The electrophysiology of thyroid surgery: electrophysiologic and muscular responses with stimulation of the vagus nerve, recurrent laryngeal nerve, and external branch of the superior laryngeal nerve
Correlation of physiologically important electromyographic (EMG) waveforms with demonstrable muscle activation is important for the reliable interpretation of evoked waveforms during intraoperative neural monitoring (IONM) of the vagus nerve, recurrent laryngeal nerve (RLN), and external branch of t...
Saved in:
Published in | The Laryngoscope Vol. 127; no. 3; p. 764 |
---|---|
Main Authors | , , , , , , , , , , , , , , , |
Format | Journal Article |
Language | English |
Published |
United States
01.03.2017
|
Subjects | |
Online Access | Get more information |
Cover
Loading…
Abstract | Correlation of physiologically important electromyographic (EMG) waveforms with demonstrable muscle activation is important for the reliable interpretation of evoked waveforms during intraoperative neural monitoring (IONM) of the vagus nerve, recurrent laryngeal nerve (RLN), and external branch of the superior laryngeal nerve (EBSLN) in thyroid surgery.
Retrospective chart review.
Data were reviewed retrospectively for thyroid surgery patients with laryngeal nerve IONM from January to December, 2015. EMG responses to monopolar stimulation of the vagus/RLN and EBSLN were recorded in bilateral vocalis, cricothyroid (CTM), and strap muscles using endotracheal tube-based surface and intramuscular hook electrodes, respectively. Target muscles for vagal/RLN and EBSLN stimulation were the ipsilateral vocalis and CTM, respectively. All other recording channels were nontarget muscles.
Fifty surgical sides were identified in 37 subjects. All target muscle mean amplitudes were significantly higher than in nontarget muscles. With vagal/RLN stimulation, target ipsilateral vocalis mean amplitude was 1,095.7 μV (mean difference range = -814.1 to -1,078 μV, P < .0001). For EBSLN stimulation, target ipsilateral CTM mean amplitude was 6,379.3 μV (mean difference range = -6,222.6 to -6,362.3 μV, P < .0001). Target muscle large-amplitude EMG responses correlated with meaningful visual or palpable muscular responses, whereas nontarget EMG responses showed no meaningful muscle activation.
Target and nontarget laryngeal muscles are differentiated based on divergence of EMG response directly correlating with presence or absence of visual and palpable muscle activation. Low-amplitude EMG waveforms in nontarget muscles with neural stimulation can be explained by the concept of far-field artifactual waveforms and do not correspond to a true muscular response. The surgeon should be aware of these nonphysiologic waveforms when interpreting and applying IONM during thyroid surgery.
4 Laryngoscope, 127:764-771, 2017. |
---|---|
AbstractList | Correlation of physiologically important electromyographic (EMG) waveforms with demonstrable muscle activation is important for the reliable interpretation of evoked waveforms during intraoperative neural monitoring (IONM) of the vagus nerve, recurrent laryngeal nerve (RLN), and external branch of the superior laryngeal nerve (EBSLN) in thyroid surgery.
Retrospective chart review.
Data were reviewed retrospectively for thyroid surgery patients with laryngeal nerve IONM from January to December, 2015. EMG responses to monopolar stimulation of the vagus/RLN and EBSLN were recorded in bilateral vocalis, cricothyroid (CTM), and strap muscles using endotracheal tube-based surface and intramuscular hook electrodes, respectively. Target muscles for vagal/RLN and EBSLN stimulation were the ipsilateral vocalis and CTM, respectively. All other recording channels were nontarget muscles.
Fifty surgical sides were identified in 37 subjects. All target muscle mean amplitudes were significantly higher than in nontarget muscles. With vagal/RLN stimulation, target ipsilateral vocalis mean amplitude was 1,095.7 μV (mean difference range = -814.1 to -1,078 μV, P < .0001). For EBSLN stimulation, target ipsilateral CTM mean amplitude was 6,379.3 μV (mean difference range = -6,222.6 to -6,362.3 μV, P < .0001). Target muscle large-amplitude EMG responses correlated with meaningful visual or palpable muscular responses, whereas nontarget EMG responses showed no meaningful muscle activation.
Target and nontarget laryngeal muscles are differentiated based on divergence of EMG response directly correlating with presence or absence of visual and palpable muscle activation. Low-amplitude EMG waveforms in nontarget muscles with neural stimulation can be explained by the concept of far-field artifactual waveforms and do not correspond to a true muscular response. The surgeon should be aware of these nonphysiologic waveforms when interpreting and applying IONM during thyroid surgery.
