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Skull base surgery. 1994 October; 4(4): 213–218.
PMCID: PMC1661811

Vagal Nerve Monitoring during Parapharyngeal Space Tumor Removal

Abstract

The vagus nerve innervates the intrinsic and extrinsic laryngeal musculature as well as the complex pharyngeal plexus. Acute paralysis of this nerve results in dysfunctional speech, deglutition, and airway protection. These untoward effects, which lead to additional infectious and aerodigestive complications, may arise following manipulation of the vagus nerve during the surgical removal of a variety of neoplasms found in the parapharyngeal space.

The vagal nerve has been intraoperatively monitored in an effort to maintain its anatomic and functional integrity. Bipolar hook-wire electrodes are introduced transcutaneously through the cricothyroid membrane and are guided into the vocalis muscle by an assistant performing direct laryngoscopy. Continuous, real-time monitoring of the vagal nerve is provided by audio and visual feedback to the operating surgeon. Potentially injurious stretching, heating, and compression of the nerve are easily detected, and monopolar stimulation of the nerve is used to map the nerve's course through the tumor bed.

This presentation outlines our technique for vagal nerve monitoring in patients with tumors of the parapharyngeal space and intact preoperative vocal cord mobility. Selected cases are presented and illustrated through intraoperative and postoperative videotapes.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Kartush JM, Larouere MJ, Graham MD, Bouchard KR, Audet BV. Intraoperative cranial nerve monitoring during posterior skull base surgery. Skull Base Surg. 1991;1(2):85–92. [PMC free article] [PubMed]
  • May M, Lavorato AS, Bleyaert AL. Rehabilitation of the crippled larynx: application of the Tucker technique for muscle-nerve reinnervation. Laryngoscope. 1980 Jan;90(1):1–18. [PubMed]
  • Biller HF, Lawson W, Som P, Rosenfeld R. Glomus vagale tumors. Ann Otol Rhinol Laryngol. 1989 Jan;98(1 Pt 1):21–26. [PubMed]

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