scholarly journals Total Endoscopic Thyroidectomy with Intraoperative Laryngeal Nerve Monitoring

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Bin Lv ◽  
Bin Zhang ◽  
Qing-Dong Zeng
Keyword(s):  
Endoscopic Thyroidectomy ◽  
Risk Difference ◽  
Laryngeal Nerve ◽  
Control Group ◽  
Injury Rates ◽  
Nerve Monitoring ◽  
Hand Surgeon ◽  
Joint Application ◽  
Left And Right ◽  
The Right

Objective. To evaluate the clinical efficacy of laryngeal nerve (LN) monitoring (LNM) during total endoscopic thyroidectomy via breast approach, with emphasis on the identification rates for RLN and EBSLN and the incidence of RLN paralysis. Materials and Methods. This retrospective study included 280 patients who underwent endoscopic thyroidectomy with or without LNM. RLN and EBSLN were identified using endoscopic magnification in the control group, while they were localized additionally by LNM in the LNM group. Demographic parameters and surgical outcomes were analyzed by statistical methods. Patients in the control group were also stratified by the side of thyroidectomy to determine difference in left and right RLN injury rates. Results. All procedures were successfully conducted without permanent LN damage. The identification rates for RLN and EBSLN were high in the LNM group compared to those of the control group, and the risk difference (RD) of temporary RLN injury between two groups was 6.3%. The risk of damage was slightly higher for the left RLN than for the right RLN in the control group, which was performed by a right-hand surgeon. Conclusion. The joint application of LNM and endoscopic magnified view endows total endoscopic thyroidectomy with ease, safety, and efficiency.

scholarly journals Effect of dental wear, stabilization appliance and anterior tooth reconstruction on mandibular movements during speech

2008 ◽  
Vol 19 (2) ◽  
pp. 151-158 ◽  
Author(s):  
Priscila de Oliveira Serrano ◽  
Fernanda Faot ◽  
Altair Antoninha Del Bel Cury ◽  
Renata Cunha Matheus Rodrigues Garcia
Keyword(s):  
Tooth Wear ◽  
Anterior Tooth ◽  
Control Group ◽  
Dental Wear ◽  
Jaw Opening ◽  
Before And After ◽  
Left And Right ◽  
The Right ◽  
Tracking Device ◽  
Mandibular Movements

This study described changes in mandibular movements during pronunciation of /m/ and /s/ sounds in Portuguese, in patients presenting dental wear before and after appliance insertion and tooth reconstruction. Subjects were divided into a control group of dentate patients and an experimental group of patients with incisal tooth wear due to bruxism. A magnetic jaw tracking device measured the jaw opening, and translations to left and right sides of the mandible during pronunciation of phonemes. Evaluations were carried out 1 week and immediately before appliance insertion; 24 h, 7, 30 and 60 days after appliance insertion; and 1 week and 1 month after tooth reconstruction. Data were submitted to two-way ANOVA, Mann-Whitney and Friedman tests (p<0.05). Jaw opening was different (p<0.05) for both sounds in all periods. The anteroposterior amplitude for /s/ showed differences immediately before and 1 month after appliance insertion (p<0.05). Lateral amplitude for the right side showed differences between groups after appliance insertion for /s/, and 1 and 2 months after appliance insertion for the /m/ (p<0.05). Volunteers with anterior tooth wear had a wider opening movement, and the movements during speech of /m/ and /s/ sounds were not changed after appliance insertion and reconstruction of teeth.

scholarly journals Recurrent laryngeal nerve monitoring during totally robot-assisted Ivor Lewis esophagectomy

2020 ◽  
Vol 405 (8) ◽  
pp. 1091-1099
Author(s):  
J. I. Staubitz ◽  
P. C. van der Sluis ◽  
F. Berlth ◽  
F. Watzka ◽  
F. Dette ◽  
...  
Keyword(s):  
Lymph Node ◽  
Recurrent Laryngeal Nerve ◽  
Laryngeal Nerve ◽  
Node Dissection ◽  
Robot Assisted ◽  
Nerve Monitoring ◽  
Ivor Lewis ◽  
Ivor Lewis Esophagectomy ◽  
Vocal Cord Paresis ◽  
The Right

