Visualization Versus Neuromonitoring of the External Branch of the Superior Laryngeal Nerve During Thyroidectomy. - Full Text View

Purpose

Injury to the external branch of the superior laryngeal nerve (EBSLN) during thyroidectomy results in lowered fundamental frequency of the voice and worsened voice performance in producing high-frequency sounds. It remains unclear if use of intraoperative nerve monitoring (IONM) can improve clinical outcome of thyroidectomy in terms of preserved individual voice performance. This study was designed to test that hypothesis.

Condition	Intervention
Thyroid, Goiter,	Device: Neuromonitoring

Study Type:	Interventional
Study Design:	Allocation: Randomized Endpoint Classification: Safety/Efficacy Study Intervention Model: Parallel Assignment Masking: Double Blind (Subject, Outcomes Assessor) Primary Purpose: Treatment
Official Title:	Randomized Controlled Trial of Visualization Versus Neuromonitoring of the External Branch of the Superior Laryngeal Nerve During Thyroidectomy.

Resource links provided by NLM:

MedlinePlus related topics: Thyroid Diseases

U.S. FDA Resources

Further study details as provided by Jagiellonian University:

Primary Outcome Measures:

The identification rate of the external branch of the superior laryngeal nerve. [ Time Frame: up to 6 months postoperatively ] [ Designated as safety issue: Yes ]

Secondary Outcome Measures:

Anatomical variability of the external branch of the superior laryngeal nerve according to Cernea classification. [ Time Frame: up to 6 months postoperatively ] [ Designated as safety issue: Yes ]
The changes in postoperative voice performance. [ Time Frame: up to 6 months postoperatively ] [ Designated as safety issue: Yes ]
The voice assessment included pre- and postoperative videostrobolaryngoscopy and analysis of maximum phonation time (MPT), voice level (VL), fundamental frequency (Fo), and voice quality rating on GRBAS scale.

Enrollment:	210
Study Start Date:	September 2009
Study Completion Date:	December 2010
Primary Completion Date:	June 2010 (Final data collection date for primary outcome measure)

Arms	Assigned Interventions
No Intervention: Visualization of the EBSLN and RLN Visual inspection of the nerves.
Experimental: Neuromonitoring of the EBSLN and RLN Electrical stimulation and monitoring of the nerves' function.	Device: Neuromonitoring Electrical stimulation of the nerve: 1 mA, 4 Hz with surface electromyography of the vocalis muscles. Other Name: IONM

Detailed Description:

Phonation changes following thyroidectomy have been reported in many investigations. They are considered to be multifactorial in origin and can be a consequence of laryngeal nerve injury or other events during thyroidectomy including arytenoids trauma after endotracheal intubation, cricothyroid dysfunction, strap muscle malfunction or lesion of the perithyroidal neural plexus, laryngotracheal fixation with impairment of vertical movement and psychological reaction to the operation. Injury to the external branch of the superior laryngeal nerve (EBSLN) can occur during the dissection and clamping of the superior thyroid vessels and the prevalence of this complication has been reported from 0.5% to 58%. This injury causes a complete paralysis of the cricothyroid muscle which results in lowered fundamental frequency of the voice and worsened voice performance in producing high-frequency sounds. Intraoperative nerve monitoring (IONM) has gained widespread acceptance as an adjunct to the gold standard of visual nerve identification and this technique can be used to identify both the recurrent laryngeal nerve (RLN) and the EBSLN. However, it remains unclear if there is any IONM added-value to the clinical outcome of thyroidectomy in terms of preserved individual voice performance. This study was designed to test that hypothesis.

Eligibility

Ages Eligible for Study:	18 Years and older
Genders Eligible for Study:	Female
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria:

thyroid pathology qualified for first-time bilateral neck surgery in a female patient with small to moderate sized goiter (below 100 ml in volume).

Exclusion Criteria:

male gender,
previous neck surgery,
unilateral thyroid pathology eligible for unilateral lobectomy,
goiter volume above 100 ml,
preoperatively diagnosed RLN palsy,
abnormal preoperative voice assessment on GRBAS scale,
pregnancy or lactation,
age below 18 years,
high-risk patients ASA 4 grade (American Society of Anesthesiology),
inability to comply with the scheduled follow-up protocol.

Contacts and Locations

Please refer to this study by its ClinicalTrials.gov identifier: NCT01395134

Locations

Poland
Jagiellonian University, College of Medicine, Department of Endocrine Surgery, 3rd Chair of General Surgery
Krakow, Poland, 31-202

Sponsors and Collaborators

Jagiellonian University

Investigators

Principal Investigator:

Marcin Barczynski, MD, PhD

Jagiellonian University, College of Medicine

More Information

Publications:

Cernea CR, Ferraz AR, Furlani J, Monteiro S, Nishio S, Hojaij FC, Dutra Júnior A, Marques LA, Pontes PA, Bevilacqua RG. Identification of the external branch of the superior laryngeal nerve during thyroidectomy. Am J Surg. 1992 Dec;164(6):634-9. Review.

Cernea CR, Ferraz AR, Nishio S, Dutra A Jr, Hojaij FC, dos Santos LR. Surgical anatomy of the external branch of the superior laryngeal nerve. Head Neck. 1992 Sep-Oct;14(5):380-3.

Randolph GW, Dralle H; International Intraoperative Monitoring Study Group; Abdullah H, Barczynski M, Bellantone R, Brauckhoff M, Carnaille B, Cherenko S, Chiang FY, Dionigi G, Finck C, Hartl D, Kamani D, Lorenz K, Miccolli P, Mihai R, Miyauchi A, Orloff L, Perrier N, Poveda MD, Romanchishen A, Serpell J, Sitges-Serra A, Sloan T, Van Slycke S, Snyder S, Takami H, Volpi E, Woodson G. Electrophysiologic recurrent laryngeal nerve monitoring during thyroid and parathyroid surgery: international standards guideline statement. Laryngoscope. 2011 Jan;121 Suppl 1:S1-16. Review.

Lifante JC, McGill J, Murry T, Aviv JE, Inabnet WB 3rd. A prospective, randomized trial of nerve monitoring of the external branch of the superior laryngeal nerve during thyroidectomy under local/regional anesthesia and IV sedation. Surgery. 2009 Dec;146(6):1167-73.

Bellantone R, Boscherini M, Lombardi CP, Bossola M, Rubino F, De Crea C, Alesina P, Traini E, Cozza T, D'alatri L. Is the identification of the external branch of the superior laryngeal nerve mandatory in thyroid operation? Results of a prospective randomized study. Surgery. 2001 Dec;130(6):1055-9.

Additional publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):

Barczyński M, Konturek A, Stopa M, Honowska A, Nowak W. Randomized controlled trial of visualization versus neuromonitoring of the external branch of the superior laryngeal nerve during thyroidectomy. World J Surg. 2012 Jun;36(6):1340-7.

Responsible Party:	Piotr Laidler / Head of the Biomedical Research Committee of the Jagiellonian University, Biomedical Research Committee of the Jagiellonian University
ClinicalTrials.gov Identifier:	NCT01395134 History of Changes
Other Study ID Numbers:	BBN/501/ZKL/1446
Study First Received:	July 13, 2011
Last Updated:	July 14, 2011
Health Authority:	Poland: Ministry of Health

Keywords provided by Jagiellonian University:

External branch of the superior laryngeal nerve,
Recurrent laryngeal nerve,
Intraoperative neuromonitoring,
Thyroid surgery

Additional relevant MeSH terms:

Goiter
Thyroid Diseases
Endocrine System Diseases

ClinicalTrials.gov processed this record on May 16, 2013