higher S1 amplitudes and positive signal rates compared with both the TCNE and ETSE (p < 0.001). For V1, the recorded amplitudes for the ETSE, TCNE, and CTNE were 453.7 ± 406.7 μV, 1363.9 ± 1063.6 μV, and 700 ± 375.1 μV. For R1, the recorded amplitudes for the ETSE, TCNE, and CTNE were 567.1 ± 556 μV, 1544.6 ± 1269.6 μV, and 720.4 ± 363.1 μV. With a threshold of 100 μV to determine positive signal, CTNE detected all EBSLN, VN, and RLN signals, whereas TC missed 13 cases (37.1%) of EBSLN.</p><p><strong>Conclusion: </strong>The CTNE showed a higher positive signal rate than ETSE and TCNE in detection of EBSLN, whereas it showed similar performance with TCNE in detection of VN and RLN. CTNE is a viable option for IONM during thyroidectomy.</p><p><strong>Level of evidence: </strong>2 Laryngoscope, 2025.</p>","PeriodicalId":49921,"journal":{"name":"Laryngoscope","volume":" ","pages":""},"PeriodicalIF":2.2000,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Laryngoscope","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1002/lary.32051","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"MEDICINE, RESEARCH & EXPERIMENTAL","Score":null,"Total":0}
引用次数: 0
Abstract
Objectives: Preservation of the recurrent laryngeal nerve (RLN) and external branch of the superior laryngeal nerve (EBSLN) is essential to maintain voice function after thyroidectomy. Intraoperative neuromonitoring (IONM) assists in nerve preservation. This study compares three IONM modalities, endotracheal surface electrode (ETSE), thyroid cartilage needle electrodes (TCNE), and cricothyroid muscle needle electrode (CTNE), in their monitoring of laryngeal muscle electromyographic (EMG) amplitude.
Methods: An observational prospective cohort study included 29 patients (21F:8M) undergoing thyroidectomy for Bethesda III-VI nodules or benign nodules >4 cm. EMG amplitudes were recorded via ETSE, TCNE, and CTNE following stimulation of the EBSLN, RLN, and vagus nerve (VN).
Results: A total of 105 nerves at risk were assessed, including 35 EBSLNs, 35 VNs, and 35 RLNs. The recorded amplitudes at S1 for the ETSE, TCNE, and CTNE were 45.6 ± 60.7 μV, 403.7 ± 865.4 μV, and 3049.4 ± 2749.8 μV. The CTNE demonstrate significantly higher S1 amplitudes and positive signal rates compared with both the TCNE and ETSE (p < 0.001). For V1, the recorded amplitudes for the ETSE, TCNE, and CTNE were 453.7 ± 406.7 μV, 1363.9 ± 1063.6 μV, and 700 ± 375.1 μV. For R1, the recorded amplitudes for the ETSE, TCNE, and CTNE were 567.1 ± 556 μV, 1544.6 ± 1269.6 μV, and 720.4 ± 363.1 μV. With a threshold of 100 μV to determine positive signal, CTNE detected all EBSLN, VN, and RLN signals, whereas TC missed 13 cases (37.1%) of EBSLN.
Conclusion: The CTNE showed a higher positive signal rate than ETSE and TCNE in detection of EBSLN, whereas it showed similar performance with TCNE in detection of VN and RLN. CTNE is a viable option for IONM during thyroidectomy.
期刊介绍：
The Laryngoscope has been the leading source of information on advances in the diagnosis and treatment of head and neck disorders since 1890. The Laryngoscope is the first choice among otolaryngologists for publication of their important findings and techniques. Each monthly issue of The Laryngoscope features peer-reviewed medical, clinical, and research contributions in general otolaryngology, allergy/rhinology, otology/neurotology, laryngology/bronchoesophagology, head and neck surgery, sleep medicine, pediatric otolaryngology, facial plastics and reconstructive surgery, oncology, and communicative disorders. Contributions include papers and posters presented at the Annual and Section Meetings of the Triological Society, as well as independent papers, "How I Do It", "Triological Best Practice" articles, and contemporary reviews. Theses authored by the Triological Society’s new Fellows as well as papers presented at meetings of the American Laryngological Association are published in The Laryngoscope.
• Broncho-esophagology
• Communicative disorders
• Head and neck surgery
• Plastic and reconstructive facial surgery
• Oncology
• Speech and hearing defects
京公网安备 11010802042870号
京ICP备2023020795号-1
分享
求助内容：
应助结果提醒方式：
扫码关注我们
