Neuromonitorización intraoperatoria y pronóstico de la motilidad laríngea tras cirugía de tiroides

  1. Pardal Refoyo, José Luis
  2. Ochoa Sangrador, Carlos
  3. Cuello Azcárate, Jesús Javier
  4. Martín Almendra, María Ángeles
Revue:
Revista ORL

ISSN: 2444-7986,  2444-7986

Année de publication: 2013

Volumen: 4

Pages: 96-105

Type: Article

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D'autres publications dans: Revista ORL

Résumé

Introduction and objectives: Neuromonitoring helps in identifying the recurrent laryngeal nerve (RLN) in thyroid surgery, reports on its functioning at the end of surgery and supports decision making. Objective: To estimate the validity of neuromonitoring with regard to postoperative laryngeal motility verified with indirect laryngoscopy. Methods: A prospective study in 185 patients (342 RLN included) undergoing first intervention of partial or total thyroidectomy. We collected qualitative variables of neuromonitoring (presence or absence of final signal after stimulation of the vagus nerve) and postoperative indirect laryngoscopy (normal motility or paralysis) performed on the 1st to 3rd day (laryngoscopy 1) and from 3rd to 4th week (laryngoscopy 2).Results: The accuracy of the test was 99.7% in laryngoscopy 1 and 98.8% in laryngoscopy 2. The positive predictive value (100%) shows the high ability of neuromonitoring to predict paralysis in case of loss of signal and the negative predictive value (99.7% in laryngoscopy 1 and 98.12% in laryngoscopy 2) indicates its predictive capacity for normal motility when there is a normal signal. Conclusions: Neuromonitoring is useful for planning and deciding different strategies in case of signal loss or if there was prior laryngeal paralysis. It is also useful in management of the airway to assist the prevention of bilateral laryngeal paralysis.

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