Intraoperative Recurrent Laryngeal Nerve Monitoring During Pediatric Cardiac and Thoracic Surgery: A Mini Review.

Benjamin Zendejas,Sukgi S Choi,Claire M Lawlor,Carlos Munoz-San Julian,Christopher Baird,Russell W Jennings

doi:10.3389/fped.2020.587177

Abstract

Objective: Review techniques for intraoperative recurrent laryngeal nerve (RLN) monitoring during pediatric surgery for esophageal atresia, tracheoesophageal fistula, tracheobronchomalacia, and cardiac surgery.Summary Background Data: Literature was reviewed for reports of intraoperative recurrent laryngeal nerve monitoring in cervical, thoracic, and cardiac surgical procedures which place the RLNs at risk for injury.Methods: Review paper.Results: The RLN is at risk during pediatric surgery for esophageal atresia, tracheoesophageal fistula, tracheobronchomalacia, and cardiac surgery. Intraoperative nerve monitoring has decreased rates of RLN injury in thyroid surgery. Intraoperative RLN monitoring techniques appropriate for pediatric surgery are discussed, including endotracheal tubes with integrated surface electrodes, adhesive surface electrodes for smaller endotracheal tubes, endolaryngeal electrodes, and automatic periodic continuous intra-operative stimulation.Conclusions: Multiple techniques exist to monitor the RLN in children undergoing cervical, cardiac, and thoracic surgery. Monitoring the RLN during procedures that place the RLNs at risk may help decrease the rate of RLN injury.

Highlights

The recurrent laryngeal nerves (RLNs) are branches of the vagus nerves that carry motor, sensory, and parasympathetic fibers to the larynx
On the left, the RLN diverges from the vagus and loops medially around the aorta posterior to the ductus arteriosus
On the right, the RLN diverges from the vagus nerve at the level of the right subclavian artery and its course toward the larynx is more lateral to the trachea-esophageal groove

Summary

Introduction

The recurrent laryngeal nerves (RLNs) are branches of the vagus nerves that carry motor, sensory, and parasympathetic fibers to the larynx. Intraoperative nerve monitoring (IONM) provides immediate feedback to the surgeon on RLN location and function during surgery. There are several current options for IONM during cervical and thoracic surgery, including surface electrodes on endotracheal tubes, endolaryngeal electrodes, and APS (automatic periodic stimulation) monitoring.

Results

Conclusion