Utilizing Surgeon-Performed Intraoperative Translaryngeal Ultrasound for Verifying Vocal Fold Function: A Troubleshooting Approach for Intraoperative Neuromonitoring in Neck Surgery

Hakan Balbaloglu; Emre Karadeniz; Ahmet Erkek; Cem Yilmaz; Mustafa Umit Ugurlu; Guldeniz Karadeniz Cakmak

doi:10.1016/j.jvoice.2024.02.022

Utilizing Surgeon-Performed Intraoperative Translaryngeal Ultrasound for Verifying Vocal Fold Function: A Troubleshooting Approach for Intraoperative Neuromonitoring in Neck Surgery

J Voice. 2024 Mar 15:S0892-1997(24)00062-6. doi: 10.1016/j.jvoice.2024.02.022. Online ahead of print.

Authors

Hakan Balbaloglu¹, Emre Karadeniz², Ahmet Erkek³, Cem Yilmaz⁴, Mustafa Umit Ugurlu⁵, Guldeniz Karadeniz Cakmak²

Affiliations

¹ Department of General Surgery, Bulent Ecevit University, School of Medicine, Zonguldak, Turkey. Electronic address: Hakanbalbaloglu@yahoo.com.
² Department of General Surgery, Bulent Ecevit University, School of Medicine, Zonguldak, Turkey.
³ Department of General Surgery, Bahcesehir University, School of Medicine, Istanbul, Turkey.
⁴ Breast Center, Istanbul, Turkey.
⁵ Department of General Surgery, Marmara University, School of Medicine, Istanbul, Turkey.

PMID: 38493015
DOI: 10.1016/j.jvoice.2024.02.022

Abstract

Introduction: We investigated transcutaneous laryngeal ultrasonography (TLUS) for assessing vocal fold (VF) mobility during thyroid and parathyroid surgeries, emphasizing its precision and utility in signal loss scenarios.

Methods: Between October 2020 and January 2023, we performed TLUS, Doppler sonography, laryngeal twitch response (LTR) palpation, and electromyography (EMG) to monitor recurrent laryngeal nerve function during neck surgeries. Postoperatively, the VF activity was verified using fiberoptic video laryngoscopy (FL). Concordance with FL was categorized based on VF activity.

Results: Of the 443 VF evaluations, no instances of permanent bilateral paralysis were noted. Temporary unilateral palsy was found in 3.38% and permanent in 0.45%. TLUS displayed 97.8% agreement with EMG and was diagnostically superior (99.7% vs 98.2%) and more affordable ($68 vs $300) compared to analogous operative durations.

Conclusion: TLUS rivals EMG in terms of intraoperative neuromonitoring accuracy and outperforms LTR. Being cost-effective, TLUS can effectively address signal loss situations, thereby averting additional surgeries.

Keywords: Intraoperative ultrasound; Recurrent laryngeal nerve; Signal loss; Thyroid; Vocal fold.