4 Laryngoscope, 127:764-771, 2017. |
Author | Kamani, Dipti Bellotti, Carlo Dralle, Henning Schneider, Rick Chiang, Feng Yu Cinquepalmi, Matteo Mahamad, Sadhana Patricio, Stephanie Dionigi, Gianlorenzo Wu, Che-Wei Kyriazidis, Natalia Randolph, Gregory Lin, Brian M Liddy, Whitney Barczynski, Marcin Barber, Samuel R |
Author_xml | – sequence: 1 givenname: Whitney surname: Liddy fullname: Liddy, Whitney organization: Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, U.S.A – sequence: 2 givenname: Samuel R surname: Barber fullname: Barber, Samuel R organization: Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A – sequence: 3 givenname: Matteo surname: Cinquepalmi fullname: Cinquepalmi, Matteo organization: Surgery of Thyroid and Parathyroid Operative Unit, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy – sequence: 4 givenname: Brian M surname: Lin fullname: Lin, Brian M organization: Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, U.S.A – sequence: 5 givenname: Stephanie surname: Patricio fullname: Patricio, Stephanie organization: Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A – sequence: 6 givenname: Natalia surname: Kyriazidis fullname: Kyriazidis, Natalia organization: Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A – sequence: 7 givenname: Carlo surname: Bellotti fullname: Bellotti, Carlo organization: Surgery of Thyroid and Parathyroid Operative Unit, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy – sequence: 8 givenname: Dipti surname: Kamani fullname: Kamani, Dipti organization: Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, U.S.A – sequence: 9 givenname: Sadhana surname: Mahamad fullname: Mahamad, Sadhana organization: Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A – sequence: 10 givenname: Henning surname: Dralle fullname: Dralle, Henning organization: Department of General, Visceral, and Vascular Surgery, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany – sequence: 11 givenname: Rick surname: Schneider fullname: Schneider, Rick organization: Department of General, Visceral, and Vascular Surgery, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany – sequence: 12 givenname: Gianlorenzo surname: Dionigi fullname: Dionigi, Gianlorenzo organization: Endocrine Surgery Research Center, Department of Surgical Sciences, University of Insubria, Varese, Italy – sequence: 13 givenname: Marcin surname: Barczynski fullname: Barczynski, Marcin organization: Department of Endocrine Surgery, Jagiellonian University College of Medicine, Krakow, Poland – sequence: 14 givenname: Che-Wei surname: Wu fullname: Wu, Che-Wei organization: Department of Otorhinolaryngology-Head and Neck Surgery, Kaohsiung Medical University Hospital, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan – sequence: 15 givenname: Feng Yu surname: Chiang fullname: Chiang, Feng Yu organization: Institute of Clinical Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan – sequence: 16 givenname: Gregory surname: Randolph fullname: Randolph, Gregory organization: Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, U.S.A |
BackLink | https://www.ncbi.nlm.nih.gov/pubmed/27374859$$D View this record in MEDLINE/PubMed |
BookMark | eNplkE1OwzAQhS0Eoj-w4QDIByDFTuw4YYcQf1IlNmVdOc44MUrsyE4KOSHXIlXpBlYjvXnzzdNboFPrLCB0RcmKEhLfNtKPqzilTJygOeUJjVie8xlahPBBCBUJJ-doFotEsIznc_S9qQFDA6r3rqvHYFzjqhE7jft69M6UOAy-Aj_e_XMZhaUtcTsENUxvsYfQORsg4E_T1zj0pp303jh7wAHeyWoI2ILfwc1kV4P3YHu8z2wrkM1xtcfCVw_eTlrhpVX1ERGGDrxx_u_RBTrTsglw-TuX6P3pcfPwEq3fnl8f7teRSrgQUUq4SJOUJYQASKmkZimTGc2UojErWAlaMC21ljJTulB5mQAvc6mI5lxlebxE1wduNxQtlNvOm3ZKsj02Gv8AC-GAIA |
