Surgical approach to submucosal lesions of the supraglottic larynx: the supero-lateral thyrotomy

1992 ◽  
Vol 106 (5) ◽  
pp. 416-419 ◽  
Author(s):  
John S. Rubin ◽  
Carl E. Silver
Keyword(s):  
Surgical Approach ◽  
Thyroid Cartilage ◽  
Superior Laryngeal Nerve ◽  
Laryngeal Nerve ◽  
Conservative Approach ◽  
Lateral Pharyngotomy ◽  
Supraglottic Carcinoma ◽  
Submucosal Lesions ◽  
Internal Lining ◽  
Supraglottic Larynx

AbstractThe surgical approach to the hypopharynx by lateral pharyngotomy as described by Trotter has found widespread use in management of supraglottic carcinoma. A similar but more conservative approach may be employed for removal of cysts and benign or well-encapsulated neoplasms of the epiglottis and supraglottic space. We call this approach a supero-lateral thyrotomy, to differentiate it from the classic lateral pharyngotomy.Surgery consists of subperichondrial resection of the superior half of the ipsilateral thyroid cartilage with preservation of internal lining and superior laryngeal nerve. The lesion may then be enucleated or resected, and the defect, if any exists, closed with overlying mucosa and the flap of preserved perichondrium. The technique has been employed in cases of paraganglioma, haemangiopericytoma and saccular cysts.

scholarly journals Anatomical landmarks of the external branch of the superior laryngeal nerve

2019 ◽  
Vol 12 (4) ◽  
pp. 161-177
Author(s):  
Viktor Y. Malyuga ◽  
Aleksandr A. Kuprin
Keyword(s):  
Thyroid Cartilage ◽  
Oblique Line ◽  
Superior Laryngeal Nerve ◽  
Laryngeal Nerve ◽  
Constrictor Muscle ◽  
External Branch ◽  
Close Proximity ◽  
Inferior Pharyngeal Constrictor ◽  
Line Type

Background. The external branch of the superior laryngeal nerve innervates a cricothyroid muscle, which provides tension in vocal cords and formation of high-frequency sounds. When the nerve is damaged during surgery, patients may notice hoarseness, inability to utter high pitched sounds, “rapid fatigue” of the voice, and dysphagia. According to literature, paresis of an external branch of the superior laryngeal nerve reaches up to 58% after thyroid surgery. Aim: to identify permanent landmarks and topographic variations of the external branch of the superior laryngeal nerve. Materials and methods. The study is based on the autopsy material (21 complexes organs of the neck) and on identification of variations of 40 external branches of the superior laryngeal nerve. We identified two permanent landmarks that are located at the minimum distance from nerve and we made metrical calculations relative to them: oblique line of thyroid cartilage and tendinous arch of the inferior pharyngeal constrictor muscle. Results. The piercing point of the nerve is always located at the inferior pharyngeal constrictor muscle without protruding beyond the oblique line of thyroid cartilage superiorly and tendinous arch of the inferior pharyngeal constrictor muscle anteriorly. The nerve had the parallel direction in 92.8% of cases (angel less than 30 degrees) relative to the oblique line and in 85.7% cases it was in close proximity to this line (at distance up to 4 mm). The proposed topographic classification of the location of the external branch of the superior laryngeal nerve is based on localization of the piercing point of the nerve relative to the length of the oblique line of thyroid cartilage and the risk of nerve damage. In 14.2% of cases, the piercing point was in the front third of the line (type I), and in 50% it was in the middle third of this line (type II). These variations of the external branch of the superior laryngeal nerve was in close proximity to the upper pole of the thyroid gland, which could have lead to its damage during surgery. In type III and IV (35.8%) – the piercing point in the muscle was located as far as possible from the upper pole of the thyroid gland and the greater part of the nerve was covered with the fibers of inferior pharyngeal constrictor muscle. Conclusion. We identified the main orienteers for the search and proposed anatomical classification of the location of the external branch on the superior laryngeal nerve.

