Vocal cord paralysis predicted by neural monitoring electrophysiologic changes with recurrent laryngeal nerve compressive neuropraxic injury in a canine model

Sidharth V. Puram; Harold Chow; Che Wei Wu; James T. Heaton; Dipti Kamani; Gautham Gorti; Feng Yu Chiang; Gianlorenzo Dionigi; Marcin Barczyński; Rick Schneider; Henning Dralle; Kerstin Lorenz; Gregory W. Randolph

doi:10.1002/hed.24225

Vocal cord paralysis predicted by neural monitoring electrophysiologic changes with recurrent laryngeal nerve compressive neuropraxic injury in a canine model

Sidharth V. Puram, Harold Chow, Che Wei Wu, James T. Heaton, Dipti Kamani, Gautham Gorti, Feng Yu Chiang, Gianlorenzo Dionigi, Marcin Barczyński, Rick Schneider, Henning Dralle, Kerstin Lorenz, Gregory W. Randolph

Research output: Contribution to journal › Article › peer-review

17 Scopus citations

Abstract

Background Recurrent laryngeal nerve (RLN) injury is a known complication of thyroid/parathyroid surgery. Intraoperative nerve monitoring (IONM) has been used to gain more information regarding the functional status of the RLN intraoperatively; however, the electromyography (EMG) parameters of RLN after nontransection neuropraxic compressive injury remain unknown. Methods We developed a canine model to identify IONM EMG correlates of postoperative vocal cord paralysis (VCP) using a standardized method to simulate surgical RLN compression sufficient to cause VCP. Results Compression nerve injury decreased EMG amplitude and increased EMG latency, with a 60% increase in RLN threshold stimulation compared to preinjury values. If RLN amplitude decreases by 80% with an absolute amplitude of 300 μV or less in combination with a latency increase of 10% or more, then nerve injury and associated VCP is likely. Conclusion These results may help surgeons to prognosticate postoperative neural function and intraoperative decision-making regarding contralateral thyroid surgery.

Original language	English
Pages (from-to)	E1341-E1350
Journal	Head and Neck
Volume	38
DOIs	https://doi.org/10.1002/hed.24225
State	Published - Apr 1 2016

Keywords

endocrine
injury
intraoperative nerve monitoring (IONM)
recurrent laryngeal nerve
thyroid surgery
vocal cord palsy

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10.1002/hed.24225

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Puram, S. V., Chow, H., Wu, C. W., Heaton, J. T., Kamani, D., Gorti, G., Chiang, F. Y., Dionigi, G., Barczyński, M., Schneider, R., Dralle, H., Lorenz, K., & Randolph, G. W. (2016). Vocal cord paralysis predicted by neural monitoring electrophysiologic changes with recurrent laryngeal nerve compressive neuropraxic injury in a canine model. Head and Neck, 38, E1341-E1350. https://doi.org/10.1002/hed.24225

@article{c93910ff72544767a387421897ed6263,

title = "Vocal cord paralysis predicted by neural monitoring electrophysiologic changes with recurrent laryngeal nerve compressive neuropraxic injury in a canine model",

abstract = "Background Recurrent laryngeal nerve (RLN) injury is a known complication of thyroid/parathyroid surgery. Intraoperative nerve monitoring (IONM) has been used to gain more information regarding the functional status of the RLN intraoperatively; however, the electromyography (EMG) parameters of RLN after nontransection neuropraxic compressive injury remain unknown. Methods We developed a canine model to identify IONM EMG correlates of postoperative vocal cord paralysis (VCP) using a standardized method to simulate surgical RLN compression sufficient to cause VCP. Results Compression nerve injury decreased EMG amplitude and increased EMG latency, with a 60% increase in RLN threshold stimulation compared to preinjury values. If RLN amplitude decreases by 80% with an absolute amplitude of 300 μV or less in combination with a latency increase of 10% or more, then nerve injury and associated VCP is likely. Conclusion These results may help surgeons to prognosticate postoperative neural function and intraoperative decision-making regarding contralateral thyroid surgery.",

keywords = "endocrine, injury, intraoperative nerve monitoring (IONM), recurrent laryngeal nerve, thyroid surgery, vocal cord palsy",

