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The investigators hypothesized that, sometimes the posterior branch of the recurrent laryngeal nerve may also have motor function. The investigators aimed to evaluate motor function of the branches in the branching recurrent laryngeal nerves in this study.
This study group consisted of consecutive patients, undergoing thyroid and parathyroid surgery with IONM. Both anterior and posterior branches of the recurrent laryngeal nerves were assessed separately by both electromyography endotracheal tube for adduction and finger palpation for detection of laryngeal twitch due to posterior cricoarytenoid abduction. The recurrent laryngeal nerves having motor function only in the anterior branches were defined as group 1, whereas the nerves having motor function both in the anterior and posterior branches were as group 2.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Group 1 | Active Comparator | The RLNs having motor function on the anterior branch assessed by intraoperative neuromonitoring. |
|
| Group 2 | Active Comparator | RLNs having motor function on anterior and posterior branch assessed by intraoperative neuromonitoring. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| intraoperative neuromonitoring | Device | NIM-Response 3.0 Intraoperative Neuromonitoring System (Medtronic Xomed, Jacksonville, FL, USA) was used to record the EMG amplitude signal for the anterior and/or posterior branches of recurrent laryngeal nerves (RLNs). |
| Measure | Description | Time Frame |
|---|---|---|
| The evoked EMG potentials of the branches of the recurrent laryngeal nerves as microvolt, by intraoperative neuromonitoring. | The nerves , due to having motor functions whether on their anterior or posterior branches, were divided into two groups. The amplitudes of the anterior and posterior branches within the group 2 were compared. | intraoperative |
| Measure | Description | Time Frame |
|---|---|---|
| The diameters of the branches of the recurrent laryngeal nerves. | The branch diameters of the recurrent laryngeal nerves were compared between the two groups. | intraoperative |
| The branching distances of the recurrent laryngeal nerves. |
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Inclusion Criteria:
Exclusion Criteria:
Preoperative recurrent laryngeal nerve palsy,
Intentional nerve transection because of cancer invasion,
Assessment failure of recurrent laryngeal nerve function due to the deficiency of the intraoperative neuromonitoring equipment,.
Parathyroidectomy operations that recurrent laryngeal nerves were not fully dissected.
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| Name | Affiliation | Role |
|---|---|---|
| Adnan Isgor, Prof. | Bahcesehir University Medical Faculty, Department of General Surgery | Study Director |
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| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 26054316 | Result | Gurleyik E. Location of motor fibers within branches of the recurrent laryngeal nerve with extralaryngeal terminal bifurcation; Functional identification by intraoperative neuromonitoring. Surgery. 2015 Nov;158(5):1339-44. doi: 10.1016/j.surg.2015.04.019. Epub 2015 Jun 6. | |
| 24493270 | Result | Fontenot TE, Randolph GW, Friedlander PL, Masoodi H, Yola IM, Kandil E. Gender, race, and electrophysiologic characteristics of the branched recurrent laryngeal nerve. Laryngoscope. 2014 Oct;124(10):2433-7. doi: 10.1002/lary.24631. Epub 2014 Mar 25. |
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| Type | Date | Date Unknown |
|---|---|---|
| Release | Aug 9, 2015 | |
| Reset | Sep 8, 2015 | |
| Release | Sep 23, 2015 | |
| Unrelease | Yes | |
| Release | Oct 25, 2015 | |
| Reset | Nov 27, 2015 | |
| Release | Apr 26, 2016 | |
| Reset | Jun 2, 2016 | |
| Release | Aug 10, 2020 | |
| Reset | Aug 28, 2020 |
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| Release Date | Unrelease Date | Unrelease Date Unknown | Reset Date | MCP Release Number |
|---|---|---|---|---|
| Aug 9, 2015 | Sep 8, 2015 | |||
| Sep 23, 2015 |
| ID | Term |
|---|---|
| D061226 | Recurrent Laryngeal Nerve Injuries |
| ID | Term |
|---|---|
| D061224 | Laryngeal Nerve Injuries |
| D007818 | Laryngeal Diseases |
| D012140 | Respiratory Tract Diseases |
| D010038 | Otorhinolaryngologic Diseases |
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| ID | Term |
|---|---|
| D064795 | Intraoperative Neurophysiological Monitoring |
| ID | Term |
|---|---|
| D016343 | Monitoring, Intraoperative |
| D008991 | Monitoring, Physiologic |
| D019937 | Diagnostic Techniques and Procedures |
| D003933 | Diagnosis |
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The branching distances of the recurrent laryngeal nerves till the entry point into the larynx, were compared between the two groups.
| intraoperative |
| 19300223 | Result | Serpell JW, Yeung MJ, Grodski S. The motor fibers of the recurrent laryngeal nerve are located in the anterior extralaryngeal branch. Ann Surg. 2009 Apr;249(4):648-52. doi: 10.1097/SLA.0b013e31819ed9a4. |
| 21126710 | Result | Chiang FY, Lu IC, Chen HC, Chen HY, Tsai CJ, Hsiao PJ, Lee KW, Wu CW. Anatomical variations of recurrent laryngeal nerve during thyroid surgery: how to identify and handle the variations with intraoperative neuromonitoring. Kaohsiung J Med Sci. 2010 Nov;26(11):575-83. doi: 10.1016/S1607-551X(10)70089-9. |
| 19917921 | Result | Cernea CR, Hojaij FC, De Carlucci D Jr, Gotoda R, Plopper C, Vanderlei F, Brandao LG. Recurrent laryngeal nerve: a plexus rather than a nerve? Arch Otolaryngol Head Neck Surg. 2009 Nov;135(11):1098-102. doi: 10.1001/archoto.2009.151. |
| 19023612 | Result | Casella C, Pata G, Nascimbeni R, Mittempergher F, Salerni B. Does extralaryngeal branching have an impact on the rate of postoperative transient or permanent recurrent laryngeal nerve palsy? World J Surg. 2009 Feb;33(2):261-5. doi: 10.1007/s00268-008-9832-1. |
| 21497872 | Result | Kandil E, Abdel Khalek M, Aslam R, Friedlander P, Bellows CF, Slakey D. Recurrent laryngeal nerve: significance of the anterior extralaryngeal branch. Surgery. 2011 Jun;149(6):820-4. doi: 10.1016/j.surg.2011.02.012. Epub 2011 Apr 17. |
| 22136844 | Result | Kandil E, Abdelghani S, Friedlander P, Alrasheedi S, Tufano RP, Bellows CF, Slakey D. Motor and sensory branching of the recurrent laryngeal nerve in thyroid surgery. Surgery. 2011 Dec;150(6):1222-7. doi: 10.1016/j.surg.2011.09.002. |
| Yes |
| Oct 25, 2015 | Nov 27, 2015 |
| Apr 26, 2016 | Jun 2, 2016 |
| Aug 10, 2020 | Aug 28, 2020 |
| D061223 | Vagus Nerve Injuries |
| D020209 | Cranial Nerve Injuries |
| D003389 | Cranial Nerve Diseases |
| D009422 | Nervous System Diseases |
| D006259 | Craniocerebral Trauma |
| D020196 | Trauma, Nervous System |
| D014947 | Wounds and Injuries |
| D064926 | Neurophysiological Monitoring |
| D013514 | Surgical Procedures, Operative |