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At least 19 recordsLinked to original sources
PubMed1987

[Effect of a modified struma resection technic on the rate of lesions of the recurrent laryngeal nerve].

Recurrent laryngeal nerve injury still remains the major problem in thyroid gland surgery and is influenced both by morphology and function of the goitre and essentially by the resection technique. Between 1982 and 1985 a total of 825 patients was operated on for the first time due to a benign goitre. In period A (Jan. 1982 to Dec. 1983) we always-- preceding the resection of the goitre--performed the ligature of the A.thyreoidea inferior (n = 412) whereas in period B (Jan. 1984 to Dec. 1985) we dispensed with it (n = 413). In neither of the two periods the preparation of the N.laryngeus recurrens--save few exceptional cases--was performed. The immediate postoperative recurrent laryngeal nerve palsy rate decreased from 4.9% in period A to 2.2% in period B, the persistent palsy rate (laryngeal control half a year postoperatively) from 2.18% to 0.48%. Due to the change to smaller, more hyperfunctional goitres in endemic areas we believe it possible to perform the resection of benign goitres without the preliminary ligature of the A.thyreoidea inferior and the preparation of the recurrent laryngeal nerve. On one hand this can lead to the facilitation of the surgical task, on the other hand to the decrease of the injury risk on the recurrent laryngeal nerve.

Adult↗
PubMedDate not supplied

Paraganglia of the human recurrent laryngeal nerve.

Recurrent laryngeal nerves (RLNs) from human autopsy material were collected and prepared for light microscopy. Within five of eight investigated RLNs, paraganglia-like organs were found, the mean cross-sectional area of which was estimated to be 0.03 mm2. These organs were composed of cells resembling the type I and type II cells of the carotid body. The possible function of laryngeal nerve paraganglia is discussed.

Cell Nucleolus↗
PubMed2000

Anastomosis between the external branch of the superior laryngeal nerve and the recurrent laryngeal nerve.

An incidental finding in the anatomy lab showed up a plexus of the external branch of the right superior laryngeal nerve (SLN), including an anastomosis with the recurrent laryngeal nerve (RLN). The external branch of the SLN divided in two extensions: The ventral extension reached the mesopharynx laterally and by supplying the latter, ended at the cricothyroid muscle. The dorsal extension formed a plexus a finger's breadth beneath the inferior margin of the pharynx, on the lateral aspect of the esophagus. The anastomosis ran from the lower part of the plexus to the RLN along the esophagus, laterally.

Cadaver↗
PubMed1996

[Presymptomatic injury of the recurrent laryngeal nerve in benign thyroid disease: contribution of electromyography].

Diagnosis of recurrent laryngeal nerve palsy is usually possible through a clinical, laryngoscopical and electromyographical approach, but at a critical stage of the nerve injury. We observed four cases of benign thyroïd tumoral processes with a preoperative electromyographic examination showing neurogenic abnormalities in the thyroarytenoid muscle without any clinical symptoms. We presume that only laryngeal electromyography permits the diagnosis of mild, even asymptomatic laryngeal recurrent nerve injury. A recurrent laryngeal nerve palsy occurs in thyroid tumors, most often in malignant conditions, rarely in benign ones. Nevertheless early forms of nerve injury with benign thyroïd pathology could be underrated. Since the functional prognosis of symptomatic laryngeal nerve palsy is doubtful, laryngeal electromyography, through its ability to diagnose early nerve injury, provides helpful indications in thyroïd benign tumoral diseases for the therapeutic decision.

Adult↗
PubMed2005

A safe and reliable technique for visualization of the laryngeal recurrent nerves in the neck.

