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Head Neck. 2018 Dec;40(12):2657-2663. doi: 10.1002/hed.25391. Epub 2018 Nov 22.

Diagnosis, anatomy, and electromyography profiles of 73 nonrecurrent laryngeal nerves.

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Jilin Provincial Key Laboratory of Surgical Translational Medicine, China Japan Union Hospital of Jilin University, Division of Thyroid Surgery, Changchun City, Jilin Province, China.
Division for Endocrine and Minimally Invasive Surgery, Department of Human Pathology in Adulthood and Childhood "G Barresi," University Hospital G Martino, University of Messina, Messina, Italy.



The purpose of this work was to compare methods of detecting nonrecurrent laryngeal nerves (NRLNs).


Specificity and sensitivity were compared in three NRLN detection methods: CT, electromyography (EMG), and A-B point comparison.


A total of 73 intraoperative pictures and 36 CT details of NRLNs are presented. Incidence of NRLN was 0.39%. Type I NRLN accounted for 50.7%, type IIA 45.2%, type IIB 4.1%. The NRLN median latency was 2.13 ms vs 3.00 ms median in an RLN control group (P < .001). When the threshold was set to 2.5 ms, EMG latency detection had 96.7% sensitivity and 91.6% specificity for detecting NRLN, and the A-B point comparison algrithm had 97.3% sensitivity and 92.5% specificity. Combining EMG latency detection with A-B point comparison achieved 100% sensitivity and specificity for detecting NRLN.


This is the largest series of NRLN presented in the literature. Latency shorter than 2.50 ms combined with the A-B point comparison method is the ideal algorithm procedure for early NRLN identification.


amplitude; anatomy; embryology; identification; latency; neuromonitoring; nonrecurrent laryngeal nerve


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