Our Summary

This research paper discusses a study conducted to evaluate the effectiveness of a new technique used during thyroid surgeries, called intraoperative transcutaneous laryngeal ultrasonography (TLUSG). The TLUSG technique is used to evaluate the twitch response of the vocal cord by stimulating the vagus nerve before dissection. The researchers compared this technique with the traditional method of laryngeal twitch palpation (LTP), which involves physically feeling for the twitch response.

The study included 110 patients (38 men and 72 women) who underwent thyroidectomy (surgical removal of the thyroid gland) and were at risk of nerve damage. The researchers found that the TLUSG technique could be used to assess the vocal cord in 93.6% of patients, compared to only 59.1% with LTP. In two patients, the TLUSG technique detected a twitch response when the traditional IONM (intraoperative neuromonitoring) signal did not. Also, 14 patients showed a twitch response on TLUSG but not on LTP.

The study concluded that the TLUSG technique is more sensitive (100%) and specific (100%) than LTP (70.21% sensitive and 100% specific). This means that TLUSG is better at correctly identifying patients with a twitch response and those without it. TLUSG also had better accuracy than LTP in patients who could be assessed using both techniques (100% vs 80.33%).

Overall, the study suggests that the TLUSG technique is a better method for assessing the twitch response of the vocal cord during thyroid surgeries than the traditional LTP method. It could be especially useful for patients who don’t show IONM signals during the stimulation of the vagus nerve before dissection.

FAQs

  1. What is transcutaneous laryngeal ultrasonography (TLUSG) and how is it used in thyroid surgeries?
  2. How does the accuracy of TLUSG compare to laryngeal twitch palpation (LTP) in assessing the vocal cord twitch response during thyroid surgery?
  3. What are the implications of using TLUSG for patients with no intraoperative neuromonitoring (IONM) signals during predissection vagus nerve stimulation?

Doctor’s Tip

A helpful tip a doctor might tell a patient about vocal cord surgery is to ask about the use of intraoperative transcutaneous laryngeal ultrasonography (TLUSG) to evaluate the vocal cord twitch response during the surgery. This technique can provide more accurate and reliable information compared to traditional methods like laryngeal twitch palpation (LTP), and can help guide the surgeon in ensuring the safety and success of the procedure.

Suitable For

Patients who are typically recommended vocal cord surgery include those with vocal cord paralysis, vocal cord nodules or polyps, vocal cord cysts, vocal cord hemorrhage, vocal cord papillomas, and other vocal cord lesions. Additionally, patients with voice disorders that do not respond to conservative treatments may also be candidates for vocal cord surgery. In some cases, vocal cord surgery may be recommended as part of treatment for conditions such as thyroid cancer or laryngeal cancer.

Timeline

Before vocal cord surgery:

  • Patient undergoes consultation with an otolaryngologist to discuss the need for vocal cord surgery.
  • Preoperative tests and evaluations are conducted to assess the patient’s vocal cord function and overall health.
  • Patient may undergo voice therapy or other conservative treatments prior to surgery.
  • Surgical date is scheduled and patient is instructed on preoperative preparations.

After vocal cord surgery:

  • Patient undergoes vocal cord surgery under general anesthesia.
  • Postoperative care includes monitoring in a recovery area and management of pain and discomfort.
  • Patient may need to follow a specific diet and voice rest instructions to aid in the healing process.
  • Follow-up appointments are scheduled to monitor the healing of the vocal cords and assess the success of the surgery.
  • Voice therapy may be recommended to improve vocal cord function and restore voice quality.
  • Patient gradually resumes normal activities and voice use under the guidance of their healthcare provider.

What to Ask Your Doctor

  1. What is the purpose of vocal cord surgery in my case?
  2. What are the potential risks and complications associated with vocal cord surgery?
  3. How will the surgery be performed and what is the expected recovery time?
  4. Will I need to undergo any additional tests or evaluations before the surgery?
  5. How will my voice be affected after the surgery?
  6. What is the success rate of this type of surgery for my condition?
  7. Will I need any speech therapy or rehabilitation after the surgery?
  8. Are there any alternative treatments or therapies that I should consider before opting for surgery?
  9. How often will I need to follow up with you after the surgery?
  10. Can you explain the use of intraoperative transcutaneous laryngeal ultrasonography (TLUSG) in evaluating the vocal cord twitch response during the surgery, and how reliable is this technique compared to other methods?

Reference

Authors: Kuo TC, Chen KY, Lai CW, Wang YC, Lin MT, Chang CH, Wu MH. Journal: J Am Coll Surg. 2022 Mar 1;234(3):359-366. doi: 10.1097/XCS.0000000000000053. PMID: 35213499