Clinical guidelines on intraoperative neuromonitoring during thyroid and parathyroid surgery

Recurrent laryngeal nerve (RLN) injury is one of the most severe complications of thyroid surgery. Hoarseness due to unilateral RLN injury and breathing disorders and even asphyxia due to bilateral RLN injury can impose serious impacts on the patient’s life. It is estimated that the incidence of RLN injury during thyroid surgeries ranges 0.3-18.9% (1-5), making RLN protection a great concern among thyroid surgeons. Intraoperative neuromonitoring (IONM) combines both the functional and anatomic techniques and has the following features: intra-operative navigation and rapid identification of the RLN distribution; predicting nerve variation and protecting of the functional integrity of RLN; clarifying the mechanism and lowering the incidence of RLN injury; and easy to perform. It is a helpful adjunct for complicated surgeries (6,7).