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At least 181 records · Page 10Linked to original sources
PubMed2005

Recurrent laryngeal nerve palsy after thyroidectomy with routine identification of the recurrent laryngeal nerve.

BACKGROUND: The aim of this study was to assess the risk of recurrent laryngeal nerve palsy (RLNP) after thyroidectomy with routine identification of the recurrent laryngeal nerve (RLN) during the operation. METHODS: The present study was confined to 521 patients, 348 total lobectomies and 178 total thyroidectomies, treated by the same surgeon. Temporary and permanent RLNP rates were analyzed for patient groups with stratification of primary operation for benign thyroid disease, thyroid cancer, Graves' disease, and reoperation. Measurement of the RLNP rate was based on the number of nerves at risk. Twenty-six RLNs in 20 thyroid cancer patients with intentional sacrifice were excluded from analysis. RESULTS: Forty RLNs (40 patients) developed postoperative RLNP. Complete recovery of RLN function was documented for 35 of the 37 patients (94.6%) whose RLN integrity had been ensured intraoperatively. Recovery from temporary RLNP ranged from 3 days to 4 months (mean, 30.7 days). Overall incidence of temporary and permanent RLNP was 5.1% and 0.9%, respectively. The rates of temporary/permanent RLNP were 4.0/0.2%, 2.0/0.7%, 12.0/1.1%, and 10.8/8.1% for groups classified according to benign thyroid disease, thyroid cancer, Graves' disease, and reoperation, respectively. CONCLUSIONS: Operations for thyroid cancer, Graves' disease, and recurrent goiter demonstrated significantly higher RLNP rates. Invasion of RLN was identified in 19.4% of patients with thyroid cancer. Postoperatively, the RLN recovered in most of the patients without documented nerve damage during the operation. Total lobectomy with routine RLN identification is recommended as a basic procedure in thyroid operations.

Adolescent↗
PubMed2000

[Intraoperative neurophysiological monitoring (IONM) of the recurrent laryngeal nerve and microdissection. Surgical techniques for decreasing the risk of recurrent laryngeal nerve paralysis].

BACKGROUND: Frequently numerous recurrent laryngeal nerve injuries occur after operations on the thyroid glands. Compared with postoperative permanent hypocalcemia, unilateral and especially double-side recurrent paresis pose serious complication. As early as 1938 specialists [1] pleaded for a routine visualisation of the nervus recurrens in operations of the thyroid gland, to reduce the risk of permanently recurring paresis. In controversial discussions of the matter specialists have opted for a demonstration of the nerve also under medico-legal aspects. Implementing functionally-critical operational strategies requires the choice of an anatomically suitable operative procedure for the removal of morphological, functional and oncological changes, as well as the avoidance of complications. METHOD: Intra-operative Monitoring is highly recommendable as a neurophysiological method of supervision combined with microdissection to ensure the safe handling of recurrent laryngeal nerve. CONCLUSION: The rate of permanent paresis on the recurrent nerve can be lowered to less than 1 per cent when this is used as a routine procedure for all operations and the treatment of the thyroid gland diseases.

Electric Stimulation↗
PubMed2004

The laryngeal mask airway Unique versus the Soft Seal laryngeal mask: a randomized, crossover study in paralyzed, anesthetized patients.

We tested the hypothesis that ease of insertion, oropharyngeal leak pressure, fiberoptic position, ease of ventilation, and mucosal trauma are different for the Soft Seal laryngeal mask airway (SSLM) and the laryngeal mask airway Unique (LMA-U). Ninety paralyzed, anesthetized adult patients (ASA I-II; 18-80 yr old) were studied. Both devices were inserted into each patient in random order. Oropharyngeal leak pressure and fiberoptic position were determined during cuff inflation from 0-40 mL in 10-mL increments and at an intracuff pressure of 60 cm H(2)O. Ease of ventilation was determined by controlling ventilation for 10 min at 8 and 12-mL/kg tidal volume and recording hemoglobin oxygen saturation, end-tidal CO(2), leak fraction, peak airway pressure, and the presence or absence of gastric insufflation. Mucosal trauma was determined by examining the first randomized device for the presence of visible and occult blood. Insertion time was shorter (P = 0.0001) and fewer attempts were required (P = 0.005) for the LMA-U. There were no failed uses of either device. Oropharyngeal leak pressures were similar, but fiberoptic position was superior with the LMA-U (P < or = 0.0003). There were no differences in hemoglobin oxygen saturation, end-tidal CO(2), leak fraction, or peak airway pressure at either tidal volume. Gastric insufflation was not detected in either group at either tidal volume. The frequency of visible (P = 0.009) and occult blood (P = 0.0001) was less with the LMA-U. We conclude that the LMA-U is superior to the SSLM in terms of ease of insertion, fiberoptic position, and mucosal trauma, but similar in terms of oropharyngeal leak pressure and ease of ventilation.

