Intraoperative neural injury management: Neuropraxic non-transection injury

Abstract

During thyroid surgery, the macroscopically intact recurrent laryngeal nerve (RLN) may cease to function, even though it is not transected. Traction, cautery, pressure, crush, or being tied in surrounding tissue are some causes of impaired function during surgery. Invisible RLN injuries (such as thermal, traction, compression, contusion, or pressure) are not detected by the surgeon's eye; only a functional assessment of the RLN with intraoperative nerve monitoring (IONM) can detect such insults. With the application of IONM, we appreciate that traction is the major cause of RLN injury during thyroid surgery.