Monitoring ENT Procedures
Intraoperative neurophysiological monitoring (IOM) is used during surgeries of the head and neck, procedures to remove tumors of the thyroid, parathyroid, and parotid glands that put cranial nerves at risk, specifically the recurrent laryngeal nerve (RLN) (branch of CNX) and the facial nerve (Dionigi et al. Surg Technol Int 19:25–37, 2010). Monitoring and testing of the cranial nerves at risk accomplishes three goals: (1) to identify the nerve within the surgical field for the purposes of aiding the surgeon in avoiding damage to the nerve during the procedure, (2) to monitor the nerve during the course of the procedure in order to provide real-time feedback to the surgeon about the activity of the nerve, and (3) to provide the surgeon with a prognostic indicator of postoperative nerve function by assessing the stimulation threshold of the nerve at the end of the procedure (Randolph et al. Laryngoscope 121 Suppl 1:S1–16, 2011). These three goals of IOM for ENT procedures contribute to the overall mission of IOM to reduce the incidence of iatrogenic neurological injury. This chapter discusses practical applications of intraoperative monitoring for thyroidectomy, parathyroidectomy, and parotidectomy.
KeywordsIschemia RLN Facial nerve Thyroidectomy Lidocaine Hyperthyroidism Goiter
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