Evidence map›Paper›PMID 36034434›Full record

ArticleFrontiers in endocrinology2022

Intraoperative EMG recovery patterns and outcomes after RLN traction-related amplitude decrease during monitored thyroidectomy.

Kuan-Lin Chiu, Ching-Feng Lien, Chih-Chun Wang, Chien-Chung Wang, Tzer-Zen Hwang, Yu-Chen Shih, Wing-Hei Viola Yu, Che-Wei Wu, Gianlorenzo Dionigi, Tzu-Yen Huang and 1 more

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In one paragraph

Article in Frontiers in endocrinology, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
1.7field-weighted citation impact, top 16% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed, 8 citations in OpenAlex.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors at 5 institutions in 2 countries.

Kuan-Lin ChiuDepartment of Otolaryngology-Head and Neck Surgery, E-Da Hospital, Kaohsiung, Taiwan.
Ching-Feng LienDepartment of Otolaryngology-Head and Neck Surgery, E-Da Hospital, Kaohsiung, Taiwan.
Chih-Chun WangDepartment of Otolaryngology-Head and Neck Surgery, E-Da Hospital, Kaohsiung, Taiwan.
Chien-Chung WangDepartment of Otolaryngology-Head and Neck Surgery, E-Da Hospital, Kaohsiung, Taiwan.
Tzer-Zen HwangDepartment of Otolaryngology-Head and Neck Surgery, E-Da Hospital, Kaohsiung, Taiwan.
Yu-Chen ShihDepartment of Otolaryngology, E-Da Cancer Hospital, Kaohsiung, Taiwan.
Wing-Hei Viola YuDepartment of Otorhinolaryngology-Head and Neck Surgery, International Thyroid Surgery Center, Kaohsiung Medical University Hospital, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
Che-Wei WuDepartment of Otorhinolaryngology-Head and Neck Surgery, International Thyroid Surgery Center, Kaohsiung Medical University Hospital, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
Gianlorenzo DionigiDivision of General Surgery, Endocrine Surgery Section, Istituto Auxologico Italiano IRCCS, Milan, Italy.
Tzu-Yen HuangDepartment of Otorhinolaryngology-Head and Neck Surgery, International Thyroid Surgery Center, Kaohsiung Medical University Hospital, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
Feng-Yu ChiangDepartment of Otolaryngology-Head and Neck Surgery, E-Da Hospital, Kaohsiung, Taiwan.
E-Da Hospital · TWI-Shou University · TWKaohsiung Medical University · TWKaohsiung Medical University Chung-Ho Memorial Hospital · TWUniversity of Milan · IT

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Objectives: Traction injury is the most common type of recurrent laryngeal nerve (RLN) injury in thyroid surgery. Intraoperative neuromonitoring (IONM) facilitates early detection of adverse electromyography (EMG) effect, and this corrective maneuver can reduce severe and repeated nerve injury. This study aimed to evaluate intraoperative patterns and outcomes of EMG decrease and recovery by traction injury. Methods: 644 patients received nerve monitored thyroidectomy with 1142 RLNs at risk were enrolled. Intermittent IONM with stimulating dissecting instrument (real-time during surgical procedure) and trans-thyroid cartilage EMG recording method (without electrode malpositioning issue) were used for nerve stimulation and signal recording. When an EMG amplitude showed a decrease of >50% during RLN dissection, the surgical maneuver was paused immediately. Nerve dissection was restarted when the EMG amplitude was stable. Results: 44/1142 (3.9%) RLNs exhibited a >50% EMG amplitude decrease during RLN dissection and all (100%) showed gradual progressive amplitude recovery within a few minutes after releasing thyroid traction (10 recovered from LOS; 34 recovered from a 51-90% amplitude decrease). Three EMG recovery patterns were noted, A-complete EMG recovery (n=14, 32%); B-incomplete EMG recovery with an injury point (n=16, 36%); C-incomplete EMG recovery without an injury point (n=14, 32%). Patients with postoperative weak or fixed vocal cord mobility in A, B, and C were 0(0%), 7(44%), and 2(14%), respectively. Complete EMG recovery was found in 14 nerves, and incomplete recovery was found in another 30 nerves. Temporary vocal cord palsy was found in 6 nerves due to unavoidable repeated traction. Conclusion: Early detection of traction-related RLN amplitude decrease allows monitoring of intraoperative EMG signal recovery during thyroid surgery. Different recovery patterns show different vocal cord function outcomes. To elucidate the recovery patterns can assist surgeons in the intraoperative decision making and postoperative management.

Indexed as

Recurrent Laryngeal Nerve InjuriesVocal Cord ParalysisElectromyographyHumansThyroidectomyTractionelectromyography (EMG)intraoperative neuromonitoring (IONM)recurrent laryngeal nerve (RLN)thyroid surgerytraction injury

Identifiers

PMID36034434
PMCPMC9403328
OpenAlexW4292729122

What OpenQuestion holds

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LicenceCC BY
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.