Monitoring of the posterior cricoarytenoid muscle represents another option for neural monitoring during thyroid surgery: Normative vagal and recurrent laryngeal nerve posterior cricoarytenoid muscle electromyographic data

2017 ◽  
Vol 128 (1) ◽  
pp. 283-289 ◽  
Author(s):  
Whitney Liddy ◽  
Samuel R. Barber ◽  
Brian M. Lin ◽  
Dipti Kamani ◽  
Natalia Kyriazidis ◽  
...  
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Thyroid Surgery ◽  
Laryngeal Nerve ◽  
Posterior Cricoarytenoid Muscle ◽  
Posterior Cricoarytenoid ◽  
Neural Monitoring

Surgical Anatomy of the Recurrent Laryngeal Nerve: Implications for Laryngeal Reinnervation

2003 ◽  
Vol 112 (5) ◽  
pp. 434-438 ◽  
Author(s):  
Edward J. Damrose ◽  
Robert Y. Huang ◽  
Gerald S. Berke ◽  
Ming Ye ◽  
Joel A. Sercarz
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Adductor Muscle ◽  
Surgical Anatomy ◽  
Laryngeal Nerve ◽  
Main Trunk ◽  
Posterior Cricoarytenoid Muscle ◽  
Laryngeal Reinnervation ◽  
Human Cadavers ◽  
Muscle Groups ◽  
Posterior Cricoarytenoid

Functional laryngeal reinnervation depends upon the precise reinnervation of the laryngeal abductor and adductor muscle groups. While simple end-to-end anastomosis of the recurrent laryngeal nerve (RLN) main trunk results in synkinesis, functional reinnervation can be achieved by selective anastomosis of the abductor and adductor RLN divisions. Few previous studies have examined the intralaryngeal anatomy of the RLN to ascertain the characteristics that may lend themselves to laryngeal reinnervation. Ten human larynges without known laryngeal disorders were obtained from human cadavers for RLN microdissection. The bilateral intralaryngeal RLN branching patterns were determined, and the diameters and lengths of the abductor and adductor divisions were measured. The mean diameters of the abductor and adductor divisions were 0.8 and 0.7 mm, while their mean lengths were 5.7 and 6.1 mm, respectively. The abductor division usually consisted of one branch to the posterior cricoarytenoid muscle; however, in cases in which multiple branches were seen, at least one dominant branch could usually be identified. We conclude that the abductor and adductor divisions of the human RLN can be readily identified by an extralaryngeal approach. Several key landmarks aid in the identification of the branches to individual muscles. These data also indicate the feasibility of selective laryngeal reinnervation in patients who might be candidates for laryngeal transplantation after total laryngectomy.

Function of the Posterior Cricoarytenoid Muscle in Phonation: In vivo Laryngeal Model

1993 ◽  
Vol 109 (6) ◽  
pp. 1043-1051 ◽  
Author(s):  
Hong-Shik Choi ◽  
Gerald S. Berke ◽  
Ming Ye ◽  
Jody Kreiman
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Fundamental Frequency ◽  
Nerve Stimulation ◽  
Sound Intensity ◽  
Vocal Folds ◽  
Laryngeal Nerve ◽  
Posterior Cricoarytenoid Muscle ◽  
Posterior Cricoarytenoid ◽  
Stimulation Of

The function of the posterior cricoarytenoid (PCA) muscle in phonation has not been well documented. To date, several electromyographic studies have suggested that the PCA muscle is not simply an abductor of the vocal folds, but also functions in phonation. This study used an in vivo canine laryngeal model to study the function of the PCA muscle. Subglottic pressure and electroglottographic, photogiottographic, and acoustic waveforms were gathered from five adult mongrel dogs under varying conditions of nerve stimulation. Subglottic pressure, fundamental frequency, sound intensity, and vocal efficiency decreased with increasing stimulation of the posterior branch of the recurrent laryngeal nerve. These results suggest that the PCA muscle not only acts to brace the larynx against the anterior pull of the adductor and cricothyroid muscles, but also functions inhibitorily in phonation by controlling the phonatory glottal width.

Evoked Electromyographic Technique for Quantitative Assessment of the Innervation Status of Laryngeal Muscles

2005 ◽  
Vol 114 (7) ◽  
pp. 563-572 ◽  
Author(s):  
David L. Zealear ◽  
Matthew R. Swelstad ◽  
Scott Fortune ◽  
Ricardo J. Rodriguez ◽  
Sung-Min Chung ◽  
...  
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Quantitative Information ◽  
Laryngeal Nerve ◽  
Noninvasive Technique ◽  
Laryngeal Muscles ◽  
Phase Study ◽  
Posterior Cricoarytenoid Muscle ◽  
Muscle Innervation ◽  
Posterior Cricoarytenoid ◽  
Thyroarytenoid Muscle

