Histopathologic Study of Carcinoma of the Hypopharynx: Implications for Conservation Surgery

1987 ◽  
Vol 96 (6) ◽  
pp. 625-629 ◽  
Author(s):  
Minoru Hirano ◽  
Shigejiro Kurita ◽  
Hisashi Tanaka
Keyword(s):  
Thyroid Cartilage ◽  
Posterior Wall ◽  
Pyriform Sinus ◽  
Laryngeal Nerve ◽  
Histopathologic Study ◽  
Conservation Surgery ◽  
Laryngeal Cartilages ◽  
Posterior Cricoarytenoid ◽  
Paraglottic Space ◽  
Organ Section

A total of 38 specimens obtained by laryngopharyngectomy were subjected to a whole organ section study. Of the 38, 31 were pyriform sinus (PS), three were postcricoid (PC), and four were posterior wall (PW) carcinomas. The results were as follows. 1) The thyroid cartilage was involved much more frequently than the other laryngeal cartilages. 2) Joint involvements were infrequent. 3) The interarytenoid, thyroarytenoid, and lateral cricoarytenoid muscles frequently were invaded by PS carcinomas, whereas PC carcinomas frequently involved the interarytenoid and posterior cricoarytenoid muscles. 4) The recurrent laryngeal nerve (RLN) was involved in all PC T3 cases, but RLN involvement was rare in PS cases. 5) Involvements of the paraglottic space and periarytenoid region were closely related to fixation of the larynx on the affected side (hemilarynx) in PS carcinomas. 6) Neither hemilarynx fixation nor PS apex involvement was a reliable landmark for determining the exact extent of laryngeal involvement. 7) Conservation surgery could have been employed in 18 of the 38 cases.

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.

Newer Technique of Laryngeal Reinnervation: Superior Laryngeal Nerve (Motor Branch) as a Driver of the Posterior Cricoarytenoid Muscle

1989 ◽  
Vol 98 (11) ◽  
pp. 907-909 ◽  
Author(s):  
Anthony J. Maniglia ◽  
Brian Dodds ◽  
M. B. Katirji ◽  
Kelly Sorensen ◽  
Mary L. Rosenbaum
Keyword(s):  
Vocal Cord ◽  
Superior Laryngeal Nerve ◽  
Anastomosis Group ◽  
Laryngeal Nerve ◽  
Motor Branch ◽  
Vocal Cord Mobility ◽  
Nerve Anastomosis ◽  
Direct Nerve ◽  
Posterior Cricoarytenoid ◽  
The Right

This report analyzes the experience gained using two different techniques to reinnervate the paralyzed vocal cord. In the neurotization group, the superior laryngeal nerve (SLN) motor branch–cricothyroid muscle pedicle was used to reinnervate the posterior cricoarytenoid muscle. In the direct nerve anastomosis group, the SLN was anastomosed to the abductor branch of the recurrent laryngeal nerve (RLN), and the ansa hypoglossi (AH) to the adductor branch of the RLN. A third group of animals (control) had the right RLN sectioned without any anastomosis. About 5 to 6 months postoperatively the animals were killed painlessly and evaluated. The neurotization group revealed vocal fold mobilization on the right side to have an average of about half of the mobility of the left, normal side. After the RLN and SLN on the left were severed as well as the AH bilaterally, the vocal cord mobility was reduced to about one fourth. The direct nerve anastomosis group showed about fourfold less vocal cord mobility than the neurotization group. After the SLN, RLN, and AH were severed bilaterally, the control group showed no vocal cord mobility. The neurotization technique has been selected for further experimentation in human adults.

RESULTS OF CONSERVATION SURGERY FOR CANCERS OF THE SUPRAGLOTTIS AND PYRIFORM SINUS

1980 ◽  
Vol 90 (4) ◽  
pp. 591???600 ◽  
Author(s):  
JOSEPH H. OGURA ◽  
JAMES E. MARKS ◽  
RICHARD B. FREEMAN
Keyword(s):  
Pyriform Sinus ◽  
Conservation Surgery

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.

scholarly journals Efficacy of Transcartilaginous Electrodes for Intraoperative Neural Monitoring During Thyroid Surgery

2020 ◽  
Vol 13 (4) ◽  
pp. 422-428 ◽  
Author(s):  
Seon Min Jung ◽  
Kyung Tae ◽  
Chang Myeon Song ◽  
Seung Hwan Lee ◽  
Jin Hyeok Jeong ◽  
...  
Keyword(s):  
Nerve Palsy ◽  
Recurrent Laryngeal Nerve Palsy ◽  
Thyroid Cartilage ◽  
Good Alternative ◽  
Intraoperative Neuromonitoring ◽  
Laryngeal Nerve ◽  
The Other ◽  
Alternative Technique ◽  
Predictive Values ◽  
Neural Monitoring

