scholarly journals Use of a single bipolar electrode in the posterior arytenoid muscles for bilateral monitoring of the recurrent laryngeal nerves in thyroid surgery

2008 ◽  
Vol 265 (12) ◽  
pp. 1549-1552 ◽  
Author(s):  
Stephan Haerle ◽  
D. Sidler ◽  
Th. Linder ◽  
W. Mueller
Keyword(s):  
Thyroid Surgery ◽  
Bipolar Electrode ◽  
Laryngeal Nerves ◽  
Recurrent Laryngeal Nerves

scholarly journals Identifying Recurrent Laryngeal Nerve in Thyroid Surgery Using Relationship with Superior Parathyroid Gland and Tubercle of Zuckerkandl

2015 ◽  
Vol 23 (3) ◽  
pp. 99-103
Author(s):  
Somesh Mozumder ◽  
Shirish Dubey ◽  
Aniruddha Dam ◽  
Anup Kumar Bhowmick
Keyword(s):  
Prospective Study ◽  
Recurrent Laryngeal Nerve ◽  
Parathyroid Gland ◽  
Thyroid Surgery ◽  
Intimate Relationship ◽  
Laryngeal Nerve ◽  
Laryngeal Nerves ◽  
Recurrent Laryngeal Nerves ◽  
A Prospective Study ◽  
Relationship Of

Introduction: Recurrent laryngeal nerves (RLN) are particularly prone to injury during thyroid surgeries due to its intimate relationship and proximity with the gland. Zuckerkandl’s tubercle (ZT) helps in preserving RLN intra operative. Material and Methods: A prospective study for identifying RLN in thyroid surgery using relationship with superior parathyroid gland and tubercle of Zuckerkandl was conducted on 50 thyroidectomy patients between August 2013 and February 2014. Results: In all cases ZT was identified. Temporary paralysis of RLN was seen in 3 (6%) cases and permanent paralysis in 2 (4%) of cases. Discussion: The site of greatest risk during thyroidectomy to the RLN is in the last 2-3 cm extralaryngeal course of the nerve. Relationship of recurrent laryngeal nerve with superior parathyroid gland and tubercle of Zukerkandl (ZT) is known. Conclusion: Use of ZT and superior parathyroids as a landmark allows safe dissection of RLN.

scholarly journals The Recurrent Laryngeal Nerve in Relation to the Inferior Thyroid Artery in Adult Filipino Cadavers

2011 ◽  
Vol 26 (2) ◽  
pp. 13-17 ◽  
Author(s):  
Jacob S. Matubis ◽  
Karen June P. Dumlao ◽  
Ryner Jose C. Carrillo
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Thyroid Surgery ◽  
Anatomical Variations ◽  
The Philippines ◽  
Laryngeal Nerve ◽  
Inferior Thyroid Artery ◽  
Laryngeal Nerves ◽  
Recurrent Laryngeal Nerves ◽  
The Right ◽  
Relationship Of

Objective: To describe the anatomic relationship of the recurrent laryngeal nerve and the inferior thyroid artery in adult cadavers in the Philippines and to compare the proportions of these anatomic relationships with those reported in the foreign literature. Methods: Study design: Descriptive, cross-sectional Setting: University of the Philippines College of Medicine Anatomy Laboratory Subjects: Fifty-four (54)  preserved cadavers (108 sides) dissected within a period from June 2008 to Aug 2010. The anatomy and position of both  the right and the left recurrent laryngeal nerves (RLN) and inferior thyroid arteries (ITA) were noted. The RLN was further classified into 2 variations: non-branching or branching prior to insertion at the cricothyroid joint, under the inferior constrictor muscle.  The ITA was also classified into non-branching and branching.  The results were compared to two foreign studies using a Z-test for two proportions. Results: Fifty four (54) cadavers (108) sides were dissected. Among the  cadavers, both the recurrent laryngeal nerves and inferior thyroid arteries had a maximum of two branches although both the RLNs and ITAs for both the right and left sides were mostly non-branching. The right side of one cadaver was noted to have both a branching RLN and a branching ITA. There were no non-recurrent laryngeal nerves seen among the 54 cadavers. For both left and right sides, the RLN was mostly dorsal to the ITA. Branching RLNs was mostly dorsal to a non-branching ITAs. Most of the non-branching RLNs were dorsal to the ITAs. Non-branching RLNs were usually dorsal to the ITA.               The local patterns of the course of the RLN in relation to the ITA approximates those of Chinese where there is predominance of the RLN dorsal to the ITA  but differs from those of Brazilians where the RLN is usually between ITA branches.    Conclusion: There are multiple anatomical variations with regards to the relationship of the RLN and the ITA. The anatomic variation among Asians may be different from Brazilians. The surgeon’s knowledge of the possible various configurations of the RLN and ITA should be able to help in identification and preservation of the RLN and prevention of complications in thyroid surgery. Keywords: recurrent laryngeal nerve, inferior thyroid  artery, thyroid surgery, Filipino cadavers, anatomical variations

