Does the Use of Intraoperative Neuromonitoring during Thyroid and Parathyroid Surgery Reduce the Incidence of Recurrent Laryngeal Nerve Injuries? A Systematic Review and Meta-Analysis
The recurrent laryngeal nerve (RLN) innervates the intrinsic muscles of the larynx, excluding the cricothyroid, and is crucial for producing sound. Injury to the RLN can lead to weakness or paralysis of the vocal cord on the same side. Unilateral paralysis can significantly affect voice quality, while bilateral paralysis may result in asphyxiation. Additionally, the RLN has branches that provide sensory innervation to the laryngeal mucosa below the vocal cords; disruption of this function can lead to aspiration. Even without severe complications, injuries to the RLN can adversely affect a patient’s quality of life. For surgeons, RLN injury is the primary cause of malpractice lawsuits associated with thyroid surgery.
Damage to the recurrent laryngeal nerve (RLN) can lead to serious complications during thyroid and parathyroid surgeries. Intraoperative neuromonitoring (IONM) has been suggested as a way to reduce the risk of RLN injuries, although the evidence is not consistent. To better understand the effectiveness of IONM, we conducted a meta-analysis. After establishing specific inclusion and exclusion criteria, we reviewed 60 studies, which included five randomized trials and eight non-randomized prospective studies.
The analysis found an odds ratio (OR) of 0.66 (95% CI [0.56, 0.79], p < 0.00001), indicating that IONM is more effective than visual identification in preventing permanent RLN injuries. Additionally, a more focused meta-analysis of studies using contemporaneous controls and routine postoperative laryngoscopy to detect RLN injuries—considered the most accurate method—showed an OR of 0.69 (95% CI [0.56, 0.84], p = 0.0003), further supporting the use of IONM. Based on these findings, it is highly advisable to use IONM during thyroid and parathyroid surgeries to improve patient outcomes.
https://www.mdpi.com/2075-4418/14/9/860
