A5085929142- Thyroid and Parathyroid Surgery
- Voice and Speech Disorders
- Airway Management and Intubation Techniques
- Thyroid Cancer Diagnosis and Treatment
- Head and Neck Anomalies
- Tracheal and airway disorders
- Meningioma and schwannoma management
- Nerve Injury and Rehabilitation
- Pituitary Gland Disorders and Treatments
- Parathyroid Disorders and Treatments
- Myasthenia Gravis and Thymoma
- Salivary Gland Tumors Diagnosis and Treatment
- Radiation Dose and Imaging
- Neurology and Historical Studies
- Cardiac, Anesthesia and Surgical Outcomes
- Anesthesia and Pain Management
- Facial Nerve Paralysis Treatment and Research
- Pain Management and Opioid Use
- Intraoperative Neuromonitoring and Anesthetic Effects
- Trigeminal Neuralgia and Treatments
- Genetic Syndromes and Imprinting
- Radiomics and Machine Learning in Medical Imaging
- Thyroid Disorders and Treatments
- Dupuytren's Contracture and Treatments
- Tumors and Oncological Cases
Massachusetts Eye and Ear Infirmary
2015-2024
Harvard University
2015-2024
Massachusetts General Hospital
2010-2018
Existing intraoperative neuromonitoring (IONM) formats stimulate the recurrent laryngeal nerve (RLN) intermittently, exposing it to risk for injury in between stimulations. We report electrophysiologic parameters of continuous vagal monitoring, utilizing a novel real-time IONM format, and relate these surgical maneuvers that delineate nascent adverse but reversible prevent injury. These results are correlated with postoperative vocal cord functional outcome.Prospective multicenter tertiary...
The purpose of this publication was to inform surgeons as the modern state‐of‐the‐art evidence‐based guidelines for management recurrent laryngeal nerve invaded by malignancy through blending domains 1) surgical intraoperative information, 2) preoperative glottic function, and 3) real‐time electrophysiologic information. These generated International Neural Monitoring Study Group (INMSG) are envisioned assist clinical decision‐making process involved in during thyroid surgery incorporating...
Background To study the diagnostic accuracy of physical examination (PE), ultrasonography (US), contrastenhanced computed tomography (CT) and in preoperative detection macroscopic nodal metastasis primary/recurrent papillary thyroid carcinoma (PTC) patients to determine if routine addition CT would be beneficial accurate lymph‐node surgery planning. Methods In a tertiary center prospective study, 162 PTC underwent evaluation by PE, US, CT. Sensitivity, specificity, positive/negative...
Objectives The electrophysiologic responses of 1,381 recurrent laryngeal nerves (RLN) during monitored neck surgery were recorded and reviewed. Study Design Retrospective case series. Methods With institutional review board approval, we reviewed thyroid other surgeries performed with intraoperative nerve monitoring (IONM) between the years 1995 2006. This list yielded consecutively RLNs, over 3,000 hours experience. All patients underwent preoperative postoperative laryngoscopy. In an...
Objectives/Hypothesis The recurrent laryngeal nerve (RLN) intraoperative monitoring (IONM) provides a new functional dynamic that adds to visual identification of the RLN optimize its management. Intraoperative has been applied initial RLN. We now apply IONM nonrecurrent (NRLN) and provide electrophysiologic anatomic parameters facilitate this technique neural for NRLN, which is at increased risk injury during thyroid surgery. Study Design Retrospective. Methods A study cases NRLN from...
Surgery for goiter embodies a unique challenge. Our objective is to provide comprehensive analysis of cervical and substernal data in two paired articles. This second article focuses on surgical management. The following null hypotheses regarding excision have been tested: 1) there are no goiter-associated risk factors difficult intubation; 2) predictive recurrent laryngeal nerve injury (RLN) or postoperative hypocalcemia; 3) difference RLN with neural monitoring versus without.A...