BACKGROUND: The risk of an injury of the laryngeal recurrent nerve is an important issue during any surgical procedure in the lower neck. METHODS: Based on our experience with the transcervical-subxiphoid bilateral videothoracoscopic maximal thymectomies, we developed an original technique of visualization for both of these nerves. The key point of the presented technique is the dissection in the lower part of the neck, beneath the level of the thyroid gland. The central step is the division of the deep cervical fascial layers covering and obscuring the recurrent nerves. Preservation of the deepest layer protects the nerves from an injury. RESULTS: We used this technique in 100 consecutive transcervical-subxiphoid bilateral videothoracoscopic maximal thymectomies without any case of permanent recurrent nerve palsy. CONCLUSION: The presented technique is safe, reliable, and relatively simple. It may be used during an extended thymectomy, as well as during a thyroid resection and other operations in the lower neck.

Fasciotomy↗
PubMed1994

Unilateral recurrent laryngeal nerve paralysis.

Recurrent laryngeal nerve (RLN) injury [without injury to the superior laryngeal nerve (SLN)] is the most common traumatic neurolaryngological lesion. The acute effects are immediate flaccidity of the ipsilateral vocal fold, loss of abduction and adduction, severe dysphonia to complete paralytic aphonia, and, frequently, aspiration of food and drink into the trachea. This article reviews the function of the four intrinsic laryngeal muscles innervated by the RLN and the individual effects of RLN transection on these muscles. Following acute denervation, the subsequent progression is either chronic denervation or nerve regeneration with laryngeal muscle reinnervation. Four possible scenarios are discussed here: complete reinnervation with synkinesis, partial reinnervation with synkinesis, mixed RLN injuries, and no reinnervation (complete paralysis). Electromyography may eventually assist the laryngologist in establishing these diagnoses, but currently not enough normative data exist for confirming laryngeal synkinesis unequivocally in every case. Treatment is generally by Teflon injection, medialization thyroplasty, arytenoid adduction procedures, or reinnervation by nerve transfer. The author's preference is nerve transfer, insofar as the quality of resultant phonatory voice, in his hands, has been superior to the other techniques.

Humans↗
PubMed2000

[Speech visualization for evaluation of iatrogenic recurrent laryngeal nerve injuries].

A study was conducted to investigate the intra operative laryngeal recurrent nerve injury and subsequent vocal disturbances. The recovery of voice condition in group of 20 patients with unilateral laryngeal nerve injury was examined by the whole range of both presurgical and postsurgical tests. Patients were selected from a group a 1867 surgical treated in 3-rd Department of Surgery Jagiellonian University School of Medicine in years 1988-1993. We recorded and analysed 1100 words with identical acoustic test. The research was conucted in 3-4 days, 3 moths, 6 months and 1 year after operation in a non-echo chamber with special equipment in the Department of Mechanic and Vibro-Acoustic of the Academy of Mining and Metallurgy in Krakow, Poland. On the basis of obtain results, we found that recovery of voice, in one year after surgery, occurs in 87.5% patients with laryngeal recurrent nerve injury.

Follow-Up Studies↗
PubMed2002

Sensitivity and specificity of intraoperative recurrent laryngeal nerve stimulation in predicting postoperative nerve paralysis.

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.

Electric Stimulation↗
PubMed1976

Causes of recurrent laryngeal nerve paralysis.

The recurrent laryngeal nerve in its course from the brain stem to the larynx follows a path that brings it in proximity to numerous structures. These structures can interfere with its function by pressure or by disruption of the nerve caused by disease invading the nerve. The various causes of recurrent laryngeal nerve paralysis that I have observed during the past 24 years are reported. In 134 patients with recurrent laryngeal nerve paralysis, the left recurrent nerve was most commonly involved. Malignant neoplasms of the lung and pulmonary tuberculosis were the most frequent causes of the paralysis.

Adolescent↗
PubMed2000

[Intraoperative electromyographic identification of the recurrent laryngeal nerve].

