Transcutaneous Electrical Stimulation of the Recurrent Laryngeal Nerve in Monkeys

1987 ◽  
Vol 96 (1) ◽  
pp. 38-42 ◽  
Author(s):  
Ira Sanders ◽  
Jonathan Aviv ◽  
Michael M. Racenstein ◽  
Warren M. Kraus ◽  
Hugh F. Biller
Keyword(s):  
Electrical Stimulation ◽  
Recurrent Laryngeal Nerve ◽  
Vocal Cord ◽  
Laryngeal Nerve ◽  
Transcutaneous Electrical Stimulation ◽  
Direct Stimulation ◽  
Glottic Closure ◽  
Unilateral Stimulation ◽  
Tracheoesophageal Groove ◽  
Stimulation Of

The recurrent laryngeal nerve (RLN) of four anesthetized adult Macaca fascicularis monkeys was stimulated by applying current with blunt electrodes placed unilaterally and bilaterally on the intact neck skin along the tracheoesophageal groove. The stimulus consisted of 2.5- to 4.0-mA cathodal pulses, each of 1-ms duration, beginning at a frequency of 10 Hz and increasing by 10-Hz increments to 100 Hz. Unilateral stimulation from 10 to 30 Hz resulted in a graded vocal cord abduction, with the maximal glottic aperture occurring at 30 Hz. Stimulation above 30 Hz produced a graded cord adduction, with nearly complete glottic closure at 100 Hz; bilateral stimulation yielded similar results, with total glottic closure at 100 Hz. Confirmation of the RLN as mediator of this frequency-dependent cord motion was achieved by surgically isolating it and attaining identical results with direct stimulation. No cardiopulmonary alterations were observed in any trial. Transcutaneous electrical stimulation of the RLN seems to be a relatively safe, reliable, and noninvasive method of controlling vocal cord position and thereby the glottic airway in monkeys.

Transcutaneous Electrical Stimulation of the Recurrent Laryngeal Nerve: A Method of Controlling Vocal Cord Position

1986 ◽  
Vol 95 (2) ◽  
pp. 152-157 ◽  
Author(s):  
Ira Sanders ◽  
Jonathan Aviv ◽  
Hugh F. Biller
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Vocal Cord ◽  
Laryngeal Nerve ◽  
Transcutaneous Stimulation ◽  
Msec Duration ◽  
Adductor Muscles ◽  
Contraction Times ◽  
The Difference ◽  
Tracheoesophageal Groove ◽  
Stimulation Of

This study was designed to examine the feasibility of transcutaneous stimulation of the recurrent laryngeal nerve. Electrical activation of the recurrent laryngeal nerve was achieved by applying a blunt electrode to the intact neck skin at specific points along the tracheoesophageal groove in anesthetized adult dogs. The stimulus consisted of 10 mA cathodal pulses, each of 1 msec duration, delivered at a frequency of 10 Hz and increased by 10 Hz increments up to 100 Hz. Vocal cord excursion was directly related to the frequency of applied current. In all six dogs studies, stimulation at 30 Hz resulted in maximal ipsilateral vocal cord adduction, while stimulation at frequencies greater than 40 Hz resulted in ipsilateral vocal cord adduction up to or across the midline. Vocal cord movement was immediate and persisted for the duration of the stimulus train. Surrounding neck muscles were not visibly activated. We propose that the observed frequency-dependent movement of the vocal cords occurred because of the difference between the contraction times of the intrinsic abductor and adductor muscles of the larynx. Transcutaneous recurrent laryngeal nerve stimulation appears promising, both as a diagnostic aid in laryngoscopy and as a therapeutic tool in controlling the glottiC aperture.

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.

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.

