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Laryngeal nerve identification during thyroid surgery — feasibility of a novel approach

L’identification du nerf laryngé pendant l’opération de la thyroïde — la faisabilité d’une nouvelle approche



Recurrent laryngeal nerve damage remains one of the most devastating complications of thyroid surgery. However, nerve identification is not always easy and a reliable method to locate nerves intraoperatively is needed.


Thirty consecutive patients were anesthetized for elective thyroid surgery using a standard technique. Indications for surgery covered a broad spectrum of conditions. In the technique described, the airway is secured with a micro laryngeal tube, and a laryngeal mask airway is inserted through which a fibreoptic scope is inserted to view the larynx. Movement of the arytenoids in response to nerve stimulation can be viewed at any time on a television monitor. The airway is secure throughout the procedure and nerve identification is continuously available.


In our study 30 patients were anesthetized and nerve stimulation used in all of them to identify both superior and recurrent laryngeal nerve. None of them developed intraoperative complications. One patient had temporary postoperative recurrent laryngeal nerve damage, which was not attributable to use of this method.


On the basis of our results so far, the method described is feasible and provides a safe method of nerve location during surgery, Laryngeal nerve stimulation is likely to become an integral part of thyroid surgery.



Les dommages du nerf laryngé récurrent demeurent la complication la plus dévastatrice de l’opération de la thyroïde. Cependant, l’identification du nerf n’est pas toujours facile et il faut trouver une méthode de détection peropératoire fiable.


Trente patients successifs ont été anesthésiés pour une opération planifiée de la thyroïde selon une technique normalisée. Selon la technique utilisée, les voies aériennes sont protégées par une microsonde laryngée et un masque laryngé est inséré. Une sonde fibroscopique est aussi insérée, au travers du masque, pour visualiser le larynx. Des mouvements des cartilages aryténoïdes, en réponse à une stimulation nerveuse, peuvent être visualisés en permanence à l’écran et l’identification du nerf est toujours possible, car la perméabilité des voies aériennes est maintenue pendant toute l’opération.


La stimulation nerveuse a été utilisée chez les 30 patients anesthésiés de notre étude afin d’identifier les nerfs laryngé supérieur et récurrent. Aucune complication peropératoire n’est survenue. Un patient a subi un dommage postopératoire temporaire du nerf laryngé récurrent, non attribué à notre méthode d’identifcation.


D’après les résultats obtenus jusqu’à maintenant, la méthode décrite est faisable et permet une identification peropératoire du nerf sans danger. La stimulation du nerf laryngé pourrait donc être intégrée à l’opération de la thyroïde.


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Correspondence to Carl L. Hillermann.

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Hillermann, C.L., Tarpey, J. & Phillips, D.E. Laryngeal nerve identification during thyroid surgery — feasibility of a novel approach. Can J Anaesth 50, 189 (2003).

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  • Vocal Cord
  • Recurrent Laryngeal Nerve
  • Laryngeal Nerve
  • Thyroid Surgery
  • Laryngeal Mask Airway