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Head and Neck Surgery

Head and Neck Surgery

We offer powered and manual head and neck surgery products to help otolaryngologists, endocrine, and general surgeons treat a variety of conditions.

About Head and Neck Surgery

Medtronic offers a broad portfolio of head and neck surgery products to help otolaryngologists, endocrine, and general surgeons treat a variety of conditions in adult and pediatric patients, such as:

Some of our key head and neck surgery products include the items below.

Powered ENT Instruments

Our Powered ENT Instruments include the multispecialty Integrated Power Console, Straightshot® M4 Microdebrider, Indigo™ Otologic Drill, Visao® High-Speed Otologic Drill, and Legend Stylus® Drill. During head and neck surgery, these tools can facilitate more precise tissue removal, visibility, and surgical access. We also offer the most comprehensive selection of application-specific blades and burs for head and neck surgery.

NIM Intraoperative Nerve Monitoring Systems

Our NIM® Nerve Monitoring Systems enable surgeons to identify and confirm motor nerve function and monitor major motor nerves during head and neck surgery, such as thyroidectomies, as well as other procedures performed by ENT, endocrine, and general surgeons. If there is a change in nerve function, the NIM System may provide visual and audible warnings to alert the surgeon. This helps reduce the risk of intraoperative nerve damage, improving safety and peace of mind for both surgeons and patients.

Nerve Stimulated with NIM Probe in a Thyroidectomy

Using a NIM stimulating probe during thyroidectomy

NIM EMG Endotracheal Tubes

Studies indicate that intraoperative nerve monitoring of the recurrent laryngeal nerve is recommended as a risk-minimizing tool during neck dissections, including thyroid surgery.1-6 Our NIM EMG Endotracheal Tubes provide an open airway for patient ventilation and intraoperative monitoring of both vocal cords.

Used with the NIM System, a properly positioned NIM EMG Endotracheal Tube can reduce the risk of injury to the patient during thyroid surgery by helping the surgeon to:

  • Identify the recurrent laryngeal, vagus, or other motor nerves at risk
  • Control manipulation during dissection
  • Verify the integrity of the nerve prior to surgical closure

Fusion ENT Navigation System

Our Fusion® ENT Navigation System is an electromagnetic image-guided surgery system that offers reliable accuracy, ease of use, and expandability. Image-guided surgery with the Fusion system can help you navigate each patient’s unique anatomy for safer, more thorough head and neck procedures when operating near important structures such as the brain, orbit, or carotid artery. The Fusion system allows customization for each surgeon, including procedure-specific pathways for FESS and lateral or anterior skull base.

Additional Products

For our complete line of head and neck surgery products, see our ENT Product Catalog.

 


References

1

Randolph, Gregory W. Surgery of the Thyroid and Parathyroid Glands. Chapter 25: Surgical Anatomy of the Recurrent Laryngeal Nerve (p316). Elsevier Science (USA), 2003.

2

Dralle H. Intraoperative monitoring of the recurrent laryngeal nerve in thyroid surgery. World J Surg. 2008 32(7):1358-66.

3

Thomusch O, Sekulla C, Walls G, Machens A, Dralle H. Intraoperative neuromonitoring of surgery for benign goiter. Amer J Surg. 2002;183(6):673–678.

4

Dralle H, Sekulla C, Haerting J, Timmermann W, Neumann HJ, Kruse E, Grond S, Mühlig HP, Richter C, Voß J, Thomusch O, Lippert H, Gastinger I, Brauckhoff M , Gimm O. Risk factors of paralysis and functional outcome after recurrent laryngeal nerve monitoring in thyroid surgery. Surgery. 2004;136:1310–1322.

5

Eisele DW. Intraoperative electrophysiologic monitoring of the recurrent laryngeal nerve. Laryngoscope. 1996;106:443–449.

6

Chiang F-Y, Lu I-C, Chen H-C, Chen H-Y, Tsai C-J, Hsiao P-J, Lee K-W, Wu C-W. Anatomical variations of recurrent laryngeal nerve during thyroid surgery; how to identify and handle the variations with intraoperative neuromonitoring. Kaohsiung J Med Sci. 2010; 26(11):575-583.

Thyroid Surgery: Why Monitor?

Thyroid Illustration

Clinical Evidence: Injury to the RLN 

It is a serious complication of thyroid surgery, yet the rate of recurrent laryngeal nerve (RLN) damage is underestimated.1-6 Clinical evidence shows the benefits of intraoperative nerve monitoring (IONM) of the RLN for nerve preservation and as a risk-minimizing tool during neck dissections, including thyroid surgery.1-4,7-15

Anatomical Variants of the RLN

Studies indicate anatomical variants are an important factor in nerve injury. With more than 25 anatomical variants of the RLN, visual identification can be difficult--even for experienced surgeons. Variations cannot be predicted preoperatively; nor does visual identification always prevent postoperative paralysis.12

Nerve Stimulated with NIM Probe in a Thyroidectomy

Detail: Using a NIM stimulating probe during thyroidectomy

"Invisible" Injury

Most RLN damage is caused by invisible injury from traction, pressure, and thermal devices.3,4,12,14  Berry's ligament is particularly vulnerable and a common site of invisible injury. IONM can assess true RLN functionality when the nerve appears visually intact.3,4

NIM System Detecting EMG Event

NIM System detects an EMG event and allows you to verify nerve function

A Valuable Surgical Adjunct

IONM is not a substitute for a detailed knowledge of anatomy or surgical skill; it is a valuable surgical adjunct to help surgeons:

  1. Locate, confirm, and map the nerves. Identifying the RLN has been shown to reduce the rate of RLN palsy.
  2. Verify and monitor nerve integrity. IONM enables surgeons to verify nerve integrity before and after dissection, monitor EMG activity to help control manipulation during dissection, obtain real-time feedback about nerve function, detect invisible RLN insults,3-4 and perform minimally invasive approaches with added confidence and precision.
NIM System Detecting and Muting an Artifact

Artifact detection software detects and mutes an artifact

NIM Systems for Nerve Monitoring

Based on over 20 years of nerve monitoring experience, the NIM-Response® 3.0 is an innovative nerve integrity monitor that can provide additional patient safety and physician peace of mind. The NIM® 3.0 offers an intuitive touchscreen interface, monitoring through bipolar cautery, artifact detection, and color-coded placement guides. Use it with our NIM TriVantage® EMG Endotracheal Tube and APS® Electrode during thyroid surgery or other head and neck surgery procedures.

NIM System Showing APS Electrode Response

NIM screen showing APS Electrode response

NIM EMG Endotracheal Tubes

The NIM TriVantage EMG Endotracheal Tube provides an open airway and intraoperative nerve monitoring of both vocal cords. It features smooth conductive silver ink electrodes, an enhanced EMG response with fewer false positives, and reduced sensitivity to movement or rotation.

APS Electrode

Used with the NIM 3.0, the APS (Automatic Periodic Stimulation) Electrode enables early detection and warning of a change in nerve function. This allows the surgeon to take immediate corrective action to prevent potential injury.16-17 It's placed on the vagus nerve and delivers continuous low-level stimulation. A baseline of nerve function is obtained and subsequent EMG responses are monitored and charted in real time.

Why Use APS Monitoring? Nerves can be at risk in between stimulations due to surgical incision, blind trauma caused by manipulation and stretching during tumor/thyroid removal, and cumulative trauma or damage that may result in neuropraxia.


References

1

Lo C, Kwok F, Yuen P. A prospective evaluation of recurrent laryngeal nerve paralysis during thyroidectomy. Archives of Surgery 2000;135(2): 204-207.

2

Dionigi G, et al. The technique of intraoperative neuromonitoring in thyroid surgery. Surg Technol Int. 2010;19: 25-37.

3

Dionigi G, et al. Why monitor the recurrent laryngeal nerve in thyroid surgery? J Endocrinal Invest. 2010; 33: 819-822.

4

Randolph GW. Surgery of the Thyroid and Parathyroid Glands. Chapter 25: Surgical Anatomy of the Recurrent Laryngeal Nerve (p316). Elsevier Science (USA), 2003.

5

Bergenfelz A, Jansson S, Kristoffersson A. Complications of thyroid surgery: results as reported in a database from a multicenter audit comprising 3,660 patients. Langenbecks Arch Surg. 2008; 393: 667-673. 

6

Ready AR, Barnes AD. Complications of thyroidectomy. Br J Surg. 1994; 81: 1555-1556.

7

Randolph GW and Dralle H with the International Intraoperative Monitoring Study Group. Electrophysiologic recurrent laryngeal nerve monitoring during thyroid and parathyroid surgery: international standards guideline statement. Laryngoscope 2011; 121:S1-S16.

8

Dralle H. Intraoperative monitoring of the recurrent laryngeal nerve in thyroid surgery. World J Surg. 2008 32(7): 1358-1366. This article received the World Journal of Surgery award for Best Paper in 2008 and identifies risk-minimizing tools to help avoid recurrent laryngeal nerve palsy. 

9

Thomusch O, Sekulla C, Walls G, Machens A, Dralle H. Intraoperative neuromonitoring of surgery for benign goiter. Amer J Surg. 2002;183(6): 673–678.

10

Dralle H, Sekulla C, Haerting J, Timmermann W, Neumann HJ, Kruse E, Grond S, Mühlig HP, Richter C, Voß J, Thomusch O, Lippert H, Gastinger I, Brauckhoff M , Gimm O. Risk factors of paralysis and functional outcome after recurrent laryngeal nerve monitoring in thyroid surgery. Surgery. 2004;136:1310–1322.

11

Eisele DW. Intraoperative electrophysiologic monitoring of the recurrent laryngeal nerve. Laryngoscope. 1996;106: 443–449.

12

Chiang F-Y, Lu I-C, Chen H-C, Chen H-Y, Tsai C-J, Hsiao P-J, Lee K-W, Wu C-W. Anatomical variations of recurrent laryngeal nerve during thyroid surgery; how to identify and handle the variations with intraoperative neuromonitoring. Kaohsiung J Med Sci. 2010; 26(11): 575-583.

13

Chiang FY, et al. Intraoperative neuromonitoring for early localization and identification of recurrent laryngeal nerve during thyroid surgery. Kaohsiung J Med Sci. 2010; 26(12): 633-638.

14

Chiang FY, et al. Standardization of intraoperative neuromonitoring of recurrently laryngeal nerve in thyroid operation. World J Surg 2010; 34(2): 223-229.

15

Dralle H, et al. What benefits does neuromonitoring bring to thyroid surgery? Artz und Krankenhaus. 2004; 369-376.

16

Schneider R, Randolph GW, Sekulla C, et al. Continuous intraoperative vagus nerve stimulation for identification of imminent recurrent laryngeal nerve injury. Head and Neck 2012; doi :10.1002/hed.23187.

17

Van Slycke S, Gillardin J-P, Brusselaers N, Vermeersch H. Initial experience with S-shaped electrode for continuous vagal nerve stimulation in thyroid surgery. Langenbecks Arch Surg. doi: 10.1007/s00423-013-1068-3. Epub 2013 Mar 5.