{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T01:17:05Z","timestamp":1768439825147,"version":"3.49.0"},"reference-count":17,"publisher":"Springer Science and Business Media LLC","issue":"6","license":[{"start":{"date-parts":[[2021,5,26]],"date-time":"2021-05-26T00:00:00Z","timestamp":1621987200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,5,26]],"date-time":"2021-05-26T00:00:00Z","timestamp":1621987200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100004770","name":"Universit\u00e0 degli Studi di Parma","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100004770","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Updates Surg"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>The external branch of the superior laryngeal nerve (EBSLN) provides motor function to the cricothyroid muscle (CTM). EBSLN damage produces changes in voice quality and projection. Intraoperative neuromonitoring (IONM) in thyroid surgery aims to optimize EBSLN control during dissection. We prospectively collected the data of 88 consecutive patients who underwent total thyroidectomy with IONM from July 2019 to December 2019. IONM was offered in the intermittent mode of application. We routinely searched for the EBSLN electromyographic (EMG) signal before (S1) and after (S2) dissection of the superior vascular peduncle. In the absence of the EMG signal, we observed the CTM twitch. We identified 141 (80%) S1 EMG signals, while we recorded the CTM twitch in 15 cases (8.5%). In 20 (11.3%) cases, we were unable to identify the EMG signal. Analysing the S2 results, we found loss of EBSLN signal in 11\/141 cases (7.8%) identified with IONM in pre-dissection stimulation. Among the 20 cases without pre-dissection identification (we had not identified the external branch of the superior laryngeal nerve or the muscle twitch), in the post-dissection evaluation, we confirmed the loss of signal in 17 of 20 cases, equal to 85% (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). Our data clearly show that intraoperative stimulation and recognition of EBSLN, performed before any dissection manoeuvre to the superior vascular thyroid pole, leads to a much higher rate of nerve conservation.<\/jats:p>","DOI":"10.1007\/s13304-021-01084-6","type":"journal-article","created":{"date-parts":[[2021,5,26]],"date-time":"2021-05-26T18:04:37Z","timestamp":1622052277000},"page":"2275-2281","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Can we routinely identify the external branch of the superior laryngeal nerves with neural monitoring?: a prospective report on 176 consecutive nerves at risk"],"prefix":"10.1007","volume":"73","author":[{"given":"Paolo","family":"Del Rio","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elena","family":"Bonati","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7632-6184","authenticated-orcid":false,"given":"Tommaso","family":"Loderer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matteo","family":"Rossini","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Federico","family":"Cozzani","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2021,5,26]]},"reference":[{"issue":"7","key":"1084_CR1","doi-asserted-by":"publisher","first-page":"811","DOI":"10.1007\/s00423-018-1723-9","volume":"403","author":"I Cheruiyot","year":"2018","unstructured":"Cheruiyot I, Kipkorir V, Henry BM et al (2018) Surgical anatomy of the external branch of the superior laryngeal nerve: a systematic review and meta-analysis. Langenbecks Arch Surg 403(7):811\u2013823. https:\/\/doi.org\/10.1007\/s00423-018-1723-9","journal-title":"Langenbecks Arch Surg"},{"issue":"5","key":"1084_CR2","doi-asserted-by":"publisher","first-page":"380","DOI":"10.1002\/hed.2880140507","volume":"14","author":"CR Cernea","year":"1992","unstructured":"Cernea CR, Ferraz AR, Nishio S, Dutra A Jr, Hojaij FC, dos Santos LR (1992) Surgical anatomy of the external branch of the