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Review
. 2022 Mar;13(1):121-132.
doi: 10.1007/s13193-021-01348-y. Epub 2021 May 17.

Seeing Is Not Believing: Intraoperative Nerve Monitoring (IONM) in the Thyroid Surgery

Anuja Deshmukh  1 , Anand Ebin Thomas  2 , Harsh Dhar  3 , Parthiban Velayutham  4 , Gouri Pantvaidya  1 , Prathamesh Pai  1 , Devendra Chaukar  1
Affiliations
Review

Seeing Is Not Believing: Intraoperative Nerve Monitoring (IONM) in the Thyroid Surgery

Anuja Deshmukh et al. Indian J Surg Oncol. 2022 Mar.

Abstract

Ensuring the integrity of the recurrent laryngeal nerve (RLN), the external branch of superior laryngeal nerve (EBSLN) and preservation of normal voice are the prime 'functional' goals of thyroid surgery. More in-depth knowledge of neuronal mechanisms has revealed that anatomical integrity does not always translate into functional integrity. Despite meticulous dissection, neural injuries are not always predictable or visually evident. Intraoperative nerve monitoring (IONM) is designed to aid in nerve identification and early detection of functional impairment. With the evolution of technique, intermittent monitoring has given way to continuous-IONM. Over the years, IONM gathered both support and flak. Despite numerous randomised studies, systematic reviews, and meta-analyses, there still prevails a state of clinical equipoise concerning the utility of IONM and its cost-effectiveness. This article inspects the true usefulness of IONM, elaborates on the optimal way to practice it, and presents a critical literature review.

Keywords: IONM; IONM review; Intraoperative nerve monitoring; Thyroid surgery.

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Conflict of interest statement

Conflict of InterestNone of the authors have any conflict of interest with respect to this manuscript.

Figures

Fig. 1
Fig. 1
Operating room layout for IONM. Abbreviations: EMG, electromyogram; ETT, endo-tracheal tube
Fig. 2
Fig. 2
A V1 stimulation: to detect non-recurrent laryngeal nerve before dissection. Abbreviations: RLN, recurrent laryngeal nerve; NRLN, non-recurrent laryngeal nerve; I, IIA, and IIB: types of non-recurrent laryngeal nerve; ITA, inferior thyroid artery; Vagus N, vagus nerve. B Method of assessing the laryngeal twitch
Fig. 3
Fig. 3
Management algorithm for loss of signal (LOS). Abbreviations: RLN, recurrent laryngeal nerve
See this image and copyright information in PMC

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