Recurrent Laryngeal Nerve Monitoring
One of the most important structures encountered during thyroid surgery for benign or cancerous tumors is the recurrent laryngeal nerve (the nerve to the voice box). Identifying and preserving this nerve is the goal of every experienced thyroid surgeon. However, in some circumstances identification may prove difficult because of dense scar tissue, variable anatomy, inflammation or displacement by the tumor, or an enlarged goiter. Some surgeons use a technique called "nerve monitoring" during surgery. The basic idea is to stimulate the nerve with a small amount of electric stimulation and evaluate movement of the vocal cords to confirm that the recurrent laryngeal nerve is present. Nerve monitoring can also be used to find and preserve a much smaller nerve - the external branch of the superior laryngeal nerve - during thyroid surgery. According to the few published studies on this topic, it has not been proven that nerve monitoring prevents injuries to the recurrent laryngeal nerve. And it appears that surgeon experience and the nature of the thyroid disease are the most important predictors. Nevertheless, it remains a useful technique for individual patients and surgeons. Whether this technique may be helpful, or should be used in a particular surgery, should be discussed with your own surgeon.