Intra-operative neurophysiological monitoring of recurrent laryngeal nerveand microdissection. Operations technique procedures for reducing the riskof recurrent laryngeal nerve paresis.

Background: Frequently numerous recurrent laryngeal nerve injuries occur af ter operations on the thyroid glands. Compared with postoperative permanent hypocalcemia. unilateral and especially double-side recurrent paresis pose serious complication. As early as 1938 specialists [1] pleaded for a routi ne visualisation of the nervus recurrens in operations of the thyroid gland , to reduce the risk of permanently recurring paresis. In controversial dis cussions of the matter specialists have opted for a demonstration of the ne rve also under medico-legal aspects. Implementing functionally critical ope rational strategies requires the choice of an anatomically suitable operati ve procedure for the removal of morphological, functional and oncological c hanges, as well as the avoidance of complications. Method: Intra-operative Monitoring is highly recommendable as a neurophysiological method of superv ision combined with microdissection to ensure the safe handling of recurren t laryngeal nerve. Conclusion: The rate of permanent paresis on the recurre nt nerve can be lowered to less than 1 per cent when this is used as a rout ine procedure for all operations and the treatment of the thyroid gland dis eases.