superior laryngeal nerve. Head Neck 14(5):380\u2013383. https:\/\/doi.org\/10.1002\/hed.2880140507","journal-title":"Head Neck"},{"issue":"4","key":"1084_CR3","doi-asserted-by":"publisher","first-page":"360","DOI":"10.1001\/archoto.2009.9","volume":"135","author":"NA Pagedar","year":"2009","unstructured":"Pagedar NA, Freeman JL (2009) Identification of the external branch of the superior laryngeal nerve during thyroidectomy. Arch Otolaryngol Head Neck Surg 135(4):360\u2013362. https:\/\/doi.org\/10.1001\/archoto.2009.9","journal-title":"Arch Otolaryngol Head Neck Surg"},{"key":"1084_CR4","doi-asserted-by":"publisher","first-page":"S1","DOI":"10.1002\/lary.24301","volume":"123","author":"M Barczynnski","year":"2013","unstructured":"Barczynnski M, Randolph GW, Cernea CR et al (2013) External branch of the superior laryngeal nerve monitoring during thyroid and parathyroid surgery: international neural monitoring study group standards guideline statement. Laryngoscope 123:S1\u2013S14","journal-title":"Laryngoscope"},{"key":"1084_CR5","doi-asserted-by":"publisher","first-page":"S1","DOI":"10.1002\/lary.27359","volume":"128","author":"R Schneider","year":"2018","unstructured":"Schneider R, Randolph GW, Dionigi G et al (2018) International neural monitoring study group guideline 2018 part I: staging bilateral thyroid surgery with monitoring loss of signal. Laryngoscope 128:S1\u2013S17","journal-title":"Laryngoscope"},{"key":"1084_CR6","doi-asserted-by":"publisher","first-page":"S1","DOI":"10.1002\/lary.21119","volume":"121","author":"GW Randolph","year":"2011","unstructured":"Randolph GW, Dralle H, Abdullah H et al (2011) Electrophysiologic recurrent laryngeal nerve monitoring during thyroid and parathyroid surgery: International standards guideline statement. Laryngoscope 121:S1\u2013S16","journal-title":"Laryngoscope"},{"key":"1084_CR7","doi-asserted-by":"crossref","unstructured":"Zhao Y, Li C, Liu X et al. (2019) Investigation on EMG Profiles of the Superior Laryngeal Nerve in a In Vivo Porcine Model. J Invest Surg Aug;33(7):596\u2013604.","DOI":"10.1080\/08941939.2018.1547462"},{"key":"1084_CR8","doi-asserted-by":"publisher","first-page":"385","DOI":"10.1007\/s40618-019-01119-1","volume":"43","author":"G Dionigi","year":"2020","unstructured":"Dionigi G, Dralle H, Materazzi G et al (2020) Nappy 20th birthday to minimally invasive video-assisted thyroidectomy. J Endocrinol Invest 43:385\u2013388","journal-title":"J Endocrinol Invest"},{"key":"1084_CR9","doi-asserted-by":"publisher","DOI":"10.23736\/S0026-4733.20.08339-X","author":"P Del Rio","year":"2020","unstructured":"Del Rio P, Cozzani F, Rossini M et al (2020) Mini-invasive thyroidectomy and Intraopertaive Neuromonitoring (IONM): a single high-volume center experience in 215 consecutive cases. Minerva Chir. https:\/\/doi.org\/10.23736\/S0026-4733.20.08339-X","journal-title":"Minerva Chir"},{"key":"1084_CR10","doi-asserted-by":"publisher","unstructured":"Dionigi G, Boni L, Rovera F et al. (2009) Neuromonitoring and video- assisted thyroidectomy: a prospective, randomized case-control evaluation. Surg Endosc May;23(5):996\u20131003. doi: https:\/\/doi.org\/10.1007\/s00464-008-0098-3. (Epub 2008 Sep 21. PMID: 18806939).","DOI":"10.1007\/s00464-008-0098-3"},{"issue":"1","key":"1084_CR11","doi-asserted-by":"publisher","first-page":"143","DOI":"10.21037\/gs-20-570","volume":"10","author":"Y Zhao","year":"2021","unstructured":"Zhao Y, Zhao Z, Wang T et al (2021) The area under the waveform of electromyography for monitoring the external branches of the superior laryngeal nerve during thyroid surgery. Gland Surg 10(1):143\u2013153","journal-title":"Gland Surg"},{"key":"1084_CR12","doi-asserted-by":"publisher","unstructured":"Iwata AJ, Liddy W, Barczy\u0144ski M et al. (2021) Superior laryngeal nerve signal attenuation influences voice outcomes in thyroid surgery. Laryngoscope doi: