Neuromonitoring of the laryngeal recurrent nerve during supracricoid laryngectomy with cricohyoidopexy

Introduction: The preservation of a functional crycoarythenoid unit during supracricoid laryngectomy with cricohyoidopexy is of foremost importance for the fulfilment of the phonatory and protective functions of the neolarynx. Thus the sparing or the recurrent nerve during surgery is of paramount significance.Materials and Methods: The laryngeal recurrent nerve was identified and exposed with the help of Neurosign 100 in 15 patients undergoing supracricoid laryngectomy with cricohyoidopexy. Following removal of the surgical specimen the integrity of the cricoarythenoid unit was confirmed by stimulation of the recurrent nerve with 1mV. The same was achieved postoperatively by means of 700 rigid videoendoscopy.Results: In all cases the recurrent nerve could be identified, presented and spared intraoperatively. We did not observe any case with immobile arythenoid. Patients could be decanulated and put on oral feeding in one month time.Conclusion: The cautious disarticulation of the cricothyroid joint complemented with monitoring of the laryngeal recurrent nerve guarantees sparing of the crycoarythenoid joint inervation, which is of enormous significance for the proper function of the neolarynx. Intraoperative confirmation of the preserved innervation of the cricoarythenoid unit allows us to distinguish between paralysis and ankylosis of the joint