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NEUROMONITORING PATIENT CARE
Webinmed’s specially trained staff offers neuromonitoring services during surgery. In addition, records of the surgery are available to the surgeon if needed post -operatively and thus offer the ‘medicolegal’ services that can be of use in various cases.
Thyroid surgery is among the most common surgical procedures, and yet, variations in the anatomy and location of nerves and poor visibility during recurrent tumor operations are the most common reasons for N. recurrent paresis. Over the past two decades, neuromonitoring has become invaluable as a way of locating and testing the function of the N. laryngeus. Neuromonitoring helps surgeons to locate the vulnerable vocal cord nerve and test its function. This is done by exciting the nerve by means of minute electric impulses from specific stimulation probes.
When the probe tip touches tissue close to the nerve, it triggers an action potential which is carried to the target muscle by the intact nerve. At the target muscle (M. vocalis = vocal cord muscle), a compound muscle action potential (CMAP) is generated, which is recorded through electromyography and made visible and audible to the surgeon.
During parotid gland surgery as well as in severe facial injuries or during surgical tumour resection, there is a risk of injuring one of the numerous motor nerves, such as N. facialis.
The nerve branches out from the brain stem into the two facial halves, innervating them throughout with its sensor and motor fibres. In parotid surgery, it runs across the operation site and is therefore particularly at risk. An injury of the N. facialis (facial paresis) results in the paralysis of facial muscles and disrupted sensation. The affected patients also suffer from the visible consequences of impaired facial movement.
This is where intraoperative neuromonitoring comes into its own to ensure that the nerves are protected during surgery. The nerve at the operation site is electrically stimulated by dedicated simulation probes. The impulses triggered travel to the target muscles where they are picked up as motor unit action potential (MUAP) by electromyography (EMG) electrodes. The signals are processed by the neuromonitor and, with modern systems, converted into a signal waveform and into acoustic signals for the surgeon.