Academic Journal
Unintended Consequences: Vagal Nerve Injury During Continuous Neuromonitoring in Thyroidectomy.
| Τίτλος: | Unintended Consequences: Vagal Nerve Injury During Continuous Neuromonitoring in Thyroidectomy. |
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| Συγγραφείς: | Zhang D; Division of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Thyroid Disease, Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine on Differentiated Thyroid Carcinoma, Changchun City, Jilin Province, China., Brucchi F; Division of General Surgery, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Auxologico Italiano, Milan, Italy.; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy., Colombo C; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.; Division of Endocrinology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Auxologico Italiano, Milan, Italy., Dionigi G; Division of General Surgery, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Auxologico Italiano, Milan, Italy.; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy., Sun H; Division of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Thyroid Disease, Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine on Differentiated Thyroid Carcinoma, Changchun City, Jilin Province, China. |
| Πηγή: | Head & neck [Head Neck] 2026 Oct; Vol. 48 (10), pp. 2627-2637. Date of Electronic Publication: 2026 Apr 09. |
| Τύπος έκδοσης: | Journal Article |
| Γλώσσα: | English |
| Στοιχεία περιοδικού: | Publisher: John Wiley And Sons Country of Publication: United States NLM ID: 8902541 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1097-0347 (Electronic) Linking ISSN: 10433074 NLM ISO Abbreviation: Head Neck Subsets: MEDLINE |
| Imprint Name(s): | Publication: New York, NY : John Wiley And Sons Original Publication: New York, NY : J. Wiley, c1989- |
| Ιατρικοί όροι (MeSH): | Thyroidectomy*/adverse effects , Thyroidectomy*/methods , Vagus Nerve Injuries*/etiology , Vagus Nerve Injuries*/epidemiology , Vagus Nerve Injuries*/prevention & control , Vocal Cord Paralysis*/etiology , Monitoring, Intraoperative*/adverse effects , Intraoperative Neurophysiological Monitoring*/adverse effects , Intraoperative Complications*/etiology, Humans ; Female ; Retrospective Studies ; Electromyography ; Middle Aged ; Male ; Adult ; Aged ; Laryngoscopy |
| Περίληψη: | Objective: To characterize the patterns, mechanisms, and outcomes of vagus nerve (VN) injury associated with continuous intraoperative neuromonitoring (CIONM) during total thyroidectomy and to outline prevention strategies. Data Sources: A prospectively maintained thyroidectomy database (2014-2024), operative records, anesthesia charts, intraoperative electromyography (EMG) data, and standardized postoperative laryngoscopy. Review Methods: Retrospective identification of all postoperative VN injuries following total thyroidectomy with CIONM. VN injury was defined as new ipsilateral vocal fold palsy with abrupt or marked VN EMG loss not attributable to recurrent laryngeal nerve (RLN) trauma, confirmed by absent proximal and preserved distal stimulation. Variables included demographics, surgical approach, device type, VN topography, timing and mechanism of injury, EMG pattern, and recovery to 180 days. Incidence was calculated per nerve at risk. Analyses were descriptive. Results: Among 1060 thyroidectomies (2120 nerves at risk), nine VN injuries occurred (0.42%). Eight were transient and one permanent. Most injuries (89%) arose during initial carotid sheath dissection or probe application, particularly in posterior VN positions or short, thick necks. Older circumferential probes were more often involved. All lesions were segmental with preserved RLN EMG. No global VN damage, macroscopic disruption, thermal injury, or intraoperative hemodynamic instability was observed. Complete EMG loss predicted the only permanent palsy; partial amplitude/latency changes resolved. Early recognition, stopping manipulation, and timely voice therapy supported recovery. Conclusion: CIONM-related VN injury rate is low (0.4%), and most cases recovered in approximately 4 months. CIONM-related VN injury is usually related to nerve exposure rather than probe handling. (© 2026 Wiley Periodicals LLC.) |
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| Contributed Indexing: | Keywords: continuous intraoperative neuromonitoring; dysphonia; thyroidectomy; vagus nerve injury |
| Entry Date(s): | Date Created: 20260410 Date Completed: 20260922 Latest Revision: 20260922 |
| Update Code: | 20260922 |
| DOI: | 10.1002/hed.70276 |
| PMID: | 41958016 |
| Βάση Δεδομένων: | MEDLINE |
| ISSN: | 1097-0347 |
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| DOI: | 10.1002/hed.70276 |