Adult↗
PubMedDate not supplied

AgNOR distribution in normal and dysplastic laryngeal mucosa and in laryngeal epidermoid carcinomas.

Samples of normal and dysplastic laryngeal mucosa and of laryngeal epidermoid carcinomas were submitted to the AgNOR silver staining technique. AgNORs were subdivided in large (LN) and small (SN) and counted separately along their sum (TN). Overlap of values is great between normal and mildly dysplastic mucosa and between moderate and severe dysplasia. Grouping together normal with mildly dysplastic mucosa, and moderate with severe dysplasia, their mean values show minimal overlap and the differences between them are highly significant. Plotting the mean values of these two groups and of carcinomas, the linear interpolations show a clearcut increase of values.

Carcinoma, Squamous Cell↗
PubMed1993

[Pseudoglottis after laryngeal trauma with bilateral recurrent laryngeal nerve paralysis].

Voice is produced by a steady flow of air from the lungs, which is segmented at the laryngeal level into a series of air puffs. The segmentation is facilitated by periodic vocal fold vibrations under physiological conditions. In some cases, as in partial laryngectomy, segmentation of air stream is caused by vibrations of the false vocal folds. Here we report a case of an air stream segmentation mechanism at the laryngeal level producing an acceptable voice quality after fracture of the larynx and bilateral vocal fold paralysis. A lateral fixation of the left vocal fold was performed because of dyspnea. Six years later the patient was reexamined, at which time he had fairly intelligible speech and did not complain about dyspnea or aspiration. The voicing source was found to be a round soft tissue lump of approximately 1.5 cm diameter. This tissue was formed from the former left arytenoid area. During phonation the right arytenoid cartilage approximated to the petiolus, while the left neoarytenoid closed the residual opening of the larynx. However, during voicing, this latter tissue exhibited a vertical vibratory pattern similar to false vocal fold vibration and mucosal vibration of true vocal folds at high pitch. It seems reasonable to speculate that the mass of the tissue lump had become well balanced so that the very low pitch of the false vocal fold and a high pitch as in head register phonation could be avoided. Since the patient suffered from a pronounced gag reflex during examination, stroboscopy was videorecorded and analyzed off-line.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1998

[Laryngeal tuberculosis and laryngeal cancer].

Account of 2 synchronic cases of tuberculosis and laryngeal carcinoma. Apart from bacteriostatic drugs one of them underwent a cordectomy the other one a total laryngectomy and neck dissection. Despite the great majority of laryngeal cancer it is compulsory to take in account the differential diagnosis with the tuberculosis, because of its possible coexistence. Perusal of national and international literature, having found only 11 of similar instances reported.

Carcinoma, Squamous Cell↗
PubMed1991

Update: ansa cervicalis to recurrent laryngeal nerve anastomosis for unilateral laryngeal paralysis.

Twenty cases of unilateral laryngeal paralysis are reported. Satisfactory follow-up intervals and data (videostroboscopy and glottographic analysis) were available on 12 patients. The excellent to normal phonatory quality achieved in many of these patients indicates that the ansa cervicalis to recurrent laryngeal nerve anastomosis is the procedure of choice in selected patients with unilateral vocal cord paralysis. Excellent medialization of the paralyzed cord, as well as correction of arytenoid malposition and thyroarytenoid muscle atrophy appear to explain the technique's success, since the reinnervated cord neither abducts nor adducts. We feel that this technique is the procedure of choice in younger patients, or those who use their voices professionally, since the phonatory quality achieved is superior to Teflon injection or Isshiki thyroplasty, and the technique is reversible.

Humans↗
PubMed1997

Spasmodic laryngeal dyspnea: a rare manifestation of laryngeal dystonia.

We describe clinical experiences in the management of three patients with laryngopharyngeal dystonia causing severe breathing problems. In contrast to spasmodic dysphonia, which presents with action-induced involuntary spasm of laryngeal muscles during speaking, all three patients showed laryngopharyngeal spasms primarily during respiration. In analogy to spasmodic dysphonia we propose the term spasmodic laryngeal dyspnea for this rare condition. Localized unilateral botulinum toxin injected into the thyroarytenoid muscle and/or ventricular folds reduced the quantity and quality of spasms and led to a pronounced improvement of breathing problems.

