Intraoperative pediatric laryngeal electromyography: Experience and caveats with monopolar electrodes

We report our experience with intraoperative laryngeal electromyography (L- EMG) using direct laryngoscopy and placement of monopolar electrodes under general anesthesia in the evaluation and management of laryngeal dysfunctio n in pediatric patients. Tn this series of case studies, we present clinica l data on 30 pediatric patients with known or suspected anatomic or neurolo gic laryngotracheal disorders evaluated with placement of shielded monopola r electrodes into the thyroarytenoid muscles during direct laryngoscopy und er general anesthesia. Diagnoses included congenital vocal fold paralysis ( VFP), laryngotracheal stenosis, cerebral palsy, laryngeal tumors, traumatic vocal fold dysfunction, and postsurgical VFP. The impact of L-EMG on patie nt management was assessed. We found that L-EMG objectively supported clini cal findings, but provided new objective data relevant toward management re commendations in only a few selected pediatric patients with new-onset voca l fold paralysis or paresis or infiltrative laryngeal tumors, and in select ed postsurgical cases involving decannulation decisions. The prognostic uti lity of L-EMG in newborns with congenital VFP has not been established. A n ormal L-EMG recording indicates an intact neuromuscular axis, but does: not guarantee vocal fold mobility or guarantee muscle function in a partially denervated or deconditioned muscle. The potential for false-negative record ings is the major limitation of this technique.