Thyroid cartilage movements during breathing

1995 ◽  
Vol 78 (2) ◽  
pp. 441-448 ◽  
Author(s):  
T. C. Amis ◽  
A. Brancatisano ◽  
A. Tully
Keyword(s):  
Electrical Stimulation ◽  
Recurrent Laryngeal Nerve ◽  
Thyroid Cartilage ◽  
Superior Laryngeal Nerve ◽  
Laryngeal Nerve ◽  
Electromyographic Activity ◽  
Tidal Breathing ◽  
Left And Right ◽  
Posterior Cricoarytenoid ◽  
Stimulation Of

We measured lateral (outward) thyroid cartilage displacement (TCD) of the larynx in six supine anesthetized (intravenous chloralose) dogs. Combined left and right TCDs were measured with linear transducers attached by a thread to the thyroid alae. During tidal breathing via a tracheostomy, phasic inspiratory TCD occurred in all dogs [0.66 +/- 0.2 mm (mean +/- SE)] together with phasic inspiratory electromyographic activity in the cricothyroid (CT) and posterior cricoarytenoid (PCA) muscles. During brief tracheal occlusions, TCD increased significantly to 1.27 +/- 0.2 mm (P = 0.001), accompanied by an increase of 95–115% in the peak CT and PCA electromyograms. Bilateral supramaximal electrical stimulation of the external branches of the superior laryngeal nerve (ExSLN) produced a TCD of 9.9 +/- 0.8 mm; however, similar stimulation of the recurrent laryngeal nerve (RLN) produced a TCD of only 1.33 +/- 0.1 mm (P = 0.0001). Furthermore, bilateral section of the ExSLN in five dogs significantly reduced tidal TCD by 48.7 +/- 24.4% (P < 0.05), and bilateral section of both the ExSLN and RLN resulted in slight phasic inward TCD (-0.06 +/- 0.05 mm). Thus, it appears that the activities of both the CT and RLN-innervated muscles (probably the PCA muscle) contribute to tidal breathing TCD. These findings suggest that inspiratory dilation of the hypopharynx is mediated by contractions of CT and PCA muscles.

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 Surgical approach to the thyroarytenoid branch of the inferior laryngeal nerve through the thyroid cartilage

2016 ◽  
Vol 31 (7) ◽  
pp. 442-447 ◽  
Author(s):  
Fabiana Araújo Sperandio ◽  
Rui Imamura ◽  
Domingos Hiroshi Tsuji ◽  
Luiz Ubirajara Sennes
Keyword(s):  
Surgical Approach ◽  
Thyroid Cartilage ◽  
Laryngeal Nerve ◽  
Inferior Laryngeal Nerve

Airway obstruction in children due to plexiform neurofibroma of the larynx

1996 ◽  
Vol 110 (11) ◽  
pp. 1065-1068 ◽  
Author(s):  
Hasse Ejnell ◽  
Mia Järund ◽  
Martin Bailey ◽  
Pontus Lindeman
Keyword(s):  
Surgical Treatment ◽  
Airway Obstruction ◽  
Rare Disease ◽  
Plexiform Neurofibroma ◽  
Superior Laryngeal Nerve ◽  
Laryngeal Nerve ◽  
Subtotal Resection ◽  
Lateral Pharyngotomy ◽  
Tumour Reduction

AbstractPlexiform neurofibroma of the larynx is a rare disease. Three cases in children with airway obstruction are presented. After tumour reduction via a lateral pharyngotomy their tracheostomies could be closed. The surgical treatment of plexiform neurofibroma of the superior laryngeal nerve is discussed and conservative, subtotal resection is recommended.

The Anatomical and Clinical Significance of the Superior Laryngeal Nerve

2021 ◽  
pp. 019459982198962
Author(s):  
Kai-ning Lu ◽  
Jin-wang Ding ◽  
Yu Zhang ◽  
Jing-jing Shi ◽  
Li Zhou ◽  
...  
Keyword(s):  
Thyroid Cartilage ◽  
Superior Laryngeal Nerve ◽  
Laryngeal Nerve ◽  
Entry Point ◽  
Horizontal Line ◽  
Lower Edge ◽  
External Branch ◽  
Starting Point ◽  
Human Cadavers ◽  
Medical University

Objective This study summarizes the anatomical features of the superior laryngeal nerve in Chinese to enable the rapid location of the superior laryngeal nerve during an operation. Study Design Retrospective analysis of anatomical data. Setting Hangzhou First People’s Hospital Affiliated to Nanjing Medical University. Methods A total of 71 embalmed human cadavers (132 heminecks) were examined over 3 months. The length and diameter of the internal and external branches of the superior laryngeal nerve and their relationships with different landmarks were recorded. Results The total length of the internal branch of the superior laryngeal nerve was 23.4 ± 6.9 mm. The length of the external branch of the superior laryngeal nerve was 47.7 ± 11.0 mm. Considering the midpoint of the lower edge of the thyroid cartilage as the starting point and using that edge as a horizontal line, when the entry point is above that line, the external branch of the superior laryngeal nerve can be found within 41.1 mm and at an angle of 57.2°. When the entry point is below the lower edge of the thyroid cartilage, the external branch of the superior laryngeal nerve can be found within 34.0 mm and at an angle of 36.5°. Conclusion The superior laryngeal nerve in Chinese people has distinct anatomical characteristics. This article provides a new method of quickly locating the external branch of the superior laryngeal nerve during the operation, which can reduce the probability of damaging the external branch of the superior laryngeal nerve.

