Abstract:

The use of thyroidectomide intraoperative nerve monitoring (IONM) is increasing. IONM has obtained many data on the anatomy and nerve injuries of the larynx nerve, and they have made a significant contribution to the increase in thyroidectomy standards. These evidence: Recurren increases the detection of the laryngeal nerve (RLN), the visual identification. The most common anatomical variation of RLN increases the detection rate of the extra-alaringeal branches. The non-recurrent guarantees the early detection and preservation of the laryngal nerve. Important data on Larinxin complex engine inervation has been obtained. RLN or extralaringeal RLN branches may contribute to the motor inertia of the cryothyroid muscle. The front branch of the extra-ingular RLNs has a constant motor function and provides motor fiber to both the abductor and adductor muscles. In addition, up to 18% of the rear branches may also contain adductor and/or abductor motor fiber. SLSE provides motor inervation to the main addictor of the vocal cord through the human conjunctive nerve by 70% to 80% to the thyro-arythenoid muscle 1/3 front. In approximately 1/3 of cases, SLSE also contributes to the posterior krikoaritenoid muscle inervation, which is the main abductor muscle of the ipsilateral vocal cord. The major component of the upper ozephageal sphincterine is the motor inervation of the cryopharyngeal muscle, in addition to the pharyngeal plexus, which is usually contributed to RLN and/or SLSE. The most common cause of 67-93% of RLN injuries is traction trauma. More than 50% of SLSE injuries are nerve cuts. In the case of RLN injury, the situation where a specific injury point on the nerve is type 1 (segmental) signal loss, and when there is no electrophysically detectable injury point after injury, it is type 2 (global) signal loss throughout the ipsilateral vagus-RLN axis. If the signal loss develops, the signal loss persists when 20 minutes are expected, or if the signal improves incomplete, the 70%-80% vocal cord paralysis (VCP) develops, the complete signal improvement does not develop, the VCP does not develop. In patients with incomplete signal healing, VCP is temporary and no permanent VCP is observed. In 15% of RLN injuries there are visual changes, while IONM RLN can estimate 100% of injuries. IONM can prevent bilateral VCP. Continuous IONM (C-IONM) is a method superior to the interval IONM where the functional integrity of the vagus/RLN axis is assessed in real time. During the upper pol disection, IONM contributes significantly to the visual and functional determination of SLSE. Routine use of IONM can minimize the risk of nerve injury. A decrease of more than 50% in the cryothyroid muscle amplitude is associated with the poor sound results of the patient. (SETB-2021-05-159)