scholarly journals Anatomical Variations in Recurrent Laryngeal Nerves in Thyroid Surgery

2020 ◽  
pp. 014556132092756 ◽  
Author(s):  
Chuanchang Yin ◽  
Bin Song ◽  
Xiaoyan Wang
Keyword(s):  
Thyroid Surgery ◽  
Vocal Cord Paralysis ◽  
Anatomical Variation ◽  
Anatomical Variations ◽  
Laryngeal Nerve ◽  
Laryngeal Nerves ◽  
Original Direction ◽  
Nonrecurrent Laryngeal Nerve ◽  
Recurrent Laryngeal Nerves ◽  
The Right

Objective: To study terminal bifurcation of recurrent laryngeal nerves (RLNs) with original direction to larynx entry and to decrease the risk of vocal cord paralysis in thyroid patients. Methods: The RLNs of 294 patients (482 sides) were dissected according to the branches into the larynx, and the original direction of each RLN trunk in thyroid surgery was recorded. Results: (1) About 30.9% of the RLNs gave off multiple branches into the larynx. (2) Two and 3 branches of RLNs into the larynx were found in 25.5% and 5.4% of the cases, respectively. (3) In 0.4% or 2 cases, the RLN trunk combined with the inferior branch of the vagus nerve. (4) Nonrecurrent laryngeal nerve appeared in 2 cases. (5) On the left side, 68.0%, 25.6%, and 6.4% of cases were found with 1, 2, and 3 bifurcations of RLN to larynx entry, respectively. On the right side, 69.8%, 25.8%, and 4.4% cases were identified with 1, 2, and 3 bifurcations of RLN to larynx entry, respectively. (6) The combining dissection approach was proved as successful and safe for protecting the RLN with no permanent RLN paresis. Conclusions: Because of the anatomical variation in RLNs with extralaryngeal bifurcation, it is necessary to increase the awareness of surgeons about these variations so as to protect bifurcated nerves in thyroid surgery.

scholarly journals SPECIFIC FEATURES OF ANESTHETIC SUPPORT IN THYROID SURGERY WITH NEUROMONITORING OF RECURRENT LARYNGEAL NERVES

2017 ◽  
Vol 14 (1) ◽  
pp. 51-57
Author(s):  
M. А. АLEKSEEV ◽  
◽  
V. А. MАKАRIN ◽  
O. V. KULESHOV ◽  
А. А. USPENSKАYA ◽  
...  
Keyword(s):  
Thyroid Surgery ◽  
Laryngeal Nerves ◽  
Recurrent Laryngeal Nerves

Neuromonitoring of recurrent laryngeal nerves in thyroid surgery − comparative study of visualisation and electrophysiology methods

2021 ◽  
Vol 100 (3) ◽  
Keyword(s):  
Thyroid Surgery ◽  
The Other ◽  
Significance Level ◽  
Cervical Spine Surgery ◽  
Laryngeal Nerves ◽  
Recurrent Injury ◽  
Group A ◽  
Recurrent Laryngeal Nerves ◽  
Group B ◽  
The Given

