Endolaryngeal Hookwire Electrodes for Intraoperative Recurrent Laryngeal Nerve Monitoring during Pediatric Thyroid Surgery

Objective. To describe the senior author's surgical technique and discuss his experience with endolaryngeal hookwire electrodes for intraoperative, recurrent laryngeal nerve monitoring during pediatric thyroid surgery. Study Design. Consecutive case series. Setting. Tertiary-care, academic, children's hospital. Subjects and Methods. A consecutive case series review of pediatric patients (age <16 years) who underwent thyroid surgery with intraoperative, endolaryngeal hookwire recurrent laryngeal nerve monitoring. Nerve injury was defined as vocal cord dysfunction present >12 months postoperatively. Results. Seventeen patients were identified. There were 5 males and 12 females, and the average age was 11.7 years (range, 4-15 years). Nineteen procedures were performed-4 hemithyroidectomies, 2 completion thyroidectomies, and 13 total thyroidectomies-with 32 nerves at risk. One patient had a recurrent laryngeal nerve injury with a nerve paresis that persisted longer than 12 months postoperatively, making our recurrent laryngeal nerve injury rate 3.1% (1/32). Fortunately, the nerve eventually recovered to normal function. Conclusion. Thyroid nodules and surgery in children consist of higher rates of malignancy and potentially higher risks for recurrent laryngeal nerve complications. Our injury rate was 3.1%. Intraoperative recurrent laryngeal nerve monitoring with endolaryngeal hookwire electrodes in pediatric thyroid surgery may be helpful in nerve identification and is very sensitive. This technique can be used in situations in which endotracheal tubes with surface electrodes cannot be accommodated by the smaller size of the pediatric airway.