Aged↗
PubMed2001

Removal of the connector on the laryngeal mask airway provides a useful alternative to the intubating laryngeal mask.

PURPOSE: We describe two cases in which fiberoptic intubation through the standard laryngeal mask airway (LMA) was successful with large-bore tracheal tubes (TTs) when an intubating LMA (ILMA) could not be used. CLINICAL FEATURES: Patient # 1, with obstructive sleep apnea, underwent elective surgical repair. His mouth opening was just under 25 mm, but difficult intubation was not anticipated. We induced general anesthesia, easily ventilated the patient by mask, and established neuromuscular blockade. Direct laryngoscopy and attempts to insert either a #5 or a #4 ILMA into the mouth failed. A standard #4 LMA, with the connector removed, was inserted, through which a 7.0 mm nasal RAE TT, fiberoptically guided, passed into the trachea at the first attempt. Patient #2, with a loosened implant after left hip arthroplasty, underwent revision prosthesis. Her neck movement was limited. We thus planned awake securing of the airway, but the patient refused. We induced anesthesia and established bag-mask-valve ventilation. The limited neck movement prevented direct laryngoscopy. Visualizing the laryngeal inlet with the fiberoptic bronchoscope (FOB) proved impossible as bloody secretions obscured the FOB's tip. Ventilation by mask was easy. As an ILMA was not available, we removed a #5 LMAs connector and passed an 8.0 mm nasal RAE TT through the LMA. Fiberoptic-guided intubation was easy. In both cases, the remainder of the intraoperative course was uneventful. CONCLUSION: A standard LMA whose connector has been removed to allow passage of TTs of >6.0 mm internal diameter may be substituted for the ILMA when necessary.

Apnea↗
PubMed2006

[Use of the size 3 ProSeal laryngeal mask airway in children. Results of a randomized crossover investigation with the Classic laryngeal mask airway].

BACKGROUND: The low-pressure airway seal of the Classic laryngeal mask airway (CLMA) can be inadequate for positive pressure ventilation (PPV) in children. The ProSeal laryngeal mask airway (PLMA) forms a more effective seal of the airway than the CLMA and facilitates gastric tube placement in adults. The size 3 PLMA can be used in adults and children. METHODS: The CLMA and PLMA were studied in random order -- crossover -- in 30 anaesthetized, non-paralysed children (average age 10.6 years, average body weight 39 kg). Airway leak pressure, maximum tidal volume, ease of insertion, quality of initial airway and fiberoptic position were determined. Gastric tube placement was assessed for the PLMA. RESULTS: The mean airway leak pressure in neutral head position (27.0 vs. 16.8 cm H(2)O), maximum flexion (38.3 vs. 26.2 cm H(2)O) and maximum extension (21.1 vs. 14.2 cm H(2)O) as well as the mean maximum tidal volume (1432 vs. 1062 ml) were significantly higher (p<0.001) for the PLMA. Air insufflation into the stomach occurred with the CLMA but not with the PLMA. Gastric tube placement was possible in all patients. CONCLUSIONS: The high reliability of g-tube placement and the significantly increased airway leak pressure seem to make the size 3 PLMA a more suitable device for PPV in children than the same size CLMA.

Adolescent↗
PubMed1999

[Is the laryngeal mask a minimally invasive instrument for securing the airway? Supplementary remarks on the paper "Injures and dangers in the use of the laryngeal mask" by V. Hempel, Anaesthesist (1999)48:399-402].

Minor laryngopharyngeal complaints following anaesthesia considerably determine postoperative patient comfort. They cannot be eliminated but reduced by experience and careful preparation and insertion technique. The incidence of minor laryngopharyngeal symptoms following the use of the laryngeal mask airway is similar to that following endotracheal intubation. However, there seems to be a distinct pattern of complaints: discomfort with swallowing is more frequent after LMA, whereas dysphonia is more often observed following endotracheal intubation. The significance of LMA cuff pressures in the pathogenesis of postoperative throat complaints remains unclear. There is sound evidence that cuff pressure is not a representative measure for the effective pressure load upon the pharyngeal mucosa. Measurement of cuff pressure is not obligatory, instead reduction of cuff volume to a "just seal" situation seems to be a reasonable approach. The laryngeal mask airway has definitely changed anaesthesiology airway management. Whether this is due to its supposedly less invasiveness compared to endotracheal intubation has not been proven by scientific investigations.

