Intraoperative Recurrent Laryngeal Nerve Monitoring-Pros and Cons-

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Preserving the recurrent laryngeal nerve (RLN) during neck surgery such as thyroidectomy is a requirement met by surgeons. However, the RLN is sometimes difficult to identify due to congenital or tumor-based reasons.br To demonstrate the pros and cons of nerve integrity monitoring (NIM) in such identification, we report 5 cases, 3 in which the RLN was safely identified and 2 in which it was not.br Cases 1 to 3 yielded satisfactory results using NIM. Even an aberrant run of the RLN its identification was easy with NIM.br Case 4 involved a left pyriform sinus fistula. Because the hypopharynx was operated on from the oral cavity, electromyography sensor tube slipped off, making NIM instable. The problem was thus oral cavity manipulation.br Case 5 involved a huge benign thyroid tumor due to which we expected the RLN to run aberrantly and mistakenly cut the RLN. NIM was still positive even after ablation possibly because of distal fiber stimulation.br Due to the very real possibility of injuring the RLNs, surgeons should therefore keep this possibility in mind.br