Recurrent laryngeal nerve monitoring with surface electrodes in pediatric thyroid surgery
Bibliographic record
Abstract
OBJECTIVE: To prospectively evaluate 1) use of endotracheal tube (ETT) surface electrodes for recurrent laryngeal nerve (RLN) monitoring in thyroid surgery in children, and 2) effects of thyroid surgery on the RLN in children. METHODS: Patients <18 years old undergoing thyroidectomy were included. Vocal cord mobility was assessed pre- and postoperatively. RLNs were monitored using adhesive or integrated electrodes. Recordings were made before and after dissection, and area under the curve and latency were compared using mixed models. RESULTS: Twenty-five children (44 nerves at risk), mean (standard deviation) age 13.1 (3.4) years (range 4.5-17.4 years), underwent thyroidectomy. Twelve (46%) monitors were adhesive. One nerve had unobtainable responses. Nerveäna Power Index (NPI) (Neurovision Medical Products, Ventura, CA) decreased, and latency increased pre- versus postdissection at all amplitudes (P < 0.0001), with change in slope of NPI affected by tumor size (P < 0.05). Postdissection, the NPI was lower, and the latency was longer when stimulating low in the neck versus near the cricothyroid joint at all stimulating amplitudes (P < 0.0001), with change in NPI related to tumor size (P < 0.0001). Changes were not associated with decreased vocal cord mobility, aspiration, or voice change. One patient had a temporary unilateral paresis that resolved by 7 weeks, and another had normal movement 3 weeks postoperatively and developed a paresis 2 months postoperatively. CONCLUSION: ETT surface electrodes are reliable for RLN monitoring in thyroid surgery in children. Thyroid surgery is associated with a decrease in RLN stimulability that is related to tumor size. The site of RLN stimulation matters when evaluating the nerve. LEVEL OF EVIDENCE: 4 Laryngoscope, 130:1583-1589, 2020.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".