Humans↗
PubMed2003

[Airway equipment and its maintenance for a non difficult adult airway management (endotracheal intubation and its alternative: face mask, laryngeal mask airway, laryngeal tube)].

The airway equipment for a non difficult adult airway management are described: endotracheal tubes with a specific discussion on how to inflate the balloon, laryngoscopes and blades, stylets and intubation guides, oral airways, face masks, laryngeal mask airways and laryngeal tubes. Cleaning and disinfections with the maintenance are also discussed for each type of airway management.

Adjuvants, Anesthesia↗
PubMed1991

Laryngeal preservation in cases of advanced laryngeal cancer treated with platinum based induction chemotherapy before local treatment.

In this study we analyse our preliminary results after treating 28 patients with locally advanced laryngeal cancer with platinum based induction chemotherapy followed by radiation therapy or surgery. The median age of our patients was 60 (46-75) years and median performance status was 80 (60-100). In 18 of the 28 patients locoregional treatment was radiation therapy with an overall response of 94.4 per cent. After a median follow-up of 26 (15-40) months 39.3 per cent of the whole group of patients are alive and disease-free and six (21.4 per cent) patients are alive and disease-free preserving their larynx. We conclude that although more extensive studies with large groups of patients and longer follow-up is needed to reach definite conclusions, it seems that platinum based induction chemotherapy can be used successfully in locally advanced laryngeal cancer followed by radiotherapy. In those cases who respond well, the patient's larynx is preserved without compromizing the overall survival.

Aged↗
PubMed2005

The ProSeal laryngeal mask airway and the laryngeal tube Suction for ventilation in gynaecological patients undergoing laparoscopic surgery.

BACKGROUND AND OBJECTIVE: ProSeal Laryngeal Mask Airway (PLMA) and Laryngeal Tube Suction (LTS), supraglottic airway devices allowing gastric drainage, were compared in this prospective, randomized study for airway management under conditions with elevated intra-abdominal pressure induced by capnoperitoneum. METHODS: Fifty patients undergoing elective gynaecological laparoscopic surgery were randomized to two groups of 25 each. After induction of general anaesthesia, devices were inserted, correct placement was verified, airway leak pressure was measured, and a gastric tube was inserted. Ease of insertion, quality of airway seal, risk of gastric insufflation and patient comfort were investigated. RESULTS: There were no differences in patient characteristics data for both groups. First-time insertion success rates were comparable for both groups: 92%--first attempt, 8%--second attempt for PLMA and LTS. Time until delivery of the first tidal volume for PLMA and LTS was 23.2 +/- 6.1 and 23.5 +/- 6.6s, airway leak pressure was 45.4 +/- 4.9 cmH2O and 45.6 +/- 6.7 cmH2O with cuff pressures adjusted to 60 cmH2O. No gastric insufflation, gas loss or signs of regurgitation were detected. Placement of a gastric tube was successful in all patients. Patients were questioned for sore throat and dysphagia after removal of devices. Sore throat was stated in 1%/0% (PLMA) and 8%/4% (LTS) after 6/24 h, dysphagia in 4%/4% (PLMA) and 12%/4% (LTS). CONCLUSIONS: Both devices provide a secure airway even under conditions of elevated intra-abdominal pressure. In this pilot study, no differences concerning handling or quality of airway seal were detected between PLMA and LTS.

Adult↗
PubMed2005

A comparison of the proseal laryngeal mask airway, the laryngeal tube S and the oesophageal-tracheal combitube during routine surgical procedures.

BACKGROUND AND OBJECTIVE: This study was performed to compare three supraglottic airway devices: the ProSeal laryngeal mask airway (PLMA), the laryngeal tube S (LTS) and the oesophageal-tracheal combitube (OTC) during routine surgical procedures. METHODS: Ninety American Society of Anesthesiologists (ASA) I-III patients scheduled for routine minor obstetric surgery were randomly allocated to the PLMA (n = 30), the LTS (n = 30) or the OTC (n = 30) group, respectively. The overall success rate, insertion time, cuff pressures and resulting airway leak pressures were determined as well as a subjective assessment of handling and the incidence of sore throat, dysphagia and hoarseness were performed. RESULTS: Insertion time until the first adequate ventilation was significantly (P < 0.0001) shorter in the PLMA (median 29 s; 25-75th percentile 25-48 s; range 10-161 s; success rate 100%) and in the LTS group (38 s; 30-44 s; 13-180 s; 100%) compared to the OTC group (75 s; 48-98 s; 35-180 s; 90%). In vivo cuff pressures and airway leak pressures increased with the inflating cuff volume in all devices and were highest in the OTC group. Postoperatively, patients in the PLMA and the LTS group complained significantly less about sore throat (P < 0.001 and 0.05) and dysphagia (P < 0.001 and 0.02) compared to the OTC group, while there was no difference regarding the incidence of hoarseness. Subjective assessment of handling was comparable with the PLMA and the LTS, but inferior with the OTC. CONCLUSIONS: In conclusion, both PLMA and LTS proved to be suitable for routine surgical procedures and proved to be superior to the OTC which cannot be recommended for routine use.