To report normative electromyography (EMG) data on the external branch of superior laryngeal nerve (EBSLN) and to compare this analogous recurrent (RLN) vagus (VN) during intraoperative neural monitoring (IONM) using both standard monopolar stimulator probe a novel bipolar probe.Prospective multiple tertiary care center study.A prospective study EBSLN, RLN VN EMG in 22 thyroid surgeries was performed. Subjects with preoperative vocal fold paralysis were excluded. Postoperative laryngoscopy...
Objective To investigate intraoperative nerve monitoring (IONM) use among thyroid surgeons. Methods A 25‐question survey was used to assess attitudes regarding IONM use. Surveys were sent surgeons registered the American Academy of Otolaryngology–Head and Neck Surgery, International Association Endocrine Surgeons, Head Society. Results Among 1,015 respondents, 83% reported using (65.1% always 18.1% reporting selective use). For users, a majority for reoperative cases (95.1%) in with...
Objective To elucidate electrophysiologic responses of the recurrent laryngeal nerves that were preoperatively paralyzed or invaded by malignancy and to use this information as an added functional parameter for intraoperative management with malignant invasion. Study Design Case series chart review. Settings Academic, tertiary care center. Subjects Methods All consecutive neck surgeries nerve monitoring performed senior author (GWR) between December 1995 January 2007 reviewed after obtaining...
Despite increasing use of intraoperative nerve monitoring (IONM), there is limited information on normative electrophysiologic electromyographic (EMG) parameters. The objective this study was to define parameters recurrent laryngeal (RLN) neuromonitoring during thyroid surgery associated with normal postoperative vocal cord function.Prospective data collection in a tertiary care center.Quantitative analysis evoked waveform amplitude and threshold performed 125 patients 167 nerves at risk....
Objectives/Hypothesis To define normative amplitude and latency of vagus, recurrent laryngeal nerve (RLN), external branch superior (EBSLN) to apply them postoperative neural function documentation. our knowledge, this is the first study report electrophysiologic characteristics all three nerves in a consecutive patient series. Study Design Prospective. Methods Quantitative analysis evoked waveform data was performed on both sides patients undergoing thyroid surgery by single surgeon. Mean...
Background: Recurrent laryngeal nerve (RLN) palsy remains a major source of morbidity after thyroid surgeries. Intraoperative neural monitoring (IONM) has gained increasing acceptance as an adjunct to standard practice visual RLN identification. Endotracheal tube (ETT) surface recording electrodes systems are now widely used for IONM; however, malpositioned ETT can cause false IONM results and requires time-consuming intraoperative verification the position readjustment by anesthesiologist....
Objectives/Hypothesis During intraoperative neural monitoring (IONM) in thyroid and parathyroid surgery, endotracheal (ET) tube migration can result a decrease vocalis electromyographic (EMG) amplitude without concordant latency elevation during stimulation of the recurrent laryngeal nerve (RLN). Study Design Retrospective review. Methods Data were reviewed retrospectively for surgery patients with IONM nerves from January 2015 to December 2015. Recordings EMG amplitudes latencies RLN...
Objectives/Hypothesis Intraoperative neural monitoring is a useful adjunct for the laryngeal nerve function assessment during thyroid and parathyroid surgery. Typically, performed by measurement of electromyographic responses recorded endotracheal tube (ETT) surface electrodes. Tube position alterations surgery can cause displacement electrodes relative to vocal cords, leading false positive loss signal. Numerous reports have denoted equipment–related issues, especially displacement, as...
Objectives/Hypothesis Correlation of physiologically important electromyographic (EMG) waveforms with demonstrable muscle activation is for the reliable interpretation evoked during intraoperative neural monitoring (IONM) vagus nerve, recurrent laryngeal nerve (RLN), and external branch superior (EBSLN) in thyroid surgery. Study Design Retrospective chart review. Methods Data were reviewed retrospectively surgery patients IONM from January to December, 2015. EMG responses monopolar...
Background: The recurrent laryngeal nerve (RLN) can be injured during thyroid surgery, which negatively affect a patient's quality of life. impact intraoperative anatomic variations the RLN on injury remains unclear. Objectives this study were to (1) better understand detailed surgical variability with worldwide perspective; (2) establish potential correlates between anatomy and electrophysiologic responses; (3) use information minimize complications assure accurate safe neuromonitoring...