Postoperative Management of Superior Laryngeal Nerve Paralysis

2016 ◽  
pp. 301-308
Author(s):  
Craig E. Berzofsky ◽  
Amy L. Cooper ◽  
Michael Jay Pitman
Keyword(s):  
Superior Laryngeal Nerve ◽  
Postoperative Management ◽  
Laryngeal Nerve ◽  
Nerve Paralysis ◽  
Laryngeal Nerve Paralysis

PS01.189: A STUDY ON THE UTILITY OF INTRAOPERATIVE NEUROSTIMULATION MONITORING SYSTEM FOR RECURRENT LARYNGEAL NERVE IN ESOPHAGECTOMY

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 103-103
Author(s):  
Fumiaki Kawano ◽  
Shinsuke Takeno ◽  
Kousei Tashiro ◽  
Rouko Hamada ◽  
Yasuyuki Miyazaki ◽  
...  
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Vocal Cord ◽  
Vocal Cord Paralysis ◽  
Postoperative Management ◽  
Laryngeal Nerve ◽  
Recurrent Laryngeal Nerve Paralysis ◽  
Recurrent Nerve ◽  
Nerve Paralysis ◽  
Laryngeal Nerve Paralysis ◽  
Stimulation Of

Abstract Background Recurrent laryngeal nerve paralysis in esophagectomy is one of the most concerned complications. In recent years, intraoperative neurostimulation monitoring system (IONM) in thyroid surgery have been widespread for identification of recurrent laryngeal nerve and assessment of soundness. Therefore, IONM is often used during esophagectomy in Japan. In this study, we examined the efficacy of IONM in the patients undergoing esophagectomy. Methods Of 66 patients underwent esophagectomy since April 2015 until December 2017, IONM used in 27 patients in the surgery for the examination of recurrent nerve paralysis. We retrospectively reviewed these cases for intraoperative findings, neurostimulation monitoring findings and their outcomes. Results Of 27 patients, 25 were male and two were female, and the median age at operation was 66 years old. Although IONM was used in cervical lymph node dissection, there were no vocal cord responses in 5 patients (left side in 4 and right side in 1) with stimulation of the vagus nerve. Because all patients had no vocal cord paralysis due to stimulation of the cervical recurrent laryngeal nerve, it was diagnosed that there was the recurrent laryngeal nerve injury due to thoracic para recurrent nerve lymph node dissection. IONM was able to facilitate the identification and preservation of cervical recurrent nerve in all patients. Three out of 5 patients with no vocal cord response by IONM were confirmed recurrent laryngeal nerve paralysis in postoperative endoscope. In patients with vocal cord paralysis by IONM, it was possible to carefully performed postoperative management. On the other hand, in patients without paralysis, extubation on the operation day seemed possible without the concern for aspiration. Conclusion By using IONM in esophagectomy, we were able to evaluate the damage of the recurrent laryngeal nerve in real-time. Confirming the intraoperative recurrent nerve injuries is important for postoperative management or prediction of postoperative aspiration pneumonia. IONM in esophagectomy was useful not only in terms of surgical procedures but also in the evaluation of postoperative management. Disclosure All authors have declared no conflicts of interest.

An in vivo model of external superior laryngeal nerve paralysis

2009 ◽  
Vol 119 (5) ◽  
pp. 1017-1032 ◽  
Author(s):  
Nelson Roy ◽  
Michael E. Barton ◽  
Marshall E. Smith ◽  
Christopher Dromey ◽  
Ray M. Merrill ◽  
...  
Keyword(s):  
Superior Laryngeal Nerve ◽  
Laryngeal Nerve ◽  
In Vivo Model ◽  
Nerve Paralysis ◽  
Laryngeal Nerve Paralysis

Videostroboscopic findings in unilateral superior laryngeal nerve paralysis and paresis

2007 ◽  
Vol 136 (4) ◽  
pp. 660-662 ◽  
Author(s):  
Veling Tsai ◽  
Andrew Celmer ◽  
Gerald S. Berke ◽  
Dinesh K. Chhetri
Keyword(s):  
Superior Laryngeal Nerve ◽  
Laryngeal Nerve ◽  
Nerve Paralysis ◽  
Laryngeal Nerve Paralysis