Abstract Purpose The robot-assisted approach for Ivor Lewis esophagectomy offers an enlarged, three-dimensional overview of the intraoperative situs. The vagal nerve (VN) can easily be detected, preserved, and intentionally resected below the separation point of the recurrent laryngeal nerve (RLN). However, postoperative vocal cord paresis can result from vagal or RLN injury during radical lymph node dissection, presenting a challenge to the operating surgeon. Methods From May to August 2019, 10 cases of robot-assisted minimally invasive esophagectomy (RAMIE) with extended 2-field lymphadenectomy, performed at the University Medical Center Mainz, were included in a prospective cohort study. Bilateral intermittent intraoperative nerve monitoring (IONM) of the RLN and VN was performed, including pre- and postoperative laryngoscopy assessment. Results Reliable mean signals of the right VN (2.57 mV/4.50 ms) and the RLN (left 1.24 mV/3.71 ms, right 0.85 mV/3.56 ms) were obtained. IONM facilitated the identification of the exact height of separation of the right RLN from the VN. There were no cases of permanent postoperative vocal paresis. Median lymph node count from the paratracheal stations was 5 lymph nodes. Conclusion IONM was feasible during RAMIE. The intraoperative identification of the RLN location contributed to the accuracy of lymph node dissection of the paratracheal lymph node stations. RLN damage and subsequent postoperative vocal cord paresis can potentially be prevented by IONM.

scholarly journals Nonrecurrent Laryngeal Nerve in the Era of Intraoperative Nerve Monitoring

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
Emin Gurleyik ◽  
Gunay Gurleyik
Keyword(s):  
Early Stage ◽  
Anatomical Variation ◽  
Vocal Cord Palsy ◽  
Laryngeal Nerve ◽  
Proximal Point ◽  
Nerve Monitoring ◽  
Risk Of Injury ◽  
Nonrecurrent Laryngeal Nerve ◽  
The Right ◽  
Intraoperative Nerve Monitoring

Nonrecurrent laryngeal nerve (non-RLN) is an anatomical variation increasing the risk of vocal cord palsy. Prediction and early identification of non-RLN may minimize such a risk of injury. This study assessed the effect of intraoperative neuromonitoring (IONM) on the detection of non-RLN. A total of 462 (236 right) nerves in 272 patients were identified and totally exposed, and all intraoperative steps of IONM were sequentially applied on the vagus nerve (VN) and RLN. Right predissection VN stimulation at a distal point did not create a sound signal in three cases (3/236; 1.27%). Proximal dissection of the right VN under IONM guidance established a proximal point, creating a positive signal. The separation point of non-RLN from VN was discovered in all three patients. Non-RLNs were exposed from separation to laryngeal entry. Positive IONM signals were obtained after resection of thyroid lobes, and postoperative period was uneventful in patients with non-RLN. Absence of distal VN signal is a precise predictor of the non-RLN. IONM-guided proximal dissection of the right VN leads to identification of the non-RLN. The prediction of non-RLN by the absence of the VN signal at an early stage of surgery may prevent or minimize the risk of nerve injury.

scholarly journals Anomalous Superior Thyroid Artery

2012 ◽  
Vol 8 (4) ◽  
pp. 429-431 ◽  
Author(s):  
Vandana Mehta ◽  
Rajesh K. Suri ◽  
Jyoti Arora ◽  
Gayatri Rath ◽  
Srijit Das
Keyword(s):  
Thyroid Gland ◽  
Laryngeal Nerve ◽  
Superior Thyroid Artery ◽  
External Laryngeal Nerve ◽  
Arterial Variations ◽  
Anomalous Artery ◽  
Unusual Distribution ◽  
Male Cadaver ◽  
Left And Right ◽  
The Right