BACKGROUND: Recurrent nerve palsy is the most important complication of thyroid surgery. Correct identification of the nerve during the surgical procedure is essential to avoid damage. METHOD: We evaluated the intraoperative electromyographic identification procedure of the recurrent laryngeal nerves in 77 consecutive patients. The operations performed were 63 subtotal resections, 6 hemithyroidectomies, 4 hemithyroidectomies in combination with subtotal resection of the opposite side and 4 thyroidectomies. RESULTS: Identification of the recurrent laryngeal nerve by electrophysiologic nerve stimulation was successful in 97.4%. Recurrent nerve palsy was not seen in postoperative laryngoscopic control. CONCLUSIONS: Intraoperative electromyography improves the identification rate of the recurrent laryngeal nerve and allows electrophysiologic verification of nerve function as a result of injury to the thyroid.

Adult↗
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↗
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↗
PubMed2006

Thyroid surgery and recurrent laryngeal nerve monitoring.

UNLABELLED: Recurrent laryngeal nerve paralysis is a much-dreaded complication of thyroid surgery. OBJECTIVE: To study the feasibility and the reliability of a recurrent laryngeal nerve monitoring technique. MATERIALS AND METHODS: This was a prospective study including 36 patients proposed for thyroid surgery with recurrent laryngeal nerve monitoring. They underwent post-operative fibre-optic laryngeal examination and speech therapist consultation. RESULTS: Our technique of nerve monitoring showed a 98 per cent sensitivity and 86 per cent specificity. CONCLUSIONS: Recurrent laryngeal nerve monitoring is a feasible and reliable technique. It can be used to avoid bilateral nerve injury and to increase the surgeon's confidence but not to replace a systematic nerve identification and a careful dissection.

Adolescent↗
PubMed2002

Benign anatomical mistakes: the correct anatomical term for the recurrent laryngeal nerve.

The term recurrent laryngeal nerve has been adopted by Nomina Anatomica (1989) and Terminologia Anatomica (1998) to describe this vagus branch from its origin, its turn dorsally around the subclavian artery and the aortic arch, and its cranial pathway until it reaches its terminal organs in the neck. However, there is still much confusion, and either the terms inferior and recurrent laryngeal nerve are used interchangeably or inferior laryngeal nerve is considered the terminal branch of the recurrent laryngeal nerve. We hereby feel that it is necessary to reassess the term and we propose the term inferior laryngeal nerve for the entire nerve under consideration, from its origin from the vagus nerve to its destinations, including tracheal, esophageal, and pharyngeal branches. If the term superior laryngeal nerve is a given, standard and accepted term in the anatomical terminology, then logically the term inferior laryngeal nerve should also be accepted, as opposed to it. Of course the upward travel of the inferior laryngeal nerve is "recurrent". When nonrecurrence is encountered together with an arteria lusoria, a retroesophageal right subclavian artery or a right aortic arch, we consider that the term nonrecurrent inferior laryngeal nerve should be used to describe the deviation from the normal.

Humans↗
PubMed2004

Recurrent laryngeal nerve identification and assessment during thyroid surgery: laryngeal palpation.

Electrical identification and monitoring of the recurrent laryngeal nerve (RLN) has been proposed as an adjunct to standard visual identification of the nerve during thyroid and parathyroid surgery. This study was undertaken to assess laryngeal palpation as an intraoperative technique for identifying and assessing the RLN during surgery and to investigate the relation between laryngeal palpation and associated laryngeal electromyographic (EMG) activity. The postcricoid region of the larynx during surgery was palpated through the posterior hypopharyngeal wall to sense posterior cricoarytenoid muscle contraction in response to ipsilateral RLN stimulation (i.e., the "laryngeal twitch response.") Laryngeal palpation was performed in a series of 449 consecutive thyroid and parathyroid surgeries with 586 RLNs at risk. All patients underwent preoperative and postoperative laryngoscopy to assess vocal cord mobility. In a subset of patients, laryngeal palpation and simultaneous laryngeal EMG recordings were compared during intraoperative RLN stimulation. In this series, there was no permanent RLN paralysis. There was one case of temporary RLN paralysis secondary to neural stretch that resolved 6 weeks postoperatively (temporary paralysis rate: 0.2% of patients, 0.2% of nerves at risk). Intraoperative laryngeal palpation of the laryngeal twitch response reliably correlated with normal postoperative vocal cord function. Loss of the laryngeal twitch response occurred in the single case of temporary paralysis in the setting of an anatomically intact nerve. Laryngeal palpation correlated well with simultaneous laryngeal EMG activity. There were no palpation-induced laryngeal injuries or laryngeal edema. There were also no RLN injuries due to repetitive neural stimulation. Intraoperative laryngeal palpation during RLN stimulation is a safe, reliable method for neural monitoring that can assist in RLN identification and assessment during thyroid and parathyroid surgery. Most importantly, it provides important prognostic information regarding ipsilateral vocal cord function at the completion of the initial side of the thyroid or parathyroid surgery. Intraoperative laryngeal palpation allows the surgeon to stage contralateral surgery if RLN damage is diagnosed, thereby avoiding the potential for bilateral vocal cord paralysis. We believe that laryngeal palpation is useful as an adjunct to formal EMG monitoring during thyroid and parathyroid surgery.