author = "Puram, {Sidharth V.} and Harold Chow and Wu, {Che Wei} and Heaton, {James T.} and Dipti Kamani and Gautham Gorti and Chiang, {Feng Yu} and Gianlorenzo Dionigi and Marcin Barczy{\'n}ski and Rick Schneider and Henning Dralle and Kerstin Lorenz and Randolph, {Gregory W.}",

note = "Publisher Copyright: {\textcopyright} 2015 Wiley Periodicals, Inc..",

year = "2016",

month = apr,

day = "1",

doi = "10.1002/hed.24225",

language = "English",

volume = "38",

pages = "E1341--E1350",

journal = "Head and Neck",

issn = "1043-3074",

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Puram, SV, Chow, H, Wu, CW, Heaton, JT, Kamani, D, Gorti, G, Chiang, FY, Dionigi, G, Barczyński, M, Schneider, R, Dralle, H, Lorenz, K & Randolph, GW 2016, 'Vocal cord paralysis predicted by neural monitoring electrophysiologic changes with recurrent laryngeal nerve compressive neuropraxic injury in a canine model', Head and Neck, vol. 38, pp. E1341-E1350. https://doi.org/10.1002/hed.24225

TY - JOUR

T1 - Vocal cord paralysis predicted by neural monitoring electrophysiologic changes with recurrent laryngeal nerve compressive neuropraxic injury in a canine model

AU - Puram, Sidharth V.

AU - Chow, Harold

AU - Wu, Che Wei

AU - Heaton, James T.

AU - Kamani, Dipti

AU - Gorti, Gautham

AU - Chiang, Feng Yu

AU - Dionigi, Gianlorenzo

AU - Barczyński, Marcin

AU - Schneider, Rick

AU - Dralle, Henning

AU - Lorenz, Kerstin

AU - Randolph, Gregory W.

PY - 2016/4/1

Y1 - 2016/4/1

N2 - Background Recurrent laryngeal nerve (RLN) injury is a known complication of thyroid/parathyroid surgery. Intraoperative nerve monitoring (IONM) has been used to gain more information regarding the functional status of the RLN intraoperatively; however, the electromyography (EMG) parameters of RLN after nontransection neuropraxic compressive injury remain unknown. Methods We developed a canine model to identify IONM EMG correlates of postoperative vocal cord paralysis (VCP) using a standardized method to simulate surgical RLN compression sufficient to cause VCP. Results Compression nerve injury decreased EMG amplitude and increased EMG latency, with a 60% increase in RLN threshold stimulation compared to preinjury values. If RLN amplitude decreases by 80% with an absolute amplitude of 300 μV or less in combination with a latency increase of 10% or more, then nerve injury and associated VCP is likely. Conclusion These results may help surgeons to prognosticate postoperative neural function and intraoperative decision-making regarding contralateral thyroid surgery.

AB - Background Recurrent laryngeal nerve (RLN) injury is a known complication of thyroid/parathyroid surgery. Intraoperative nerve monitoring (IONM) has been used to gain more information regarding the functional status of the RLN intraoperatively; however, the electromyography (EMG) parameters of RLN after nontransection neuropraxic compressive injury remain unknown. Methods We developed a canine model to identify IONM EMG correlates of postoperative vocal cord paralysis (VCP) using a standardized method to simulate surgical RLN compression sufficient to cause VCP. Results Compression nerve injury decreased EMG amplitude and increased EMG latency, with a 60% increase in RLN threshold stimulation compared to preinjury values. If RLN amplitude decreases by 80% with an absolute amplitude of 300 μV or less in combination with a latency increase of 10% or more, then nerve injury and associated VCP is likely. Conclusion These results may help surgeons to prognosticate postoperative neural function and intraoperative decision-making regarding contralateral thyroid surgery.

KW - endocrine

KW - injury

KW - intraoperative nerve monitoring (IONM)

KW - recurrent laryngeal nerve

KW - thyroid surgery

KW - vocal cord palsy

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U2 - 10.1002/hed.24225

DO - 10.1002/hed.24225

M3 - Article

C2 - 26348472

AN - SCOPUS:84941052732

SN - 1043-3074

VL - 38

SP - E1341-E1350

JO - Head and Neck

JF - Head and Neck

ER -

Vocal cord paralysis predicted by neural monitoring electrophysiologic changes with recurrent laryngeal nerve compressive neuropraxic injury in a canine model

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