Feasibility of Cricothyroid Muscle Needle Electrode for Monitored Thyroidectomy

IF 2 3区医学 Q3 MEDICINE, RESEARCH & EXPERIMENTAL Laryngoscope Pub Date : 2025-02-13 DOI:10.1002/lary.32051

Wen Liang Joel Lau FRCS, Che-Wei Wu MD, PhD, Man Hon Tang FRCS, Han Boon Oh FRCS, Wei Keat Cheah FRACS, Moon Young Oh MD, Young Jun Chai MD, PhD

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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.

Level of Evidence

2 Laryngoscope, 135:1843–1849, 2025

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环甲肌针电极监测甲状腺切除术的可行性。

目的：保留喉返神经和喉上神经外支是甲状腺切除术后维持声带功能的关键。术中神经监测（IONM）有助于神经保存。本研究比较了三种IONM模式，气管内表面电极（ETSE）、甲状腺软骨针电极（TCNE）和环甲肌针电极（CTNE）监测喉肌肌电图（EMG）振幅的情况。方法：一项观察性前瞻性队列研究包括29例（21F:8M）因Bethesda III-VI型结节或bbbb4 cm的良性结节行甲状腺切除术。在刺激EBSLN、RLN和迷走神经（VN）后，通过ETSE、TCNE和CTNE记录肌电图振幅。结果：共评估了105个危险神经，其中ebsln 35个，vn 35个，rnn 35个。ETSE、TCNE和CTNE在S1处的振幅分别为45.6±60.7 μV、403.7±865.4 μV和3049.4±2749.8 μV。结论：CTNE对EBSLN的阳性信号率高于ETSE和TCNE，而对VN和RLN的阳性信号率与TCNE相似，CTNE对EBSLN的阳性信号率高于ETSE和TCNE。CTNE是甲状腺切除术中IONM的可行选择。证据等级：2喉镜，2025。

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来源期刊

Laryngoscope 医学-耳鼻喉科学

CiteScore

6.50

自引率

7.70%

发文量

500

审稿时长

2-4 weeks

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