The variations in the pattern of distribution of superior thyroid artery assume paramount importance for neck surgeons, in view of its vital topographical relationship to the external laryngeal nerve. In this study, we report an unusual variation in the arterial supply of the thyroid gland, which was detected during a routine dissection of an adult male cadaver. The right superior thyroid artery was absent whereas the left superior thyroid artery took origin from the left common carotid artery and showed a dominant pattern of distribution supplying the superior aspect of both the left and right lobes of the thyroid gland. It exhibited a usual relationship with the left external laryngeal nerve. The inferior thyroid arteries did not show any unusual distribution. Knowledge of such arterial variations related to the thyroid gland is immensely helpful for surgeons in order to put ligature on anomalous artery and to avoid damage to vital structures in this area, such as the external laryngeal nerve.http://dx.doi.org/10.3126/kumj.v8i4.6246 Kathmandu Univ Med J 2010;8(4):429-31 

scholarly journals Intima-Media Thickness Measurements of the Common Carotid Artery in Patients with Central Serous Chorioretinopathy: A Case-Control Study

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Kobra Nasrollahi ◽  
Amirhossein Farahi ◽  
Fatemeh Paknazar ◽  
Mohamadreza Akhlaghi ◽  
Farhad Fazel ◽  
...  
Keyword(s):  
Central Serous Chorioretinopathy ◽  
Case Control Study ◽  
Intima Media Thickness ◽  
Case Control ◽  
Control Group ◽  
Media Thickness ◽  
Left And Right ◽  
The Difference ◽  
The Right ◽  
Control Study

Purpose. To evaluate the intima-media thickness (IMT) of the left and right common carotid arteries (CCA) as an indicator of subclinical atherosclerosis in patients with central serous chorioretinopathy (CSCR). Methods. This was a case-control study involving patients with CSCR and a matched healthy control group. The mean and difference of the left and right CCA IMT were determined and compared between the two groups using carotid duplex high-resolution B-mode ultrasound equipment. Results. The study enrolled 32 CSCR patients (68.8% female, mean age 38.22 ± 5.42 years) and 32 controls (65.6% female, mean age 39.56 ± 5.33 years). The difference in common carotid IMT between the right and left sides was significantly greater in the CSCR group than in the control group ( p < 0.001 ). Additionally, according to logistic regression analysis, patients with CSCR had a greater chance of having differences in IMT between the two sides when compared to the control group (OR: 1.29, 95% CI: 1.09–1.52). Conclusion. Our findings indicated that in the CSCR group, the difference between the right and left sides of CCA IMT was significantly greater than in the control group.

scholarly journals Experience of Intraoperative Recurrent Laryngeal Nerve monitoring in a Single Center-normative Recurrent Laryngeal Nerve Electromyographic Data

2017 ◽  
Vol 9 (1) ◽  
pp. 1-6
Author(s):  
Rajeev Parameswaran ◽  
Gilbert Soh ◽  
James Wai Kit Lee ◽  
Oh Han Boon ◽  
Tan Wee Boon ◽  
...  
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Laryngeal Nerve ◽  
Parathyroid Surgery ◽  
Nerve Monitoring ◽  
Number Of Patients ◽  
Significant Difference ◽  
Hoarse Voice ◽  
Stimulation Current ◽  
The Right ◽  
Recurrent Laryngeal Nerve Monitoring