Blood Pressure↗
PubMed2006

Comparison of the laryngeal mask (LMA) and laryngeal tube (LT) with the new perilaryngeal airway (CobraPLA) in short surgical procedures.

BACKGROUND AND OBJECTIVE: We compared the laryngeal mask airway (LMA) and the laryngeal tube (LT) with the newly introduced perilaryngeal airway (CobraPLA, PLA) with regard to haemodynamic responses induced by airway insertion, clinical performance and occurrence of postoperative sore throat after short surgical procedures. METHODS: After premedication, 90 ASA I-II patients awaiting short surgical procedures were randomized to receive, LMA, LT or PLA. Anaesthesia was induced with intravenous propofol (2.5 mg kg(-1)) and mivacurium (0.2 mg kg(-1)). Number of attempts, time of insertion of the device, any other unwanted effect, mean aterial pressure, heart rate, oxygen saturation and end-tidal carbon dioxide were recorded. At the end of surgery, the cuff of the device was immediately deflated and the airway device was removed. The device was examined and noted for the presence of visible blood. Patients were asked to rate their throat soreness, dysphonia and dysphagia 1 and 24 h postoperatively. RESULTS: There were no differences in haemodynamic variables. Insertion times for the devices were similar (LMA: 20 +/- 11 s, LT: 19 +/- 14 s and PLA: 21 +/- 12 s.) The success rates at first insertion were lower in the (LMA group (57%) when compared with the PLA (97%, P < 0.05). The number and type of airway interventions for achieving an effective airway were similar. When the airways were removed 50% of the PLA devices had positive blood traces, while only 17% of the LMA and LT devices had positive blood traces (P < 0.01). Fifty percent of the patients suffered from a sore throat in the PLA group, which was significantly higher than in the LMA and LT groups (P < 0.05). CONCLUSION: We conclude that haemodynamic, ventilation and oxygenation variables throughout the surgery were similar with, LMA, LT and PLA, but LT and PLA were easier to insert; LMA and LT caused less mucosal trauma.

Adult↗
PubMed2006

Comparison of LMA Unique, Ambu laryngeal mask and Soft Seal laryngeal mask during routine surgical procedures.

BACKGROUND AND OBJECTIVE: This study was performed to compare three disposable airway devices, the LMA Unique (LMA-U), the Ambu laryngeal mask (Ambu LM) and the Soft Seal laryngeal mask (Soft Seal LM) for elective general anaesthesia during controlled ventilation in non-paralysed patients. METHODS: One hundred and twenty ASA I-III patients scheduled for routine minor obstetric surgery were randomly allocated to the LMA-U (n = 40), Ambu LM (n = 40) or Soft Seal LM (n = 40) groups, respectively. Patients were comparable with respect to weight and airway characteristics. A size 4 LMA was used in all patients and inserted by a single experienced anaesthesiologist. Oxygenation, overall success rate, insertion time, cuff pressure and resulting airway leak pressure were determined as well as a subjective assessment of handling and the incidence of sore throat, dysphagia and hoarseness. RESULTS: Time of insertion was shortest with the Ambu LM, while failure rates were comparable with the LMA-U, the Ambu LM and the Soft Seal LM (median 19 s; range 8-57 s; success rate 100% vs. 14; 8-35; 97% vs. 20; 12-46; 95%). Insertion was judged 'excellent' in 75% of patients in the LMA-U group, in 70% of patients in Ambu LM group and in 65% of patients in the Soft Seal LM group. There was no difference between devices with respect to postoperative airway morbidity at 6 h or 24 h following surgery. CONCLUSIONS: All three disposable devices were clinically suitable with respect to insertion times, success rates, oxygenation, airway and leak pressures, as well as to subjective handling and postoperative airway morbidity.

Air Pressure↗