“IF THE VOCAL CORD (VOCAL CORD) IS THE ORCHESTRA, THE RECURRENT LARYNGEAL NERVE (VOCAL NERVES) IS THE CONDUCTOR OF THIS ORCHESTRA.”
Intraoperative Nerve Monitoring (IOSM) is the function of laryngeal nerve functions by stimulation of the nerve. It is the monitoring of the EMG recordings. The laryngeal nerve is responsible for speech and swallowing by connecting the brain to the larynx. In this method; First, the laryngeal nerve is found, the nerve and neighboring tissues are stimulated, and the nerve and its branches in the study area are tried to be revealed.
'Total Thyroidectomy' surgery is a surgery in which the thyroid gland is removed unilaterally or bilaterally, completely from the body. is the removal process. The Recurrent Laryngeal Nerve (RLS-voice nerve), which is the most important laryngeal nerve, anatomically originates from the Vagus nerve, which comes from the head and continues in the rib cage, and enters the neck again. Afterwards, it works in close cooperation with the trachea, esophagus and thyroid and brings stimulation to the vocal cords. Vocal cords are; They are functional structures inside our air pipes that allow us to breathe by opening and closing sideways and to make sounds by vibrating. Negative effects of RLN are one of the most serious complications of thyroid surgery. If the nerve damage is unilateral, problems ranging from changes in the character of the voice to hoarseness develop. In case of bilateral damage; Due to the inability to make sound and breathe following the end of the surgery, it may be necessary to insert a perforated tube into the air tube, that is, a "tracheostomy". It is understood that these undesirable conditions are temporary as they resolve within six months following the surgery. If it continues after this period, it should be considered that the problem will continue for the patient's life. These problems can disrupt the general quality of life by affecting both the person's social and business life, as well as their psychological state. It can cause voice-related problems to become more prominent, especially in individuals who use their voices in business life (voice artists, teachers, religious officials, etc.). Recent studies have shown that visualizing the RLN along its entire course in the neck at the surgical site significantly reduces the risk of nerve injury. Rates of permanent RLN injury range from 0.4 to 4 percent in various series. feature It is stated that the risk of permanent damage in secondary interventions for recurrent and residual tissue increases up to 20 percent.
IOSM contributes to the surgery being performed faster but safer. Constantly giving visual and auditory warnings to the surgical team creates positive feedback in terms of more careful application of the surgical technique. At the same time, it allows the detection of the nerve section that is visually intact but functionally damaged and allows nerve repair at the same time. IONM warns the surgeon to avoid a possible tracheostomy procedure if the procedure is continued on the opposite side if there is doubt about the RLN integrity in the strength test performed on one side.
IOSM' It should be kept in mind that this method is not a replacement for monitoring the nerve through anatomical knowledge and surgical experience, but is an auxiliary method that provides additional information regarding the movement-providing function of the nerve.
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