{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T11:30:00Z","timestamp":1783769400846,"version":"3.55.0"},"reference-count":41,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2023,12,24]],"date-time":"2023-12-24T00:00:00Z","timestamp":1703376000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Madrid\u2019s community","award":["P2022-BMD\/7321"],"award-info":[{"award-number":["P2022-BMD\/7321"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Objective: Our objective is the description of the technique of vagus nerve stimulation in carotid triangle in order to monitor the recurrent laryngeal nerve (RLN) during thyroid and parathyroid surgery. Methods: We stimulated the vagus nerve in the carotid triangle during 150 thyroid or parathyroid surgeries using a monopolar electromyography electrode inserted under the mastoid process towards the jugular foramen as a cathode, and using another subdermal electrode in the mastoid as an anode. Another complementary method of vagus stimulation was achieved with a pair of subdermal electrodes, placing the cathode at the mandibular angle and the anode at the mastoid. Results: In all patients, compound muscle action potential (CMAP) was recorded in the vocal cords with both stimulation techniques, allowing semi-continuous monitoring to be carried out. Intraoperative lesions were detected in 16 of the cases; 9 of them were transient with CMAP recovery achieved when modifying surgical maneuvers. Conclusions: Vagus nerve stimulation in the carotid triangle is a reliable technique for monitoring the RLN in thyroid surgery. Vagus nerve stimulation in the carotid triangle is effective and safe for RLN monitoring, and it is a clear alternative to direct continuous stimulation of the nerve that by contrast requires its dissection in the carotid sheath.<\/jats:p>","DOI":"10.3390\/jcm13010102","type":"journal-article","created":{"date-parts":[[2023,12,24]],"date-time":"2023-12-24T20:42:30Z","timestamp":1703450550000},"page":"102","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Vagus Nerve Stimulation in the Carotid Triangle: An Effective Method for Monitoring the Recurrent Laryngeal Nerve in Thyroid and Parathyroid Surgery"],"prefix":"10.3390","volume":"13","author":[{"given":"Alfredo","family":"Traba","sequence":"first","affiliation":[{"name":"Neurology and Neurophysiology, Hospital Universitario HM Sanchinarro, C\/de O\u00f1a 10, 28050 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela","family":"de Abreu","sequence":"additional","affiliation":[{"name":"Neurology and Neurophysiology, Hospital Universitario HM Sanchinarro, C\/de O\u00f1a 10, 28050 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clara","family":"Nevado","sequence":"additional","affiliation":[{"name":"Neurology and Neurophysiology, Hospital Fundaci\u00f3n Alcorc\u00f3n, C\/Budapest 1, 28922 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hip\u00f3lito","family":"Duran","sequence":"additional","affiliation":[{"name":"General and Digestive Surgery Department, Hospital Universitario HM Sanchinarro, C\/O\u00f1a 10, 28050 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Gil","sequence":"additional","affiliation":[{"name":"General and Digestive Surgery Department, Hospital Universitario HM Montepr\u00edncipe, Av. de Montepr\u00edncipe 25, 28660 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda","family":"P\u00e9rez Seoane","sequence":"additional","affiliation":[{"name":"General and Digestive Surgery Department, Hospital Universitario HM Montepr\u00edncipe, Av. de Montepr\u00edncipe 25, 28660 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Lopez-Gonzalez","sequence":"additional","affiliation":[{"name":"Ram\u00f3n y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain"},{"name":"Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, University of Alcal\u00e1, 28801 Alcala de Henares, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2588-1708","authenticated-orcid":false,"given":"Miguel A.","family":"Ortega","sequence":"additional","affiliation":[{"name":"Ram\u00f3n y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain"},{"name":"Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcal\u00e1, 28801 Alcal\u00e1 de Henares, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melchor","family":"\u00c1lvarez-Mon","sequence":"additional","affiliation":[{"name":"Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, University of Alcal\u00e1, 28801 Alcala de Henares, Spain"},{"name":"Immune System Diseases-Rheumatology and Internal Medicine Service, University Hospital Prince of Asturias, Networking Research Center on for Liver and Digestive Diseases (CIBEREHD), 28806 Alcal\u00e1 de Henares, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pedro","family":"Martin","sequence":"additional","affiliation":[{"name":"General and Digestive Surgery Department, Hospital Universitario HM Montepr\u00edncipe, Av. de Montepr\u00edncipe 25, 28660 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan","family":"San Roman","sequence":"additional","affiliation":[{"name":"General and Digestive Surgery Department, Hospital Universitario HM Torrelodones, Av. Castillo Olivares s\/n, 28250 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0412-939X","authenticated-orcid":false,"given":"Raul","family":"D\u00edaz-Pedrero","sequence":"additional","affiliation":[{"name":"Ram\u00f3n y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain"},{"name":"Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, University of Alcal\u00e1, 28801 Alcala de Henares, Spain"},{"name":"General and Digestive Surgery Department, Hospital Universitario HM Rivas Vaciamadrid, 28521 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,12,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1002\/lary.21119","article-title":"Electrophysiologic Recurrent Laryngeal Nerve monitoring during thyroid and parathyroid surgery: International standards guideline statement","volume":"121","author":"Randolph","year":"2011","journal-title":"Laryngoscope"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1002\/lary.27359","article-title":"International Neural Monitoring Study Group Guideline 2018 Part I: Staging Bilateral Thyroid Surgery with Monitoring Loss of Signal","volume":"128","author":"Schneider","year":"2018","journal-title":"Laryngoscope"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"764","DOI":"10.1002\/lary.26147","article-title":"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","volume":"127","author":"Liddy","year":"2017","journal-title":"Laryngoscope"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2206","DOI":"10.1002\/lary.27086","article-title":"Safety of High-Current Stimulation for Intermittent Intraoperative Neural Monitoring in Thyroid Surgery: A Porcine Model","volume":"128","author":"Lu","year":"2018","journal-title":"Laryngoscope"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"607","DOI":"10.21037\/gs.2016.11.10","article-title":"Continuous intraoperative neural monitoring of the recurrent nerves in thyroid surgery: A quantum leap in technology","volume":"5","author":"Schneider","year":"2016","journal-title":"Gland. 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Med., 12.","DOI":"10.3390\/jcm12010305"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/1\/102\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T21:41:13Z","timestamp":1760132473000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/1\/102"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,12,24]]},"references-count":41,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,1]]}},"alternative-id":["jcm13010102"],"URL":"https:\/\/doi.org\/10.3390\/jcm13010102","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,12,24]]}}}