Introduction: Recurrent laryngeal nerve (RLN) injury one of the most serious complications of thyroid, parathyroid and cervical spine surgery. Injuries to external branches of superior laryngeal nerves are described as uncommon. This complication is so severe that it may actually result in disability of voice professionals (like teachers, singers, actors, speakers, managers, etc.). Enhanced efforts are developed in the current clinical practice to increase intraoperative RLN protection through electrophysiological monitoring of laryngeal innervation and simultaneous RLN visualisation. Methods: The study was designed as a prospective observational study. A set of 100 consecutive procedures was selected from the overall set, randomised by surgeons to two groups: A – neuromonitoring (IONM) was used; B – RLN identification and visualisation without IONM. One team included an expert (more than 1000 procedures) and a surgeon in training (less than 100 procedures), and the other team includeda two experienced surgeons (one with more than 150 procedures and the other with more than 500 procedures). Each team performed several procedures a week. The comparison was performed using statistical methods and using the Index of Recurrent Injury (IRI). The purpose of the study was to compare the incidence of RLN paresis in procedures using neuromonitoring (IONM) and intraoperative visualisation of the anatomic non-injured nerve, performed by the two teams. Results: We analysed 100 consecutive thyroid surgeries, 50 procedures both in group A and B. Group A included 43 total thyroidectomies and 7 hemithyroidectomies. Two cases of one-side temporary RLN palsy were found and IRI was 1.075. Group B included 48 total thyroidectomies and 2 hemithyroidectomies. Two cases of one-side temporary RLN palsy were found, as well, and IRI was 1.02. The IRI values thus characterise asymmetric patient sets, and although minor, the asymmetry is reflected in the result. Overall incidence of RLN injuries in the entire set of selected procedures followed during the given year was 1.3%. The set included 16 temporary and 4 permanent RLN palsies, unilateral in all cases. No bilateral permanent or temporary palsy was observed in the followed period. Thyroid surgery IRI was 2.26 in this period. The set was compared to group A and group B patients; the results show no statistically significant differences on 1% significance level (p=0.01). Conclusions: The study showed no statistically significant differences in RLN incidence (permanent unilateral palsy) between procedures without and with IONM, performed by surgeons with different levels of experience in thyroid surgery. As shown by the study, IONM can be helpful for surgeons in training and less experienced surgeons and it can limit the incidence of RLN morbidity in thyroid surgery.

Evaluation of the Learning Curve for Intraoperative Neural Monitoring of the Recurrent Laryngeal Nerves in Thyroid Surgery*

2015 ◽  
Vol 86 (12) ◽  
Author(s):  
Krzysztof Pragacz ◽  
Marcin Barczyński
Keyword(s):  
Learning Curve ◽  
Thyroid Surgery ◽  
Predictive Value ◽  
Postoperative Function ◽  
Laryngeal Nerves ◽  
Technical Errors ◽  
Group I ◽  
Group Ii ◽  
Recurrent Laryngeal Nerves ◽  
Neural Monitoring

AbstractIntraoperative neuromonitoring facilitates identification of the recurrent laryngeal nerves (RLN) and allows for predicting their postoperative function. Nevertheless, the outcome of thyroid surgery monitoring is affected by both the experience of the operator and his mastering of the technique.was the assessment of the learning curve for intraoperative RLN neuromonitoring.. The prospective analysis included 100 consecutive thyroid operations performed by a single surgeon during implementation of RLN neuromonitoring in a district surgical ward in Staszów. RLN neuromonitoring was performed in keeping with the recommendations of the International Neural Monitoring Study Group using a C2 NerveMonitor (Inomed, Germany). The outcomes of initial 50 procedures (group I: 08/2012-07/2013) were compared with the results of subsequent 50 operations (group II: 08/2013-07/2014). The evaluation included demographic and intraoperative data along with predictive value of the method and complications.. In group II as compared to group I, a significant reduction of operative time was noted (102.1±19.4 vs 109.9±19; p=0.045), along with an increased percentage of identified RLNs (99% vs 89.2%; p=0.006), a decreased percentage of correction-requiring technical errors (8% vs 24%; p=0.029), an improved negative predictive (99% vs 89.3%; p<0.001) and positive value (75% vs 55.6%; p<0.001), as well as a decreased percentage of RLN injuries (3% vs 14%; p=0.006).. Mastering the technique of intraoperative RLN neuromonitoring in thyroid surgery requires the surgeon to perform independently approximately 50 monitored procedures, what allows for achieving the predictive value of the method that is comparable to outcomes published by referral centers.

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