Detection of abnormally running left recurrent laryngeal nerve using intraoperative nerve monitoring during upper mediastinal mass resection in a 2-year-old male patient

Abstract

A 2-year-old, male patient with a mediastinal cystic mass causing tracheal stenosis underwent complete resection of the mass via a partial median sternotomy. The risk of left recurrent laryngeal nerve (RLN) injury seemed high because the mass was located just between the trachea and the esophagus. To reduce the risk of injury to the RLN, intraoperative nerve monitoring (IONM) was used with an adhesive laryngeal electrode, which was wrapped around an endotracheal tube with a 4.0-mm inner diameter. Electromyography of the vocal cords was successfully performed, allowing the left RLN to be clearly detected intraoperatively. The patient's postoperative course was uneventful, and he had no postoperative symptoms of RLN palsy. Esophageal duplication cyst was pathologically diagnosed. IONM can be applied even to infants and may be very useful for improving procedural safety and avoiding damage to the RLN during rection of a mediastinal mass.