Synchronous Electrical Stimulation of Laryngeal Muscles: An Alternative for Enhancing Recovery of Unilateral Recurrent Laryngeal Nerve Paralysis

2014 ◽  
Vol 28 (4) ◽  
pp. 524.e1-524.e7 ◽  
Author(s):  
Alejandro Garcia Perez ◽  
Xochiquetzal Hernández López ◽  
Víctor Manuel Valadez Jiménez ◽  
Arturo Minor Martínez ◽  
Pablo Antonio Ysunza
Keyword(s):  
Electrical Stimulation ◽  
Recurrent Laryngeal Nerve ◽  
Laryngeal Nerve ◽  
Recurrent Laryngeal Nerve Paralysis ◽  
Nerve Paralysis ◽  
Laryngeal Muscles ◽  
Laryngeal Nerve Paralysis ◽  
Stimulation Of

Functional Electrical Stimulation for the Treatment of Bilaterial Recurrent Laryngeal Nerve Paralysis

1986 ◽  
Vol 95 (1) ◽  
pp. 47-51 ◽  
Author(s):  
Randal A. Otto ◽  
William Davis
Keyword(s):  
Electrical Stimulation ◽  
Recurrent Laryngeal Nerve ◽  
Vocal Cord ◽  
Functional Electrical Stimulation ◽  
Intrathoracic Pressure ◽  
Laryngeal Nerve ◽  
Recurrent Laryngeal Nerve Paralysis ◽  
Nerve Paralysis ◽  
Laryngeal Nerve Paralysis ◽  
Trigger Stimulus

We have previously presented the concept of electrophysiologic pacing of bilaterally paralyzed vocal cord abductors as a solution to the difficult problem incurred in this clinical situation. Initially, we demonstrated that it was indeed feasible to electrophysiologically pace abduction of the vocal cords synchronously with respiration, employing the EMG activity of the diaphragm as a trigger stimulus. Further research has led us to evaluate other possible physiologic trigger stimuli to ascertain which of these will prove most suitable in long-term pacing studies. In this article, we will report our preliminary results, employing negative intrathoracic pressure occurring with respiration—as detected by an implanted pressure transducer as a trigger stimulus. This device was interfaced with a muscle stimulator attached to electrodes placed in the cricoarytenoid muscles in five canines whose recurrent laryngeal nerves had been sectioned bilaterally. In all animals, obvious physiologic synchrony of vocal cord abduction and a reduciton of negative inspiratory intratracheal pressure was achieved during electrical pacing. This reinforces our initial findings that it is indeed feasible to pace vocal cord abduction in bilaterial recurrent laryngeal nerve paralysis with resultant return of physiologic normality to the glottis. Thus, functional electrical stimulation offers an alternative approach to the difficult problems incurred in the patient with bilateral recurrent laryngeal nerve paralysis. It also demonstrates that physiologic negative intrathoracic pressure activity occurring with inspiration can be a trigger source.

Medullary Carcinoma of the Thyroid Masquerading as Idiopathic Vocal Cord Paralysis

1982 ◽  
Vol 90 (1) ◽  
pp. 81-84
Author(s):  
Leonard L. Hays ◽  
Wijdan A. Luqman ◽  
R. Kim Davis ◽  
Ltc Dick R. Smith
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Vocal Cord ◽  
Diagnostic Test ◽  
Vocal Cord Paralysis ◽  
Recurrent Disease ◽  
Medullary Carcinoma ◽  
Laryngeal Nerve ◽  
Serum Calcitonin ◽  
Preoperative Diagnostic ◽  
Tracheoesophageal Groove

Medullary carcinoma of the thyroid (MCT) may masquerade for months as idiopathic vocal cord paralysis, especially in patients whose thyroid is difficult to accurately and completely palpate. A case of vocal cord paralysis secondary to invasion of the recurrent laryngeal nerve by nonfamilial MCT in a nonpalpable portion of the tracheoesophageal groove is presented. Serum calcitonin by radioimmunoassay proved to be the only definitive preoperative diagnostic test. This assay is also an effective marker to establish evidence of residual or recurrent disease.

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