Introduction: Thyroid surgery in children is associated with high risk of recurrent laryngeal nerves (RLN) damage. It is due to complex and variable anatomy, high bleeding which decreasing visualization and requiring instrumental hemostasis. Large goiters change of syntopy, metastatic process requires bigger aggression and volume of intervention. The risk of damage significantly increases during repeated operations due to the scar process. There is significant experience of intraoperative neuromonitoring in adult patients. Such studies in children are not sufficient, and recommendations are often automatic transferred from adult practice.
Aim: To evaluate the effectiveness of intraoperative neuromonitoring of the recurrent laryngeal nerves during thyroid surgery in children.
Materials and Methods: 33 children from seven to 17 years old were operated on: 32 with thyroid diseases and one with parathyroid carcinoma. Intraoperative neuromonitoring was performed for 32 children. During surgery, RLN were mapped by monopolar stimulating probe. Nerve conduction after mobilization was tested by bipolar stimulating probe. In all cases was control of the electrical conductivity from n. Vagus. All children underwent otolaryngology examination before and after the operation with an assessment of the vocal cords mobility.
Results: Stimulation level during nerve mapping in children should be lower (up to 1 mA) compared with adult patients (from 2 mA). This allows getting an answer to the impulse with more local stimulation. In two cases, the use of monopolar coagulation had a pronounced effect on equipment in the form of false answers. In 5 cases the signal was lost both through the recurrent laryngeal nerve as n. Vagus. In case of parathyroid carcinoma ipsilateral lost of signal led to a reduction of intervention volume to avoid bilateral paresis. Nerve damage level could be determined by stimulation on different sites. Characteristic, in all cases the nerve was not visually damaged. Otolaryngology examination confirmed partial unilateral paresis in all these cases. Clinically, paresis was not manifested by changes in voice. Significant positive dynamics to improve of the vocal cords mobility in injured site was noted after a course of phoniatric rehabilitation.
Conclusion: Intraoperative neuromonitoring in children does not reduce the number of paresis (15%). This allows to change the surgical tactics in time and more active way to conduct phoniatric rehabilitation. These circumstances, as well as the improvement of surgical techniques using neuromonitoring, give a hope for improving the results of surgical treatment of thyroid diseases in children.
19 - 21 Sep 2019
European Society for Paediatric Endocrinology