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Intraoperative Neural Injury Management: Neuropraxic Non-transection Injury

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The Recurrent and Superior Laryngeal Nerves

Abstract

During thyroid surgery, the macroscopically intact recurrent laryngeal nerve (RLN) may cease to function, even though it is not transected. Traction, cautery, pressure, crush, or being tied in surrounding tissue are some causes of impaired function during surgery. Invisible RLN injuries (such as thermal, traction, compression, contusion, or pressure) are not detected by the surgeon’s eye; only a functional assessment of the RLN with intraoperative nerve monitoring (IONM) can detect such insults. With the application of IONM, we appreciate that traction is the major cause of RLN injury during thyroid surgery.

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Authors and Affiliations

  1. 1st Division of Surgery, Department of Surgical Sciences and Human Morphology, University of Insubria, Viale Guicciardini 9, Varese, 21100, Italy

    Gianlorenzo Dionigi M.D., F.A.C.S., Ph.D.

  2. The Claire and John Bertucci Endowed Chair in Thyroid Surgery Oncology, Harvard Medical School, Boston, MA, USA

    Gregory W. Randolph M.D.

  3. Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology—Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA, USA

    Gregory W. Randolph M.D.

  4. Department of Surgery, Endocrine Surgery Service, Massachusetts General Hospital, Boston, MA, USA

    Gregory W. Randolph M.D.

  5. Department of Endocrine/Sarcoma Surgery/Institution of Clinical Neuroscience, Karolinska University Hospital/Karolinska Institutet, Stockholm, Sweden

    Per Mattsson M.D., Ph.D.

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  1. Gianlorenzo Dionigi M.D., F.A.C.S., Ph.D.
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  2. Gregory W. Randolph M.D.
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  3. Per Mattsson M.D., Ph.D.
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Correspondence to Gianlorenzo Dionigi M.D., F.A.C.S., Ph.D. .

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  1. The Claire and John Bertucci Endowed Cha, Harvard Medical School, Boston, Massachusetts, USA

    Gregory W. Randolph

Electronic Supplementary Material

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RLN segmental type 1 injury due to traction. Nerve injury is neither appreciated by surgeon eye nor by high definition endoscopy magnification. By means of IONM, the surgeon identifies the site of injury: the RLN loses stimulation proximal to the point of traction injury and retains nerve stimulation distal to the point of traction injury. Subsequent VN stimulation is negative (AVI 37675 kb)

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Dionigi, G., Randolph, G.W., Mattsson, P. (2016). Intraoperative Neural Injury Management: Neuropraxic Non-transection Injury. In: Randolph, G. (eds) The Recurrent and Superior Laryngeal Nerves. Springer, Cham. https://doi.org/10.1007/978-3-319-27727-1_20

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