Int J Thyroidol.  2022 Nov;15(2):140-143. 10.11106/ijt.2022.15.2.140.

Intraoperative Neuromonitoring with Adhesive Skin Electrodes for a Patient with Papillary Thyroid Carcinoma with Lateral Neck Metastasis: a Case Report

• Kim YJ
• Lee DW
• Lee KD
• Lee HS

• KMID: 2536502
• DOI: http://doi.org/10.11106/ijt.2022.15.2.140

Abstract

Intraoperative neuromonitoring (IONM) of recurrent laryngeal nerve during thyroidectomy has been widely applied worldwide. Adhesive skin electrodes have been recently suggested as an alternative to applying electromyography (EMG) tube during IONM. However, it has been considered that application of adhesive skin electrodes for IONM may be limited in cases when wide extent of skin flap elevation is required. Up to this date, there has been no study presenting the feasibility of applying skin electrodes for IONM during concomitant thyroidectomy and lateral neck dissection in patients with thyroid cancer. In this study, we report a successful application of adhesive skin electrodes for IONM of recurrent laryngeal nerve during thyroidectomy conducted with lateral neck dissection.

Keyword

Eletromyography; Neck dissection; Electrodes

Figure

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  Fig. 1 The preoperative ultrasonography (A) shows a 6 mm sized hypoechoic thyroid nodule abutting to the posterior capsule, located in right middle portion of thyroid. The CT scan (B) shows a 1.3 cm sized enhancing lymph node with calcifications (arrow) between the common carotid artery and the internal jugular vein at right supraclavicular area.

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  Fig. 2 Photographs of surgical procedure. (A) A pair of disposable pre-gelled surface electrodes were attached to the skin at both lateral margins of the thyroid cartilage. (B) Lateral neck dissection was performed at the right neck, with minimal flap elevation over the thyroid cartilage. (C) During thyroidectomy, the recurrent laryngeal nerve (black arrowhead – distal portion, white arrowhead – proximal portion) was well-exposed and confirmed using intraoperative nerve monitoring.

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  Fig. 3 Electromyogram (EMG) signals at each stage of intraoperative neuromonitoring procedure (V1-R1-R2p-R2d-V2).

Reference

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