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Case Reports
. 2025 Apr;47(4):E46-E49.
doi: 10.1002/hed.28038. Epub 2024 Dec 18.

Role of the Laryngeal Adductor Reflex in the Prevention of Thermal Injury to the Recurrent Laryngeal Nerve in Thyroid Surgery: A Case Report

M Ángeles Sánchez Roldán  1   2 , Dulce Moncho  1 , Mercedes Velasco  3 , E Madalina Petriman  3 , Héctor Duque  4 , Ramón Vilallonga  2   5 , Manuel Armengol  2   5 , Óscar González  5
Affiliations
Case Reports

Role of the Laryngeal Adductor Reflex in the Prevention of Thermal Injury to the Recurrent Laryngeal Nerve in Thyroid Surgery: A Case Report

M Ángeles Sánchez Roldán et al. Head Neck. 2025 Apr.

Abstract

Background: Intraoperative neuromonitoring (IONM) of the recurrent laryngeal nerve (RLN) aims to detect and prevent iatrogenic damage during thyroid surgery. Mechanisms of injury include traction, heat damage, and nerve transection. Continuous IONM (C-IONM) techniques detect impending damage due to traction and heat related when they are still reversible.

Methods: We present a 73-year-old woman who underwent a total thyroidectomy due to a goiter. The IONM included intermittent IONM (I-IONM) in combination with C-IONM using the laryngeal adductor reflex (LAR). The intraoperative neurophysiological signals recorded were correlated with the surgical maneuver and the postoperative evaluation.

Results: During surgery, a significant decrease in left LAR amplitude was observed, coinciding with the use of the harmonic. After some corrective maneuvers, the intraoperative signals recovered, and the postoperative examination showed adequate VF function.

Conclusions: C-IONM of the RLN using the LAR can be a valuable tool for detecting and preventing thermal spread injury during thyroid surgery.

Keywords: continuous intraoperative monitoring; heat injury; laryngeal adductor reflex; recurrent laryngeal nerve; thyroid surgery.

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References

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