Adolescent↗
PubMed2000

Intraoperative monitoring of recurrent laryngeal nerve function.

Intraoperative recurrent laryngeal nerve identification is sometimes difficult in reoperative cervical dissection or operation for inflammatory thyroid disorders. Three modalities have been described to intraoperatively assess nerve function: vocal cord visualization with fiberoptic bronchoscopy or direct laryngoscopy, electromyelographic surveillance of arytenoid muscle function, and cord function assessment with an electromyelogram-electrode endotracheal tube. Our study focused on patients requiring cervical dissection for thyroid or parathyroid disease in which intraoperative recurrent laryngeal nerve function was monitored by nerve stimulation with a concentric bipolar probe. Impulses were tracked via a specialized electrode-bearing endotracheal tube with signal transduction to a recording monitor. No operative nerve injuries occurred in the patients of our study group. This surveillance technique's several advantages include use of standard intubation techniques with no increase in operative time, nerve stimulation tracings that are quantifiable and reproducible with production of a permanent record, and less subjectivity due to observer variability. We believe these factors make the electromyelogram-electrode endotracheal tube approach to intraoperative recurrent laryngeal nerve assessment the optimal technique.

Electromyography↗
PubMed1987

Ultrastructural observations of organelle accumulation in the equine recurrent laryngeal nerve.

The left recurrent laryngeal nerves from five horses with sub-clinical neuropathy were examined by light and electron microscopy in a study designed to examine accumulation of axonal organelles at paranodal and internodal locations. Transverse sections of the nerve showed scattered fibres with split myelin sheaths and axonal accumulation of organelles. On longitudinal sections these collections were seen to result from an axonal outpouching in which dense lamellar bodies and mitochondria had accumulated. These paranodal collections, which could be found on both sides of the node, were often associated with infoldings of the terminal loops of myelin and with occasional paranodal demyelination. The fact that many of the organelles in the outpouches were lysosomal in nature was confirmed by their positive staining for cathepsin D activity. Longitudinal sections demonstrated a number of axons which were swollen over a long distance and which contained focal accumulations of similar organelles. In places, however, there was a clear separation between these organelles and the cytoskeletal proteins. In each case these swollen axons were surrounded by Schwann cell nuclei and their processes, forming well-ordered onion bulbs. The possibility that these two types of changes, i.e. the paranodal accumulations and the axonal swellings could result from a disturbance in axonal transport in this distal axonopathy is discussed.

Animals↗
PubMed1994

A new method for intraoperative recurrent laryngeal nerve monitoring.

The recurrent laryngeal nerve is at risk of iatrogenic injury during surgical procedures in which its anatomical location is exposed. Borrowing from biotechnology currently available for facial nerve monitoring, we have developed a method of electrophysiologically assessing the function of the recurrent laryngeal nerve during technically difficult neck surgeries. Electromyographic as well as nerve action potential recordings are monitored using the Xomed-Treace Nerve Integrity Monitor-2 (NIM-2). This method differs from those previously published in that it is much less cumbersome and time-consuming. The technique as well as an illustrative case are reported.

Adult↗