Monitoring ENT procedures

Abstract

Intraoperative neurophysiological monitoring (IOM) is used during procedures of the head and neck. Procedures to remove tumors of the thyroid, parathyroid, and parotid glands put cranial nerves at risk, specifically the recurrent laryngeal nerve (RLN) (branch of CNX) and the facial nerve [1]. Electrophysiological testing and monitoring of the cranial nerves at risk accomplishes three goals: (1) to identify the nerve within the surgical field for the purposes of aiding the surgeon in avoiding damage to the nerve during the procedure, (2) to monitor the nerve during the course of the procedure in order to provide real-time feedback to the surgeon about the activity of the nerve, and (3) to provide the surgeon with a prognostic indicator of postoperative nerve function by assessing the stimulation threshold of the nerve at the end of the procedure [2]. These three goals of IOM for ENT procedures contribute to the overall mission of IOM to reduce the incidence of iatrogenic neurological injury. This chapter discusses practical applications of intraoperative monitoring for thyroidectomy, parathyroidectomy, and parotidectomy.