Objectives: The purpose of this study was to develop a minimally invasive, noninjurious evoked electromyographic technique that could accurately quantitate the level of innervation of laryngeal muscles with recurrent laryngeal nerve stimulation. Methods: A four-phase study was conducted in 24 canines, including 1) identification of the best stimulation-recording configuration, 2) statistical analysis of sensitivity and accuracy, 3) evaluation of safety, and 4) identification of the laryngeal muscle(s) that contribute to the evoked response. Results: The results demonstrated that an entirely noninvasive technique is not feasible. The stimulating cathode must be invasive to ensure discrete activation of the recurrent laryngeal nerve, whereas both recording electrodes should remain on the surface with one overlying the thyroid ala. This configuration proved to be highly accurate, with an error rate of only 6% to 7%, and with sensitivity sufficient to detect a signal in a nerve with fewer than 1% of the axons intact. There was no evidence of nerve injury in any animal over the course of 350 stimulus needle penetrations. By use of neuromuscular blockade to identify those muscles generating the surface response, the thyroarytenoid muscle was found to be the primary contributor, whereas the posterior cricoarytenoid muscle was uninvolved. Conclusions: This evoked electromyographic technique could provide quantitative information regarding the extent of muscle innervation during denervation and regeneration in case of laryngeal paralysis.

Sensitivity and Specificity of Intraoperative Recurrent Laryngeal Nerve Stimulation in Predicting Postoperative Nerve Paralysis

2002 ◽  
Vol 111 (11) ◽  
pp. 1005-1007 ◽  
Author(s):  
Randal A. Otto ◽  
C. Spencer Cochran
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Sensitivity And Specificity ◽  
Nerve Stimulation ◽  
Predictive Value ◽  
Injury Rate ◽  
Laryngeal Nerve ◽  
Nerve Paralysis ◽  
Posterior Cricoarytenoid Muscle ◽  
The Status ◽  
Posterior Cricoarytenoid

Bilateral recurrent laryngeal nerve (RLN) paralysis after thyroidectomy is infrequent, but serious when it occurs. Intraoperative knowledge of the status of the nerve after dissection could potentially provide the surgeon with important decision-making information. The current study examines the sensitivity and specificity of intraoperative stimulation of the RLN during thyroid surgery for predicting postoperative RLN deficits. Eighty-one RLNs in 55 patients were identified to be at risk of injury during thyroidectomy or parathyroidectomy performed between January 1998 and February 2000. Intraoperative determination of RLN function was evaluated with a disposable nerve stimulator (Xomed, Jacksonville, Florida) set at 0.5 mA. Injury was assessed by palpating for a contraction of the posterior cricoarytenoid muscle while the stimulus was applied. Postoperative assessment of RLN integrity was determined by using indirect or direct laryngoscopy to visualize vocal fold mobility. Nine RLNs failed to elicit a posterior cricoarytenoid contraction after nerve stimulation, and 4 RLNs were determined to be deficient in the postoperative evaluation. The calculated sensitivity and specificity were 75% and 92.2% with a positive predictive value of 33.3% and negative predictive value of 98.6%. The RLN injury rate was 4.94%. We conclude that intraoperative RLN stimulation is a relatively safe and useful method of determining what RLN function will be after thyroid or parathyroid surgery.

scholarly journals Intraoperative Monitoring of the Recurrent Laryngeal Nerve during Thyroidectomy: A Standardized Approach Part 2

2012 ◽  
Vol 4 (1) ◽  
pp. 33-40 ◽  
Author(s):  
Henning Dralle ◽  
Antonio Sitges-Serra ◽  
Peter Angelos ◽  
Manuel C Durán Poveda ◽  
Gianlorenzo Dionigi ◽  
...  
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Thyroid Surgery ◽  
Intraoperative Monitoring ◽  
Surgical Anatomy ◽  
Laryngeal Nerve ◽  
Nerve Monitoring ◽  
Concise Overview ◽  
Monitoring Procedure ◽  
Intraoperative Nerve Monitoring ◽  
Neural Monitoring

ABSTRACT This is the second of two articles on intraoperative neural monitoring. The aim of part one was to provide a concise overview of intraoperative nerve monitoring in thyroid surgery and its effectiveness. Part 1 included a brief review of the surgical anatomy of the recurrent laryngeal nerve and described the surgical landmarks which can be used to identify the nerve during surgery. Part 2 will describe in detail a standardized approach to intraoperative nerve monitoring during thyroid surgery. A brief review of the nerve monitoring procedure and all its requirements will be discussed. The article concludes with the description of a troubleshooting algorithm for intraoperative loss of signal. How to cite this article Poveda MCD, Dionigi G, Sitges- Serra A, Barczynski M, Angelos P, Dralle H, Phelan E, Randolph G. Intraoperative Monitoring of the Recurrent Laryngeal Nerve during Thyroidectomy: A Standardized Approach Part 2. World J Endocr Surg 2012;4(1):33-40.

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