scholarly journals VIRIATION OF THE EXTERNAL BRANCH OF THE SUPERIOR LARYNGEAL NERVE

2019 ◽  
Vol 21 (1) ◽  
pp. 84-88
Author(s):  
V Y Malyuga ◽  
A A Kuprin
Keyword(s):  
Thyroid Gland ◽  
Thyroid Cartilage ◽  
Oblique Line ◽  
Superior Laryngeal Nerve ◽  
Laryngeal Nerve ◽  
Type I ◽  
Constrictor Muscle ◽  
Point Of Entry ◽  
External Branch ◽  
Inferior Pharyngeal Constrictor

Till now, there is no universal clinical classification about variations of the external branch of the superior laryngeal nerve despite the multiple classifications that was proposed. The aim of this research is identification and systematization of topographic types of the external branch of the superior laryngeal nerve. The study is based on the autopsy material (21 complexes organs of the neck) and on identification of variations of 40 external branches of the superior laryngeal nerve. We identify two permanent landmark that are located at the minimum distance from nerve and on which we made metrical calculations: oblique line of thyroid cartilage, tendinous arch of the inferior pharyngeal constrictor muscle. The “entry” point of the nerve is always located on the inferior pharyngeal constrictor muscle,and not protruding beyond the oblique line of thyroid cartilage superiorly and tendinous arch of the inferior pharyngeal constrictor muscle anteriorly. The proposed topographic classification of the location of the external branch of the superior laryngeal nerve is based on localization of point of pierced of the nerve relating to the length of the oblique line of thyroid cartilage. In 64.2% of cases, the external branch of the superior laryngeal nerve was in close proximity to the upper pole of the thyroid gland, which could lead to its damage during surgery (type I and II). In type III and IV (35.8%) - the point of "entry" in the muscle was located as far as possible from the upper pole of the thyroid gland, and most of the nerve was covered by the fibers of the inferior pharyngeal constrictor muscle.

Arterial Baroreceptor Fibers in the Recurrent Laryngeal Nerve

1973 ◽  
Vol 82 (2) ◽  
pp. 228-234 ◽  
Author(s):  
Stanley G. Strauss ◽  
Hiroyuki Fukuda ◽  
John A. Kirchner
Keyword(s):  
Blood Pressure ◽  
Recurrent Laryngeal Nerve ◽  
Aortic Arch ◽  
Thyroid Cartilage ◽  
Pressure Sensors ◽  
Superior Laryngeal Nerve ◽  
Nerve Fibers ◽  
Baroreceptor Reflex ◽  
Laryngeal Nerve ◽  
Stimulation Of

Stimulation of the larynx, as during intubation, can produce significant cardiac arrhythmias. Investigation of the cause of these arrhythmias has led us to believe that they are in part due to stimulation of a baroreceptor reflex pathway which passes through the larynx rather than to initiation of a simple reflex in the larynx itself. Pressure sensors (baroreceptors) in the aortic arch form part of a system which monitors systemic blood pressure. Stimulation of these baroreceptors produces, via a medullary reflex arc, a slowing of the heart rate, a decrease in sympathetic vascular tone, and as a result a drop in blood pressure. The pathway from the aortic arch baroreceptors has heretofore been thought to run directly through the vagus nerve. We have shown, however, that in the rat a significant number of fibers from aortic arch baroreceptors run in the left recurrent laryngeal nerve (RLN), through the larynx into the left superior laryngeal nerve (SLN), and only then into the vagus. Blocking or cutting the left RLN produces a significant drop in overall baroreceptor reflex activity, and furthermore, nerve fibers have been isolated in the left RLN which show exactly the same patterns of discharge as those from arterial baroreceptors elsewhere. It is our belief that at least some of the arrhythmias produced during laryngeal manipulation can be explained on the basis of mechanical compression producing stimulation of the baroreceptor fibers as they pass along the thyroid cartilage through the ramus communicans between the RLN and SLN. Further work needs to be done to show that compression does in fact stimulate the baroreceptor pathway, but there is now little doubt that, in experimental animals, such a pathway exists.

Sign in / Sign up

Export Citation Format

Share Document