Intraoperative monitoring of the recurrent laryngeal nerve during thyroid surgery in childhood

Background. Benign or malignant thyroid diseases are often treated surgically in adults and children. Intraoperative damage to the recurrent laryngeal nerve (RLN) is a common and severe complication. In adult surgery, therefore, the intraoperative monitoring (IOM) of the RLN has been used for several years. The question is whether this method can be used in paediatric surgery for the identification and functional control of integrity of the RLN. Methods. Surgical treatment of benign (9x) or malignant (1x) thyroid diseases was performed in ten children with 16 nerves at risk (NAR). The function of the vocal cord was controlled in all children before and after surgical treatment. Intraoperative identification and functional control of the recurrent nerve was performed using Neurosign 100 and placing a need le-electrode transligamentous into the vocal muscle. All results before and after resection of the thyroid gland were documented Results. Clear and reliable identification of the RLN was possible in all cases. All NAR showed an unchanged physiological nerve signal before and after surgical resection of the thyroid gland. However, in one young patient postoperative control of the vocal cord revealed a partial paralysis despite the unchanged intraoperative signal of the RLN. Control after a period of 6 months in this patient was normal. Conclusion. IOM of the RLN can be used easily in paediatric surgery. A clear and positive identification of the RLN was possible in all patients. Therefore, IOM of the RLN could be a helpful and easy method for the prevention of intraoperative damage to the RLN during thyroid surgery in childhood.