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Clinical application and results of the electrophysiological laryngeal nerves identification in surgeries in case of goiter

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ABSTRACT
Background. Analysis of the results of clinical application of the developed method of laryngeal nerves electrophysiological identification.
Material and methods. Electrophysiological identification of the recurrent and superior laryngeal nerves was performed intraoperatively in 200 patients operated on goiter. A total of 354 studies of laryngeal nerves were conducted to identify them. Among them, there were 45 unilateral researches and 308 bilateral.
Results. In the first region, nerves were identified in 327 cases and unidentified – in 27 cases. In the second region, among the tissues of the surgical wound, nerves were identified in 337 studies and unidentified – in 17. Regarding unidentified nerves in 3 patients on both sides, there were two cases of thyroid cancer and one – multinodular recurrent goiter. In the third section among 354 patients, the external branch of the superior laryngeal nerve was identified in 329 (92.9 %) and unidentified in 25. Unidentified nerves are those cases where the nerves are not electrophysiologically isolated among the tissues of the surgical wound, but clearly defined their places of passing. There were no intraoperative injuries of the laryngeal nerves.
Conclusions. The technology of intraoperative identification of the laryngeal nerves can identify both the recurrent and superior nerves of the larynx, or determine the probable areas of its passage and prevent their injuries during the surgery.
Key words: laryngeal injuries, prophylaxis, intraoperative electrophysiological identification, results.

INTRODUCTION
The frequency of injuries of the recurrent laryngeal nerves is from 0.3 to 12 % and, despite the application of different methods of neuromonitoring, has no tendency to decrease. In order to reduce the frequency of injuries of the recurrent and superior laryngeal nerves in surgeries regarding goiter, we developed a method of electrophysiological identification of the laryngeal nerves among the tissues of the surgical wound1,2. The analysis of clinical application and its results are presented in this work.
OBJECTIVE
Analysis of results of clinical application of the developed method of electrophysiological laryngeal nerves identification.
MATERIAL AND METHODS
Electrophysiological identification of the recurrent and superior laryngeal nerves was performed intraoperatively in 200 patients who underwent surgical intervention of goiter. Among them there were 14 men and 186 women aged 21 to 74 years. Indications for surgery in 46 cases were unilateral nodular goiter with compression syndrome; in 79 – bilateral nodular and in 11 – recurrent goiter with compression on the neck; in 21– cancer of the thyroid gland and in 43 – toxic goiter. A total of 354 studies was conducted on the identification of laryngeal nerves.

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