CitedBy_id | crossref_primary_10_1007_s00405_017_4666_9 crossref_primary_10_35420_jcohns_2018_29_2_157 crossref_primary_10_1007_s13304_017_0442_z crossref_primary_10_1177_01945998211011062 crossref_primary_10_1080_08941939_2017_1362489 crossref_primary_10_1002_lary_28883 crossref_primary_10_1002_lary_29413 crossref_primary_10_1007_s40136_021_00349_3 crossref_primary_10_3389_fendo_2023_1303159 crossref_primary_10_1016_j_anorl_2017_11_010 crossref_primary_10_3390_jcm13010102 crossref_primary_10_1007_s12020_020_02345_x crossref_primary_10_1016_j_aforl_2019_10_014 crossref_primary_10_1089_thy_2017_0680 crossref_primary_10_4174_astr_2019_96_6_269 crossref_primary_10_1002_lary_26456 crossref_primary_10_1016_j_anorl_2020_04_005 crossref_primary_10_1002_lary_26392 crossref_primary_10_1002_lary_28032 crossref_primary_10_3389_fendo_2021_705346 crossref_primary_10_3389_fendo_2021_795281 crossref_primary_10_1002_lary_27362 crossref_primary_10_1002_lary_28033 crossref_primary_10_1080_00015458_2021_1894733 crossref_primary_10_1007_s13304_021_01084_6 crossref_primary_10_1007_s13193_021_01490_7 |
ContentType | Journal Article |
Copyright | 2016 The American Laryngological, Rhinological and Otological Society, Inc. |
Copyright_xml | – notice: 2016 The American Laryngological, Rhinological and Otological Society, Inc. |
DBID | CGR CUY CVF ECM EIF NPM |
DOI | 10.1002/lary.26147 |
DatabaseName | Medline MEDLINE MEDLINE (Ovid) MEDLINE MEDLINE PubMed |
DatabaseTitle | MEDLINE Medline Complete MEDLINE with Full Text PubMed MEDLINE (Ovid) |
DatabaseTitleList | MEDLINE |
Database_xml | – sequence: 1 dbid: NPM name: PubMed url: https://proxy.k.utb.cz/login?url=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed sourceTypes: Index Database – sequence: 2 dbid: EIF name: MEDLINE url: https://proxy.k.utb.cz/login?url=https://www.webofscience.com/wos/medline/basic-search sourceTypes: Index Database |
DeliveryMethod | no_fulltext_linktorsrc |
Discipline | Medicine |
EISSN | 1531-4995 |
ExternalDocumentID | 27374859 |
Genre | Journal Article |
GroupedDBID | --- --Z .55 .GJ 05W 08G 08P 0R~ 123 1L6 1OB 1OC 31~ 33P 354 3WU 4.4 4Q1 4Q2 4Q3 53G 5RE 8-1 85S 8UM A00 AAESR AAHHS AAKAS AANLZ AAONW AAQQT AASGY AAWTL AAXRX AAZKR ABCUV ABJNI ABOCM ABPPZ ABQWH ABXGK ACAHQ ACBWZ ACCFJ ACCZN ACGFS ACGOF ACMXC ACPOU ACXBN ACXQS ADBBV ADBIZ ADBTR ADEOM ADKYN ADMGS ADOZA ADXAS ADZCM ADZMN AE3 AEEZP AEGXH AEIGN AENEX AEQDE AEUQT AEUYR AFBPY AFFNX AFFPM AFGKR AFPWT AFTRI AFUWQ AFZJQ AHBTC AHMBA AHRYX AIACR AITYG AIURR AIWBW AIZYK AJBDE ALMA_UNASSIGNED_HOLDINGS ALUQN AMYDB ASPBG AVWKF AZBYB AZFZN AZVAB BDRZF BFHJK BHBCM BMXJE BRXPI CGR CS3 CUY CVF DCZOG DRFUL DRMAN DRSTM DUUFO EBS ECM EIF EJD EMOBN EX3 F5P FEDTE FUBAC G-S GODZA H0~ HGLYW HVGLF HZ~ H~9 IH2 J5H JF9 JG8 KBYEO KMI L7B LATKE LEEKS LH4 LITHE LOXES LUTES LW6 LYRES M18 MEWTI MRFUL MRMAN MRSTM MSFUL MSMAN MSSTM MXFUL MXMAN MXSTM MY~ N4W NNB NPM NTWIH O66 O9- OAG OAH OHT OL1 OLG OLH OLU OLV OLY OLZ OVD OWU OWV OWW OWX OWY OWZ P-K P2P P2W P4E PALCI PQQKQ QRW RIWAO RJQFR ROL RWI SAMSI SUPJJ T8P TEORI TN5 UHB V9Y VVN WBKPD WH7 WHWMO WIH WIJ WIK WOHZO WOQ WOW WUP WVDHM WXSBR WYJ X7M XOL XV2 XXN XYM YFH YOC YQY ZFV ZGI ZXP ZZTAW ~S- |
ID | FETCH-LOGICAL-c3577-60576364300eeaacaf464a818cc124b4def74faffaa8cfbc9d3e5d9ac0f55c892 |
IngestDate | Sat Sep 28 08:49:14 EDT 2024 |
IsPeerReviewed | true |
IsScholarly | true |
Issue | 3 |
Keywords | Thyroid surgery electrophysiology recurrent laryngeal nerve electromyography vagus intraoperative neural monitoring external branch of the superior laryngeal nerve |