ABSTRACT Introduction Injury to the recurrent laryngeal nerve (RLN) remains a significant morbidity during thyroid and parathyroid surgery. The aim of this study is to elucidate normative RLN electromyographic (EMG) parameters. Materials and methods This is a retrospective cohort study of patients who underwent Intraoperative neuromonitoring during thyroid and parathyroid surgery from February 2014 to March 2015. The inomed C2 NerveMonitor was used. We recorded the stimulation current, amplitude, and latency of the RLN before and after nerve dissection. We also observed the number of patients who had hoarse voice after surgery. Results A total of 46 patients (14 male, 32 female) averaging 51 years old in age (20-77 years) were analyzed. The most commonly performed surgical procedure was total thyroidectomy (53.2%). The median stimulation current for both the right and left RLN was 0.500 mA. The median amplitude for the left RLN was 1.060 mV and greater than that for the right RLN (0.930 mV) (p = 0.30). The median latency for the right RLN and left RLN was 2.40 ms with no difference between the sides. (p = 0.58). Post dissection, the right RLN amplitude remained identical whereasthe left RLN amplitude decreased. Latencies of both RLNs decreased although the difference was not significant. Nature of pathology and site of surgery did not influence RLN latency and amplitude. No patients had hoarse voice. Conclusion This study highlights the normative EMG parameters for bilateral RLN nerve stimulation in an Asian population. No significant difference was noted in both pre- and postdissection RLN EMG parameters. How to cite this article Soh G, Lee JWK, Boon OH, Boon TW, Parameswaran R, Yuan NK. Experience of Intraoperative Recurrent Laryngeal Nerve monitoring in a Single Centernormative Recurrent Laryngeal Nerve Electromyographic Data. World J Endoc Surg 2017;9(1):1-6.

Newer Techniques of Laryngeal Reinnervation

1989 ◽  
Vol 98 (1) ◽  
pp. 8-14 ◽  
Author(s):  
Anthony J. Maniglia ◽  
Brian Dodds ◽  
Kelly Sorensen ◽  
N. Kumar ◽  
M. B. Katirji
Keyword(s):  
Vocal Cord ◽  
Superior Laryngeal Nerve ◽  
Laryngeal Nerve ◽  
Control Group ◽  
Pedicle Flap ◽  
Motor Branch ◽  
Cricothyroid Muscle ◽  
Vocal Cord Mobility ◽  
Posterior Cricoarytenoid ◽  
The Right

We relate the experience obtained in the use of the right superior laryngeal nerve (motor branch)–cricothyroid muscle pedicle flap in dogs in an attempt to reinnervate the right posterior cricoarytenoid muscle (PCA). The right vocal cord was paralyzed by severance and removal of 2.5 cm of the right recurrent laryngeal nerve. Evaluation 6 months postoperatively revealed the vocal fold remobilization on the right side to have an average of about one half the mobility of the left, normal side. After the recurrent laryngeal and superior laryngeal nerves on the left were severed, the vocal cord mobility dropped to only about one fourth. This suggests that the dogs had contralateral reinnervation. Nevertheless, the right vocal cord mobility, driven only by the right superior laryngeal nerve, was enough to secure an adequate airway without the need for a tracheotomy. This experiment was statistically significant on comparison with a control group. Electromyographic studies as well as PCA histochemistry were performed.

scholarly journals Protection of the external branch of the superior laryngeal nerve in Transoral endoscopic thyroidectomy vestibular approach (TOETVA): an observational study

2021 ◽  
Author(s):  
Zhen Wu ◽  
Jugao Fang ◽  
Hongzhi Ma ◽  
Xiao Chen ◽  
Qi Zhong ◽  
...  
Keyword(s):  
Contractile Activity ◽  
Endoscopic Thyroidectomy ◽  
Thyroid Cartilage ◽  
Superior Laryngeal Nerve ◽  
Laryngeal Nerve ◽  
External Branch ◽  
Protective Strategies ◽  
The Right ◽  
Intraoperative Nerve Monitoring ◽  
Vestibular Approach