Objectives. This study was conducted evaluate the efficacy of electromyography (EMG) using transcartilaginous (TC) electrodes through the thyroid cartilage and perichondrium.Methods. We prospectively collected EMG data from intraoperative neuromonitoring (IONM) of 54 nerves at risk in 38 patients during thyroidectomy. We followed standardized IONM procedures in all operations. EMG signals from both endotracheal tube (ET) electrodes and TC needle electrodes were recorded simultaneously. We compared the characteristics of the EMG signals and the efficacy of both methods.Results. Significantly higher mean EMG amplitudes were recorded by TC electrodes than by ET electrodes in all four-step procedures (V1-R1-R2-V2, <i>P</i><0.001). Loss of signal (LOS) occurred in five patients in ET electrodes, but in only two patients in TC electrodes. Postoperative laryngoscopy revealed recurrent laryngeal nerve palsy in the two patients who showed LOS from both the ET and TC electrodes, and vocal cord movement was intact in the other three patients. Therefore, the positive predictive values of LOS in ET and TC electrodes were 40% and 100%, respectively.Conclusion. EMG recording using TC needle electrodes is feasible and effective, making it a good alternative technique for IONM.

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.

Stimulation of vagal C-fibers alters timing and distribution of respiratory motor output in cats

1989 ◽  
Vol 67 (6) ◽  
pp. 2249-2256 ◽  
Author(s):  
H. R. Holmes ◽  
J. E. Remmers
Keyword(s):  
Vagus Nerve ◽  
Recurrent Laryngeal Nerve ◽  
Breathing Pattern ◽  
Laryngeal Nerve ◽  
C Fibers ◽  
Vascular Congestion ◽  
Vagal Afferent ◽  
Posterior Cricoarytenoid ◽  
The Right ◽  
Decerebrate Cats

Pulmonary vascular congestion or pulmonary embolism in humans produces shallow tachypnea, and indirect experimental evidence suggests that this characteristic breathing pattern may result from activation of vagal unmyelinated afferents from the lung. We have investigated, in decerebrate cats, reflex changes in breathing pattern and in the activation of the diaphragm, posterior cricoarytenoid, and thyroarytenoid muscles caused by activating C-fiber afferents in the vagus nerve. The right vagus nerve was sectioned distal to the origin of the recurrent laryngeal nerve, eliminating vagal afferent traffic although preserving motor innervation of the larynx on that side. The left cervical vagus was stimulated electrically, and efferent activation of the laryngeal muscles was avoided by cutting the left recurrent laryngeal nerve. Transmission to the brain of vagal afferent traffic resulting from this stimulation was controlled by graded cold block of the nerve cranial to the site of application of the stimulus. Activation of C-fibers, when A-fibers were blocked, significantly decreased respiratory period and amplitude of diaphragm inspiratory burst. In addition, this selective activation of vagal C-fibers augmented postinspiratory activity of the diaphragm and recruited phasic expiratory bursts in the thyroarytenoid. We conclude that, in unanesthetized decerebrate cats, afferent traffic of vagal C-fibers initiates a pontomedullary reflex that increases respiratory frequency, decreases tidal volume, and augments braking of expiratory airflow.

Effects of Recurrent Laryngeal Nerve Transection and Vagotomy on Respiratory Contraction of the Cricothyroid Muscle

1989 ◽  
Vol 98 (5) ◽  
pp. 373-378 ◽  
Author(s):  
Gayle E. Woodson
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Superior Laryngeal Nerve ◽  
Upper Airway ◽  
Vocal Folds ◽  
Laryngeal Nerve ◽  
Electromyographic Activity ◽  
Airway Occlusion ◽  
Cricothyroid Muscle ◽  
Bilateral Vagotomy ◽  
Posterior Cricoarytenoid

The cricothyroid muscle (CT) appears to be an accessory muscle of respiration. Phasic inspiratory contraction is stimulated by increasing respiratory demand. Reflex activation of the CT may be responsible for the paramedian position of the vocal folds, and hence airway obstruction, in patients with bilateral recurrent laryngeal nerve (RLN) paralysis. Previous research has demonstrated the influence of superior laryngeal nerve (SLN) afferents on CT activity. The present study addresses the effects of vagal and RLN afferents. Electromyographic activity of the CT and right posterior cricoarytenoid muscle was monitored in anesthetized cats during tracheotomy breathing and in response to tracheal or upper airway occlusion in the intact animal. This was repeated following left RLN transection, bilateral vagotomy, and bilateral SLN transection. Vagotomy abolished CT response to tracheal occlusion and markedly reduced the response to upper airway occlusion. Vocal fold position following RLN transection appeared to correlate with CT activity; however, observed changes were minor.

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