What is the role of EMG in the prevention of recurrent laryngeal nerve injury during thyroid surgery?

Updated: Feb 27, 2020
  • Author: Pramod K Sharma, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Use of EMG is controversial and has not been recommended for routine thyroid surgery given the low rate of RLN injury. The authors know of no randomized studies that have been performed to compare the rate of postoperative RLN palsy in visual versus electrophysiologic RLN detection in thyroid surgery. (A literature review by Deniwar et al indicated that adjunctive use of intraoperative electrophysiologic neuromonitoring may be no more effective than visual nerve identification alone for avoiding RLN injury during thyroid surgery; no significant difference in the incidence of RLN injuries was found in a comparison of both monitoring methods. [10] ) The additional information EMG provides may be beneficial in patients undergoing revision thyroid surgery, in patients with previously radiated necks, in patients with large masses, or in patients with contralateral nerve palsy.

In the setting of unilateral vocal-fold paralysis, management of the contralateral thyroid is controversial. In the authors' experience, given the low rate of RLN injury, the best approach is not changing appropriate oncologic management and proceeding with total thyroidectomy. Exceptions may include a young patient who presents with a low (< 6) multifactor activated immune cell (MAIC) score. For such a patient, nonoperative treatment may be considered, with appropriate care coordinated with an endocrinologist.

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