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Start date: 2010End date: 2019Has files: NoAuthor: search.filters.author.Isgor, AdnanItem Type: PublicationType: search.filters.itemtype.Proceedings Paper

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    Is intraoperative neural monitoring necessary for exploration of the superior laryngeal nerve?
    (MOSBY-ELSEVIER, 2017) Uludag, Mehmet; Aygun, Nurcihan; Kartal, Kinyas; Besler, Evren; Isgor, Adnan; Istanbul Sisli Hamidiye Etfal Training & Research Hospital; Bahcesehir University
    Background. We aimed to evaluate the contribution of intraoperative neuromonitoring to the visual and functional identification of the external branch of the superior laryngeal nerve and the effect on postoperative voice changes. Methods. The prospective data of 221 patients (183 women, 38 men) who underwent thyroid operation with intraoperative neuromonitoring for exploration of the external branch of the superior laryngeal nerve were evaluated retrospectively. The surface endotracheal tube-ased Medtronic NIM3 (Medtronic, Jacksonville, FL) intraoperative neuromonitoring device was used. The function of the external branch of the superior laryngeal nerve was evaluated by cricothyroid muscle twitch. Additionally, the contribution of the external branch of the superior laryngeal nerve to vocal cord adduction was evaluated using electromyographic records. Results. A total of 374 (95.2%) of 393 external branch of the superior laryngeal nerves were identified, 145 (36.9%) external branch of the superior laryngeal nerves were identified visually before being stimulated with a probe, and 130 (33.1 %) external branch of the superior laryngeal nerves were identified visually after being identified with a probe. Although 99 (25.2%) external branch of the superior laryngeal nerves were identified with a probe, they were not visualized. Intraoperative neuromonitoring provided meaningful contributions to visual (P = .001) and functional (P = .001) identification of the external branch of the superior laryngeal nerve. Positive electromyographic responses were recorded from 257 external branch of the superior laryngeal nerves (68.7 %). After the patients with recurrent laryngeal nerve palsy were excluded, voice changes were detected in 6 (3.3 %) of 184 patients with identified external branch of the superior laryngeal nerves and 3 (20%) of 15 patients in whom at least 1 external branch of the superior laryngeal nerve could not be identified with intraoperative neuromonitoring. Conclusion. Intraoperative neuromonitoring provided an important contribution to the visual and functional identification of the external branch of the superior laryngeal nerve. Intraoperative neuromonitoring is a helpful adjunct for identifying the external branch of the superior laryngeal nerve.
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    Motor function of the recurrent laryngeal nerve: Sometimes motor fibers are also located in the posterior branch
    (MOSBY-ELSEVIER, 2016) Uludag, Mehmet; Aygun, Nurcihan; Isgor, Adnan; Istanbul Sisli Hamidiye Etfal Training & Research Hospital; Bahcesehir University
    Background. The function of the extralaryngeal branches of the recurrent laryngeal nerve (RLN) has yet to be described precisely. The goal of this study was to evaluate the incidence and motor function of the extralaryngeal branches of the RLN. Methods. Our study group consisted of 335 consecutive patients undergoing thyroid and parathyroid operations in whom the branches of the RLNs (n = 200) were evaluated with intraoperative nerve monitoring and by measuring the distance from the point of branching of the RLN into anterior and posterior branches and the entry of the individual branches into the larynx defined as the branching distance. Anterior and posterior branches of the RLN were assessed separately by electromyography (using a standard electromyography endotracheal tube) for adduction and by finger palpation for abduction. The RLNs were classified as having motor function only in the anterior branches (Group 1) or function both in the anterior and posterior branches (Group 2). Results. There were 185 RLNs in Group I and 15 RLNs in Group 2 assessed by intraoperative nerve monitoring. Motor function was detected in all anterior branches of the RLN (100%) and in 8% of the posterior branches. The mean branching distance was greater in Group 2 compared with Group 1 (24.1 +/- 13.6 mm, 17.3 +/- 8.5 mm, respectively, P = .045). Conclusion. Although the anterior branch of RLN always has motor function, the posterior branch also has motor function in about 8% of patients. The probability of detecting motor function in the posterior branch was greater among early branching RLNs, which have a greater branching distance. The surgeon should remember that posterior branches may contain motor fibers and protect these branches to avoid postoperative vocal cord dysfunction.