Abstract
Purposes: Cernea classification is applied to describe the external branch of the superior laryngeal nerve (EBSLN). Using intraoperative neural monitoring we evaluated whether or not this classification is useful for predicting which EBSLN subtype has an increased risk of injury. Methods: An analysis of 400 EBSLN. The identification of EBSLN was achieved with both cricothyroid muscle twitch and the glottis evoked electromyography response. We defined S1 initial EBSLN stimulation at identification and S2 final nerve stimulation achieved in the most cranial aspect of the nerve exposed above the area of surgical dissection after superior artery ligation. Results: The mean S1 amplitude acquired was 259+/67 (180–421), 321 +/79 (192–391), 371 +/38 (200–551) μV, respectively, for type 1, 2A, 2B (p = 0.08). The S1 and S2 amplitudes were similar in type 1 (p = 0.3). The S1 and S2 determinations changed significantly in type 2A and 2B (p = 0.04 and 0.03). EBSLN which demonstrated a >25 % decreased amplitude in S2 increased significantly from Type 1 (4.9 %) to Type 2A (11.2 %) and 2B (18 %) (p = 0.01). None of type 1, 2.8 % type 2A and 3 % type 2B showed a loss of EBSLN conductivity. The latency determinations did not vary significantly for any parameter compared. Conclusions: The Cernea classification was, therefore, found to predict the risk of EBSLN stress. We identified amplitude differences between S1 and S2 determinations in type 2A and 2B, thus confirming that surgical dissection in these subtypes is, therefore, extremely difficult to perform.
| Original language | English |
|---|---|
| Pages (from-to) | 785-791 |
| Number of pages | 7 |
| Journal | Surgery Today |
| Volume | 46 |
| Issue number | 7 |
| DOIs | |
| Publication status | Published - 2016 Jul 1 |
Fingerprint
Keywords
- Cernea classification
- EBSLN
- External branch of the superior laryngeal nerve
- INMSG
- Intraoperative nerve monitoring
- IONM
- Nerve injury
- Neural monitoring study group
ASJC Scopus subject areas
- Surgery
Cite this
Prospective validation study of Cernea classification for predicting EMG alterations of the external branch of the superior laryngeal nerve. / Dionigi, Gianlorenzo; Kim, Hoon Yub; Randolph, Gregory W.; Wu, Che Wei; Sun, Hui; Liu, Xiaoli; Barczynski, Marcin; Chiang, Feng Yu.
In: Surgery Today, Vol. 46, No. 7, 01.07.2016, p. 785-791.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Prospective validation study of Cernea classification for predicting EMG alterations of the external branch of the superior laryngeal nerve
AU - Dionigi, Gianlorenzo
AU - Kim, Hoon Yub
AU - Randolph, Gregory W.
AU - Wu, Che Wei
AU - Sun, Hui
AU - Liu, Xiaoli
AU - Barczynski, Marcin
AU - Chiang, Feng Yu
PY - 2016/7/1
Y1 - 2016/7/1
N2 - Purposes: Cernea classification is applied to describe the external branch of the superior laryngeal nerve (EBSLN). Using intraoperative neural monitoring we evaluated whether or not this classification is useful for predicting which EBSLN subtype has an increased risk of injury. Methods: An analysis of 400 EBSLN. The identification of EBSLN was achieved with both cricothyroid muscle twitch and the glottis evoked electromyography response. We defined S1 initial EBSLN stimulation at identification and S2 final nerve stimulation achieved in the most cranial aspect of the nerve exposed above the area of surgical dissection after superior artery ligation. Results: The mean S1 amplitude acquired was 259+/67 (180–421), 321 +/79 (192–391), 371 +/38 (200–551) μV, respectively, for type 1, 2A, 2B (p = 0.08). The S1 and S2 amplitudes were similar in type 1 (p = 0.3). The S1 and S2 determinations changed significantly in type 2A and 2B (p = 0.04 and 0.03). EBSLN which demonstrated a >25 % decreased amplitude in S2 increased significantly from Type 1 (4.9 %) to Type 2A (11.2 %) and 2B (18 %) (p = 0.01). None of type 1, 2.8 % type 2A and 3 % type 2B showed a loss of EBSLN conductivity. The latency determinations did not vary significantly for any parameter compared. Conclusions: The Cernea classification was, therefore, found to predict the risk of EBSLN stress. We identified amplitude differences between S1 and S2 determinations in type 2A and 2B, thus confirming that surgical dissection in these subtypes is, therefore, extremely difficult to perform.
AB - Purposes: Cernea classification is applied to describe the external branch of the superior laryngeal nerve (EBSLN). Using intraoperative neural monitoring we evaluated whether or not this classification is useful for predicting which EBSLN subtype has an increased risk of injury. Methods: An analysis of 400 EBSLN. The identification of EBSLN was achieved with both cricothyroid muscle twitch and the glottis evoked electromyography response. We defined S1 initial EBSLN stimulation at identification and S2 final nerve stimulation achieved in the most cranial aspect of the nerve exposed above the area of surgical dissection after superior artery ligation. Results: The mean S1 amplitude acquired was 259+/67 (180–421), 321 +/79 (192–391), 371 +/38 (200–551) μV, respectively, for type 1, 2A, 2B (p = 0.08). The S1 and S2 amplitudes were similar in type 1 (p = 0.3). The S1 and S2 determinations changed significantly in type 2A and 2B (p = 0.04 and 0.03). EBSLN which demonstrated a >25 % decreased amplitude in S2 increased significantly from Type 1 (4.9 %) to Type 2A (11.2 %) and 2B (18 %) (p = 0.01). None of type 1, 2.8 % type 2A and 3 % type 2B showed a loss of EBSLN conductivity. The latency determinations did not vary significantly for any parameter compared. Conclusions: The Cernea classification was, therefore, found to predict the risk of EBSLN stress. We identified amplitude differences between S1 and S2 determinations in type 2A and 2B, thus confirming that surgical dissection in these subtypes is, therefore, extremely difficult to perform.
KW - Cernea classification
KW - EBSLN
KW - External branch of the superior laryngeal nerve
KW - INMSG
KW - Intraoperative nerve monitoring
KW - IONM
KW - Nerve injury
KW - Neural monitoring study group
UR - http://www.scopus.com/inward/record.url?scp=84941363453&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84941363453&partnerID=8YFLogxK
U2 - 10.1007/s00595-015-1245-9
DO - 10.1007/s00595-015-1245-9
M3 - Article
C2 - 26362419
AN - SCOPUS:84941363453
VL - 46
SP - 785
EP - 791
JO - Surgery Today
JF - Surgery Today
SN - 0941-1291
IS - 7
ER -