Intraoperative electromyographic identification of the recurrent laryngeal nerve

Background: Recurrent nerve palsy is the most important complication of thyroid surgery. Correct identification of the nerve during the surgical procedure is essential to avoid damage. Method: We evaluated the intraoperative electromyographic identification procedure of the recurrent laryngeal nerves in 77 consecutive patients. The operations performed were 63 subtotal resections, 6 hemithyroidectomies. 4 hemithyroidectomies in combination with subtotal resection of the opposite side and 4 thyroidectomies. Results: Identification of the recurrent laryngeal nerve by electrophysiologic nerve stimulation was successful in 97.4%. Recurrent nerve palsy was not seen in postoperative laryngoscopic control. Conclusions: Intraoperative electromyography improves the identification rate of the recurrent laryngeal nerve and allows electrophysiologic verification of nerve function as a result of injury to the thyroid.