https:\/\/doi.org\/10.1002\/lary.29413.","DOI":"10.1002\/lary.29413"},{"issue":"3","key":"1084_CR13","doi-asserted-by":"publisher","first-page":"764","DOI":"10.1002\/lary.26147","volume":"127","author":"W Liddy","year":"2017","unstructured":"Liddy W, Barber SR, Cinquepalmi M et al (2017) The electrophysiology of thyroid surgery: electrophysiologic and muscular responses with stimulation of the vagus nerve, recurrent laryngeal nerve, and external branch of the superior laryngeal nerve. Laryngoscope 127(3):764\u2013771","journal-title":"Laryngoscope"},{"key":"1084_CR14","doi-asserted-by":"publisher","unstructured":"Zhang D, Pino A, Caruso E et al (2020) Neural monitoring in thyroid surgery is here to stay. Gland Surg 9(Suppl 1): S43-S46. doi: https:\/\/doi.org\/10.21037\/gs.2019.10.24. (PMID: 32055497; PMCID: PMC6995897).","DOI":"10.21037\/gs.2019.10.24"},{"issue":"7","key":"1084_CR15","doi-asserted-by":"publisher","first-page":"785","DOI":"10.1007\/s00595-015-1245-9","volume":"46","author":"G Dionigi","year":"2016","unstructured":"Dionigi G, Kim HY, Randolph GW et al (2016) Prospective validation study of Cernea classification for predicting EMG alterations of the external branch of the superior laryngeal nerve. Surg Today 46(7):785\u2013791","journal-title":"Surg Today"},{"key":"1084_CR16","doi-asserted-by":"publisher","unstructured":"Mangano A, Lianos GD, Boni L et al. (2014) Intraoperative neuromonitoring of the external branch of the superior laryngeal nerve during thyroidectomy: the need for evidence-based data and perioperative technical\/technological standardization. ScientificWorldJournal 2014:692365. doi: https:\/\/doi.org\/10.1155\/2014\/692365. (Epub 2014 Nov 24. PMID: 25525624; PMCID: PMC4265369).","DOI":"10.1155\/2014\/692365"},{"issue":"8","key":"1084_CR17","doi-asserted-by":"publisher","first-page":"2175","DOI":"10.1007\/s00405-013-2557-2","volume":"270","author":"A Sanabria","year":"2013","unstructured":"Sanabria A, Ramirez A, Kowalski LP et al (2013) Neuromonitoring in thyroidectomy: a meta-analysis of effectiveness from randomized controlled trials. Eur Arch Otorhinolaryngol 270(8):2175\u20132189. https:\/\/doi.org\/10.1007\/s00405-013-2557-2","journal-title":"Eur Arch Otorhinolaryngol"}],"container-title":["Updates in Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s13304-021-01084-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s13304-021-01084-6\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s13304-021-01084-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,11,21]],"date-time":"2021-11-21T18:07:00Z","timestamp":1637518020000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s13304-021-01084-6"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,5,26]]},"references-count":17,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["1084"],"URL":"https:\/\/doi.org\/10.1007\/s13304-021-01084-6","relation":{},"ISSN":["2038-131X","2038-3312"],"issn-type":[{"value":"2038-131X","type":"print"},{"value":"2038-3312","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,5,26]]},"assertion":[{"value":"16 March 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"5 May 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"26 May 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors certify that there is no conflict of interest with any financial organization regarding the material discussed in the manuscript.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"All Authors have nothing to disclose.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Disclosure statement"}},{"value":"The protocol was approved by the Institutional Review Board (prot.n.38133\/2018 of Univeristy Hospital of Parma).","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Patients signed an informed consent before surgery. The use of the IONM was explained in an effort to improve laryngeal nerves identification.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}}]}}