Prevention of intraoperative injuries of the laryngeal nerves. Literature review and own data

Based on the recent literature data, analysis has been performed for causes of laryngeal nerve injuries and methods their prevention during thyroid surgery. Literature data demonstrate that over past 20 years incidence remained stable, from 0.1 to 3.0 % more. It does not tend decrease despite introduction neuromonitoring. The authors presented peculiarities monitoring recurrent nerves external branch superior options evaluating its results.
 own clinical material, comparative assessment number nature resulted phonation disorders after surgical treatment patients with goiter. first group consisted 208 who underwent only visual identification larynx To prevent nerve, method gradual separate ligation artery branches capsule was used. second involved 201 surgery using intraoperative neuromonitoring by author’s method.
 Analysis our material showed in they were almost 2.5 times less than surgeries nerves. established use enabled an increase identified reduction rate trauma, paresis disorders. emphasized replace nerves, but complements it. In complex cases, results are crucial making a technical decision surgery.
 amended topographic anatomical proportions organs anterior part neck different forms goiter create conditions possibility occurrence depend correctness surgeon’s actions adequacy situation. order these injuries, following important requirements surgeon technology performing should be considered: knowledge anatomy anterior, lateral parts neck, larynx, posterior mediastinum; possession elements sequence depending situation, particular cervical, thoracic, goiter, compression syndrome; dry operating field calm, without haste performance operation at adequate lighting. complicated situations tissue differentiation optics used as well intermittent or continuous neuromonitoring.