Transcricothyroid electromyographic monitoring of the recurrent laryngeal nerve

Objectives/Hypothesis: To determine the usefulness of intraoperative nerve monitoring using an electrode placed in the midline through the cricothyroid membrane. Study Design: Retrospective records review. Methods: Patients of the otolaryngology department of our tertiary care academic medical center were identified if they had undergone either total thyroidectomy or total thyroid lobectomy accompanied by bilateral electromyographic (EMG) monitoring of the recurrent laryngeal nerve (RLN) between January 2007 and October 2007. Results: Forty-three patients were identified who had a total throidectomy or a total thyroid lobectomy. Nineteen of the 43 had intraoperative EMG monitoring of the RLN with placement of a single EMG electrode through the cricothyroid membrane; 11 had a thyroidectomy, and eight had a thyroid lobectomy. Overall, 30 at-risk nerves were stimulated with an EMG probe; 27 responded adequately and three (paralyzed before surgery) were unresponsive. Conclusions: Central placement of an EMG electrode through the cricothyroid membrane into the thyroarytenoid musculature is a safe and reliable technique for bilateral monitoring of the RLN that facilitates evaluation of postoperative function.