Prospective analysis of the efficacy of continuous intraoperative nerve monitoring during thyroidectomy, parathyroidectomy, and parotidectomy

OBJECTIVE: Continuous intraoperative electromyographic monitoring was prosp ectively performed in ail parotidectomies, thyroidectomies, and parathyroid ectomies over approximately 5 years to assess the efficacy of this technolo gy. STUDY DESIGN AND SETTING: Continuous intraoperative nerve monitoring with p erioperative nerve assessment was performed, The postresection minimal stim ulation level of the nerves was determined to evaluate if this level would predict nerve function postoperatively, RESULTS: Forty-four parotidectomies and 70 thyroid/parathyroid operations w ere performed with 140 nerves at risk (44 facial, 96 recurrent laryngeal). The incidence of temporary facial paralysis was 15.9% (7 of 44) and the inc idence of permanent paralysis was 0%. The incidence of temporary recurrent laryngeal nerve paralysis in terms of nerves at risk was 1.0% (1 of 96), an d the incidence of permanent recurrent laryngeal nerve paralysis was 0%. Al l patients with normally functioning facial and recurrent laryngeal nerves postoperatively had minimal stimulation levels less than or equal to 0.4 mA , CONCLUSION: Continuous Intraoperative nerve monitoring was associated with extremely low rates of temporary and permanent nerve paralysis in our serie s of 140 nerves at risk as compared to the rates documented in the literatu re.