As we push deeper into the 21st century our surgical armamentarium is being continuously expanded. Never more true has this been than in the area of ENT / Head and Neck Surgery. Remarkable technological progress coupled with creative clinical thinking has led to the development of surgical advances that ultimately aim to improve patient outcomes and reduce morbidity. NEUROMONITORING AND HEAD AND NECK SURGERY Quoting a highly respected mentor, the head and neck certainly provides “anatomy for the connoisseur”. It is an extremely complicated region of the human body with a plethora of structures vital for both form and function. When operating within the head and neck region protecting these structures is paramount. Cranial nerve neuromonitoring is now widely used in head and neck surgery. Its broadest application has been in the monitoring of the facial nerve in both intracranial as well as extracranial surgery. Intracranially, surgical procedures on the temporal bone can place the nerve at risk - specifically acoustic neuroma surgery and tympanomastoid surgery. Extracranially, the nerve is most at risk during parotid surgery but also submandibular gland surgery and neck dissections, specifically the marginal mandibular nerve branch. In all of these instances the neuromonitor can be useful to facilitate the safe dissection of these nerves and predict post-operative outcomes with intraoperative stimulation at the completion of the procedure. The more recent application has been to thyroid and parathyroid surgery. By using monitoring electrodes placed on a correctly positioned endotracheal tube the recurrent laryngeal nerves can be monitored during surgery. This can certainly be useful in cases where one nerve may already be affected by the disease or in cases of revision surgery where the nerve may be difficult to dissect in scarred tissue planes. Beyond simple identification and preservation of gross function, subtle neuropraxia injuries and resultant changes in voice outcomes can be monitored for, and avoided, with use of the neuromonitor. pindaramagazine.com.au Pindara Magazine 71
Pindara Private Hospital Magazine - Issue Ten
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