A variety of electromyography (EMG) recording methods were reported during intraoperative neural monitoring (IONM) of recurrent laryngeal nerve (RLN) in thyroid surgery. This study compared two surface recording methods that were obtained by electrodes on endotracheal tube (ET) and thyroid cartilage (TC). This study analyzed 205 RLNs at risk in 110 patients undergoing monitored thyroidectomy. Each patient was intubated with an EMG ET during general anesthesia. A pair of single needle electrode was inserted obliquely into the TC lamina on each side. Standard IONM procedure was routinely followed, and EMG signals recorded by the ET and TC electrodes at each step were compared. In all nerves, evoked laryngeal EMG signals were reliably recorded by the ET and TC electrodes, and showed the same typical waveform and latency. The EMG signals recorded by the TC electrodes showed significantly higher amplitudes and stability compared to those by the ET electrodes. Both recording methods accurately detected 7 partial loss of signal (LOS) and 2 complete LOS events caused by traction stress, but only the ET electrodes falsely detected 3 LOS events caused by ET displacement during surgical manipulation. Two patients with true complete LOS experienced temporary RLN palsy postoperatively. Neither permanent RLN palsy, nor complications from ET or TC electrodes were encountered in this study. Both electrodes are effective and reliable for recording laryngeal EMG signals during monitored thyroidectomy. Compared to ET electrodes, TC electrodes obtain higher and more stable EMG signals as well as fewer false EMG results during IONM. Copyright (C) 2017, Kaohsiung Medical University.
[1]Kaohsiung Med Univ, Kaohsiung Med Univ Hosp, Dept Otolaryngol Head & Neck Surg, 100 TzYou 1st Rd, Kaohsiung 807, Taiwan.
[2]Kaohsiung Med Univ, Coll Med, Fac Med, Kaohsiung, Taiwan.
[3]Kaohsiung Med Univ, Kaohsiung Med Univ Hosp, Dept Anesthesiol, Kaohsiung, Taiwan.
[4]Univ Messina, Dept Human Pathol Adulthood & Childhood G Barresi, Univ Hosp Policlin G Martino, Div Endocrine Surg, Via C Valeria 1, I-98125 Messina, Italy.
[5]Harvard Med Sch, Massachusetts Eye & Ear Infirm, Div Thyroid & Parathyroid Endocrine Surg, Dept Otolaryngol,Dept Otol & Laryngol, Boston, MA USA.
[6]Jilin Univ, China Japan Union Hosp, Div Thyroid Surg, Jilin Prov Key Lab Surg Translat Med, Changchun, Jilin, Peoples R China.
[7]Kosin Univ, Coll Med, Dept Otolaryngol Head & Neck Surg, Busan, South Korea.
[8]Hanyang Univ, Dept Otolaryngol Head & Neck Surg, Coll Med, Seoul, South Korea.
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