ISSN ONLINE: 2558-815X
ISSN PRINT: 1584-9244
ISSN-L: 1584-9244

Electrophysiological identification of nerves of the larynx among the tissuesof operative wound in goiter surgeries

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ABSTRACT
The objective of the study was to analyze the technology of electrophysiological identification of laryngeal nerves in goîter surgeries.
Methods: The technology of electrophysiological identification of laryngeal nerves in goiter surgeries was developed. It is based on the recording of changes in the sound vibrations generated by the passage of air through the voice gap, the area of which changes in the event of a change in the tension of vocal cords from electrostimulation of the laryngeal nerves. The greatest changes in the frequency and amplitude of sound vibrations occur when electrostimulation of tissues near the nerve and the nerve itself. This phenomenon allows to determine the location of the nerve and prevent its injury.
Results: The method was tested in 173 patients who had been operated for goiter. There were no cases of temporary or permanent disorders of phonation.

Conclusions: The developed technology of electrophysiological identification of laryngeal nerves in goiter surgeries is reliable, easy to apply, and is not expensive. The influence of other factors on its results was not noted.
Key words: intraoperative trauma of laryngeal nerves, prevention, electrophysiological identification.

INTRODUCTION 

Intraoperative injuries of the laryngeal recurrent nerves are the most common and serious complications of goiter surgeries. Their frequency ranges from 0.3 to 2.5 % (according to some authors – up to 12 %) and has no tendency to decrease. The number of nerve injuries increases to 11–20 % in surgeries for recurrent goiter and cancer1–3. Over the past 10–15 years, there were papers devoted to neuro-monitoring of the outer branch of the upper laryngeal nerve4–8. The analysis of publications on neuronal monitoring of the larynx nerves suggests that the methods of electrostimulation and monitoring used today do not allow reducing the frequency of its damage. In other words, their use is not a priority and, in comparison with the gold standard – the visualization of the larynx nerves, does not reduce the frequency of parestheses of the larynx and postoperative disorders of its vocal function. They are useful only to verify if the nerve is intact or damaged. Therefore, there were opinions that raise the question of the feasibility of such monitoring. After all, it does not reduce the frequency of nerve injuries, significantly prolongues the duration of the operation, and the expensive equipment used unjustifiably increases the cost of surgery8–10.

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