Transcutaneous laryngeal ultrasonography versus electromyography in assessing the vocal cords’ function in thyroid surgery: A comparative study on perioperative outcomes

Vocal cord palsy (VCP) is the most serious complication as aspiration, and dysphagia after neck surgeries. Therefore, various methods are available to assess the immobilization of the vocal cord. Intraoperative neuromonitoring has been the usual method to check the efficient integrity of the recurrent laryngeal nerve. In recent years, transcutaneous laryngeal ultrasonography (TLUS) has appeared as an alternative method. Sixty-four patients underwent thyroid surgery, group I (32 patients) IONM examined by electromyography to evaluate the VC functions, and group II TLUS (32 patients) using a superficial liner ultrasound probe. Complications, patient satisfaction, enhanced recovery, extubation time, and long stay in hospitals and ICU were recorded. Statistically highly significant enhanced recovery time in IONM group was 29.58±9.86 and TLUS group was 2.75±0.81, p 0.001. No significant difference in patients’ satisfaction, (p 0.05). In the IONM group, 5 patients (15.6%) had decay signals, 2 patients (6.3%) had hematoma formation, 8 patients (25.0%) had unilateral vocal cord palsy, and 2 patients (6.3%) had delayed extubation and long stay time in the ICU. TLUS group, 2 patients (6.3%) had decay signals, 2 patients (6.3%) had hematoma formation, 5 patients (15.6%) had unilateral vocal cord palsy, and 1 patient (3.1%) had delayed extubation and long time in the ICU. Given the risk of injury RLN during thyroid and neck surgeries, the lateral approach of TLUS had a significantly better overall VC visualization rate than the classic midline approach in peri-operative patients, and IONM can be useful in difficult cases.