Injury to recurrent laryngeal nerve (RLN) during thyroid operation remains a significant source of morbidity. The use of intraoperative neural monitoring (IONM) during thyroid surgery has given surgeons a tool for better understanding of the mechanisms of RLN injury. With the application of IONM, the surgeon can evaluate the functional status of RLN in addition to the visual information. At times there may be partial or total loss of nerve conduction to nerve stimulation indicating RLN stress or injury has occurred. The surgeon can also evaluate the surgical maneuver that produced the impending or actual RLN injury. By elucidating the mechanism of RLN injury, IONM can help clinicians plan intra- and post-operative treatment. In recent years, experimental studies of IONM have addressed several research issues, especially RLN injury models and prevention strategies. Animal IONM research provides a valuable tool for studying electrophysiology, severity, and recovery in various RLN injuries. Lessons learned from clinical and animal researches have immediate applications in establishing reliable strategies for preventing intraoperative RLN injury. This article reviewed the literature to summary the improved understanding of RLN injuries with the progress on IONM relevant clinical and animal researches.
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