Language | English |
License | 2016 The American Laryngological, Rhinological and Otological Society, Inc. |
LinkModel | OpenURL |
MergedId | FETCHMERGED-LOGICAL-c3577-60576364300eeaacaf464a818cc124b4def74faffaa8cfbc9d3e5d9ac0f55c892 |
PMID | 27374859 |
ParticipantIDs | pubmed_primary_27374859 |
PublicationCentury | 2000 |
PublicationDate | 2017-03-00 |
PublicationDateYYYYMMDD | 2017-03-01 |
PublicationDate_xml | – month: 03 year: 2017 text: 2017-03-00 |
PublicationDecade | 2010 |
PublicationPlace | United States |
PublicationPlace_xml | – name: United States |
PublicationTitle | The Laryngoscope |
PublicationTitleAlternate | Laryngoscope |
PublicationYear | 2017 |
SSID | ssj0017350 |
Score | 2.4053128 |
Snippet | Correlation of physiologically important electromyographic (EMG) waveforms with demonstrable muscle activation is important for the reliable interpretation of... |
SourceID | pubmed |
SourceType | Index Database |
StartPage | 764 |
SubjectTerms | Adult Aged Cohort Studies Electric Stimulation - methods Electromyography - methods Female Follow-Up Studies Humans Laryngeal Muscles - innervation Laryngeal Muscles - surgery Male Middle Aged Monitoring, Intraoperative - methods Preoperative Care - methods Primary Prevention - methods Recurrent Laryngeal Nerve - physiology Recurrent Laryngeal Nerve Injuries - prevention & control Retrospective Studies Thyroid Gland - innervation Thyroid Gland - surgery Thyroidectomy - adverse effects Thyroidectomy - methods Treatment Outcome Vagus Nerve - physiology Vocal Cord Paralysis - prevention & control |
Title | The electrophysiology of thyroid surgery: electrophysiologic and muscular responses with stimulation of the vagus nerve, recurrent laryngeal nerve, and external branch of the superior laryngeal nerve |
URI | https://www.ncbi.nlm.nih.gov/pubmed/27374859 |
Volume | 127 |
hasFullText | |
inHoldings | 1 |
isFullTextHit | |
isPrint | |
link | http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwnV1Lb9QwELa2ICEuiPcb-cCtZMnGyTrhhipQhdieWqm3ynbsEqlJVukuUvsH-1_4Fcz4kURZQMAliuJ4tNn5MuNxZr4h5C2Tpsy14ZEqFYuwvXEkIOiJVCrKZSIZZynWDq-Olocn6ZfT7HQ2-zHKWtpu5Fxd_7Ku5H-0CtdAr1gl-w-a7YXCBTgH_cIRNAzHv9ax72Njdygcn5L96n_VtVW5f-mKnm37ncl9nqe13vpM1M4ly2pf7gZvfu07e4U0gu_iHNlcMUUSFdPhTr3ldoLpV805MhT3gyg6EEzvS2ze8S2IudwiuXLbTaeNl8n4YF_tcGvLZvq0oap0TgH7-jV6KMYQnfQdxES91RdDGuRB1YDnW4uLunKlSZuNbgdxrll9h1ZuNd4AAafaZ4DNdTDaEAcXrllnb9Ud5YCHLxvZaO5o03d8h-OixWefQ1jpeEBHIFrXFkWw3ONp7ljM_zw64fEOQ3tkj-fYZOQI95X89y7Osrgnz03eDz8Cyar9xEngYxdAx_fJPR-50I8Ohg_ITDcPyZ2Vz814RG5AaXQHjbQ11KORejR-2LmrUhQAQwMWaY9FilikIyw6cZpaLFKLm3e0RyLtIRWGUGz4g6jDYRARcDid9JicfP50fHAY-TYhkWIZ5xEE5OAkYWUdx1oLoYRJl6mAhahSYHpkWoIpSo0wRohcGamKkumsLISKTZapvEiekFtN2-hnhJrYiCRZLFTJs1Qy8MA6KZayACkLZrLFc_LUqeBs7bhgzoJyXvx25CW5O6D2FbltwPjo17CS3cg3FgQ_AQlHr0U |
link.rule.ids | 780 |
linkProvider | National Library of Medicine |
openUrl | ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info%3Asid%2Fsummon.serialssolutions.com&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=The+electrophysiology+of+thyroid+surgery%3A+electrophysiologic+and+muscular+responses+with+stimulation+of+the+vagus+nerve%2C+recurrent+laryngeal+nerve%2C+and+external+branch+of+the+superior+laryngeal+nerve&rft.jtitle=The+Laryngoscope&rft.au=Liddy%2C+Whitney&rft.au=Barber%2C+Samuel+R&rft.au=Cinquepalmi%2C+Matteo&rft.au=Lin%2C+Brian+M&rft.date=2017-03-01&rft.eissn=1531-4995&rft.volume=127&rft.issue=3&rft.spage=764&rft_id=info:doi/10.1002%2Flary.26147&rft_id=info%3Apmid%2F27374859&rft_id=info%3Apmid%2F27374859&rft.externalDocID=27374859 |