Laryngeal Findings in Superior Laryngeal Nerve Paralysis: A Controversy

1981 ◽  
Vol 89 (3) ◽  
pp. 463-470 ◽  
Author(s):  
Tom I. Abelson ◽  
Harvey M. Tucker
Keyword(s):  
Functional Anatomy ◽  
Superior Laryngeal Nerve ◽  
Laryngeal Nerve ◽  
Muscle Dysfunction ◽  
Review Of The Literature ◽  
Nerve Paralysis ◽  
Laryngeal Nerve Paralysis ◽  
Cricothyroid Muscle

The diagnosis of superior laryngeal nerve paralysis is infrequently made because of disagreement concerning the laryngeal findings in unilateral cricothyroid muscle dysfunction. Results of experimental unilateral superior laryngeal nerve paralysis in dogs and humans are shown with a review of the literature. The findings are documented by electromyographic studies and laryngeal photographs, and serve to clarify aspects of the functional anatomy of the cricothyroid muscle and the cricoid and thyroid cartilages.

A Pressure-Regulated Model of Normal and Pathologic Phonation

1994 ◽  
Vol 111 (6) ◽  
pp. 807-815 ◽  
Author(s):  
Sina Nasri ◽  
Ali Namazie ◽  
Jody Kreiman ◽  
Joel A. Sercarz ◽  
Bruce R. Gerratt ◽  
...  
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Nerve Stimulation ◽  
Superior Laryngeal Nerve ◽  
Laryngeal Nerve ◽  
Recurrent Laryngeal Nerve Paralysis ◽  
Experimental Conditions ◽  
Nerve Paralysis ◽  
Laryngeal Nerve Paralysis ◽  
Arytenoid Adduction

Recent evidence suggests that the lung-thorax system functions as a constant pressure source during phonation. However, previous animal models used a constant flow source. This article describes an in vivo canine model that maintains a constant subglottic pressure during phonation to more closely simulate the pulmonary system. At any given subglottic pressure, increasing levels of recurrent laryngeal nerve stimulation resulted in a significant rise in resistance followed by a plateau. Increasing levels of superior laryngeal nerve stimulation, however, produced no significant change in glottal resistance. Three experimental conditions were studied: Normal, unilateral recurrent laryngeal nerve paralysis, and paralysis followed by arytenoid adduction. In normal canines, maximal vocal efficiency values were the highest, indicating the best match between pressure and resistance. The vocal efficiency values were significantly lower in recurrent laryngeal nerve paralysis, indicating pressure-resistance mismatch. Arytenoid adduction increased the maximal vocal efficiency values and decreased the mismatch observed in the paralyzed state. These findings may provide insight into an understanding of normal and pathologic laryngeal behavior.

Laryngeal Behavior in Unilateral Superior Laryngeal Nerve Paralysis

1994 ◽  
Vol 103 (2) ◽  
pp. 93-97 ◽  
Author(s):  
Shinzo Tanaka ◽  
Minoru Hirano ◽  
Hirohito Umeno
Keyword(s):  
Diagnostic Procedure ◽  
Superior Laryngeal Nerve ◽  
Laryngeal Nerve ◽  
Nerve Paralysis ◽  
Test Task ◽  
Laryngeal Nerve Paralysis ◽  
Cricothyroid Muscle ◽  
Model Study ◽  
Animal Model Study ◽  
Posterior Glottis

Laryngeal behavior in unilateral superior laryngeal nerve (SLN) paralysis was investigated in animal models and clinical cases. The occurrence of an oblique glottis caused by rotation of the posterior glottis to the paralytic side was the main focus of this study. The animal model study employed live dogs. When the SLN on one side was sectioned, spontaneous phonation did not cause a significantly oblique glottis. When the unaffected SLN was electrically stimulated during spontaneous phonation, an oblique glottis occurred. When the SLN was unilaterally stimulated during spontaneous phonation with both SLNs sectioned, a markedly oblique glottis occurred. In the clinical study, larynges of 17 patients with SLN paralysis were examined during a test task in which a low-pitched phonation was followed by a high-pitched phonation. The purpose of this task was to activate the unaffected cricothyroid muscle during the test phonation. Five patients could not perform the test task. The glottis obviously rotated in 9 patients, whereas no significant rotation of the glottis occurred in 3. One of the latter 3 had an incomplete paralysis, and the other 2 had marked scarring around the laryngeal framework. We conclude that a unilateral SLN paralysis causes a rotation of the posterior glottis to the paralytic side when the unaffected cricothyroid muscle is markedly activated. The test consisting of low-pitched phonation followed by high-pitched phonation is a relatively simple and accurate diagnostic procedure for unilateral SLN paralysis.

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