Abstract Background: Avoiding injury of the external branch of the superior laryngeal nerve（EBSLN） is one of the major challenges during thyroid surgery, especially in transoral endoscopic thyroidectomy vestibular approach (TOETVA). This study aimed to investigate the protective strategies of the EBSLN during TOETVA. Methods: In order to protect the EBSLN during TOETVA, we adopted the method of identification the nerve by anatomy and localization. The method of anatomy involves the dissection of EBSLN by complete transection of the sternothyroid muscle in the attachment of the thyroid cartilage. The method of localization involves nerve stimulation localization, which produces cricothyroid contractile activity through intraoperative nerve monitoring stimulation (IONM). Concurrently, patients were evaluated preoperatively and at 1 and 3 weeks postoperatively in an individual prospective cohort study using a stroboscopic laryngoscope and the voice handicap index-10 (VHI-10). The VHI-10 score was used to evaluate voice changes. Results: We retrospectively analyzed patients with papillary thyroid cancer (PTC) who underwent TOETVA in the thyroid center of the Beijing Tongren hospital between February 2018 and June 2020. Patients with recurrent laryngeal nerve（RLN）damage were excluded. Sixty patients were enrolled in this study, of which four underwent total thyroidectomy. Intraoperatively, 56 EBSLNs were located (56/64, 87.50%). Among these, the left EBSLN was identified in 20/25(80.00%) and the right EBSLN was identified in 36/39 (92.31%) cases. One week postoperatively, a blinded stroboscopic laryngoscope examination showed that no patient had paresis of the EBSLN. However, the VHI-10 score was significantly higher than the preoperative value (10.58 ± 4.54 vs. 3.00 ± 1.54, p＜0.01). At three weeks postoperatively, the overall score was still different from that preoperatively (4.83 ± 3.34 vs. 3.00 ± 1.54, p＜0.01); however, the vast majority of patients returned to their preoperative status. Conclusion: In TOETVA, the EBSLN can be well exposed by transection of the sternothyroid muscle, and combined with IONM, the protection of the function of the EBSLN can be guaranteed. Simultaneously, we observed that TOETVA could cause a short-term voice handicap in patients, with such changes generally returning to normal within three weeks.

scholarly journals Blood Pressure Correlates Asymmetrically with Neuropeptidase Activities of the Left and Right Frontal Cortices

Symmetry ◽  
2021 ◽  
Vol 13 (1) ◽  
pp. 105
Author(s):  
Ana Belén Segarra ◽  
Isabel Prieto ◽  
Inmaculada Banegas ◽  
Magdalena Martínez-Cañamero ◽  
Marc de Gasparo ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Frontal Cortex ◽  
Control Group ◽  
Physiological Processes ◽  
Propranolol Group ◽  
Membrane Bound ◽  
Left And Right ◽  
Positive Correlations ◽  
Cardio Vascular ◽  
The Right

It was suggested that the brain-heart connection is asymmetrically organized. However, evidence connecting neurochemical factors from each brain hemisphere with changes in cardio-vascular functions have not yet been reported. In order to analyze potential asymmetrical connections between brain neurochemical factors with cardio-vascular functions, we studied the level of correlations between the left and right frontal cortex (FC) soluble (Sol) and membrane-bound (MB) neuropeptide-degrading enzymes alanyl (AlaAP), cystinyl (CysAP), and glutamyl (GluAP) aminopeptidase activities, involved among others in the metabolism of angiotensins, with heart rate (HR), systolic (SBP), and diastolic (DBP) blood pressure, in rats treated or not with hypotensive or hypertensive drugs such as captopril, propranolol or L-NAME. The present study suggests the existence of a bidirectional asymmetrical connection between these brain neuropeptidases and cardio-vascular functions. Specifically, depending on treatment, in control group, Sol AlaAP from the left FC correlates negatively with SBP and DBP. In captopril-treated animals, MB CysAP and MB GluAP from the right FC correlate negatively with HR. In L-NAME treated rats, Sol CysAP from the right FC correlates negatively with DBP. No significant correlations were observed in the propranolol group. Considering together all the values obtained from the left or the right cortex of the four groups regardless of drug treatment, the results demonstrated significant negative correlations between these neuropeptidase activities, mainly from the left frontal cortex, with the levels of systolic and diastolic blood pressure. Remarkably, these findings contrast drastically with previously reported results indicating significant positive correlations between the left frontal cortex with other peripheral functions such as water intake and diuresis. Both results represent noteworthy information that strongly supports the concept of a bidirectional asymmetric organization of neurovisceral integration involving left and right brain neurochemical processes with peripheral physiological functions, most probably mediated by the autonomic nervous system. Overall, the present results suggest that cognitive functions involving the frontal cortex may be asymmetrically connected with peripheral physiological processes, and vice versa.

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