Intraoperative recurrent laryngeal nerve monitoring.

Intraoperative nerve monitoring has become common for surgical procedures in which cranial or peripheral nerves may be compromised. Intraoperative monitoring of recurrent laryngeal nerve function can be accomplished by recording electromyographic activity from fine-wire electrodes placed in the vocalis muscle. The technique and instrumentation for this are adapted from those used in intraoperative facial nerve monitoring for acoustic neuroma excision. Specifically, a commercially available instrument, the XOMED-NIM provides the capability for monitoring the vocalis muscle electromyogram by means of visual and auditory display. It also provides the capability for performing evoked electromyographic tests of nerve integrity. Intraoperative monitoring of the recurrent laryngeal nerve during thyroidectomy may assist in the more precise dissection of the nerve as well as in verification of nerve integrity during the operative procedure, thus reducing the risk of injury.