Guidelines for Complications of Cancer Treatment Vol VIII Part B

When the EBSLN is damaged unilaterally, it usually goesunnoticed by a normal individual. A trained singer will noticea change in pitch variation, with inability to go to a higherpitch and may affect the singing career. Hence in a professionalvoice user extreme care should be taken to preserve the EBSLNand the patient should be adviced of this possibility. Onexamination the damaged side will show a bowed vocal cordwrinkly or wavy in appearance and at a lower level than theopposite cord.Bilateral EBSLN damage causes a lower pitch voice which isweaker and breathy. The singing will be severely affected athigher notes but not the conversational speech.2. Nerve Monitoringa. Per primum setting:The literature is divided on the routine use of nervemonitoring for identifying and preserving nerves duringthyroidectomy. In a large prospective study across 7133nerves at risk, Thomusch O et al., showed a significantreduction in RLN damage with neuro-monitoringOther studies by Shino M et al., and Dralle H et al.,(2008) have not shown to reduce the incidence of nervetrauma intra-operatively. In a large retrospective study,Dralle et al., analyzing outcomes of 30,000 nerves atrisk failed to show any advantage with neuro-monitoring.b. Revision Surgery:In the re-operative setting a study from Mayo Clinic,Yarbrough et al., failed to show any added advantage ofneuromonitoring over visual identification andmeticulous surgical technique. More over addition ofneuromonitoring significantly added to the cost of theprocedures.In summary, the best method for nerve preservation is athorough understanding of normal anatomy of the nerve194