scholarly journals Reinnervation of the diaphragm by the inferior laryngeal nerve to the phrenic nerve in ventilator-dependent tetraplegic patients with C3-5 damage

2017 ◽  
Vol 3 (4) ◽  
pp. 00052-2017 ◽  
Author(s):  
Eric Verin ◽  
Capucine Morelot-Panzini ◽  
Jesus Gonzalez-Bermejo ◽  
Benoit Veber ◽  
Brigitte Perrouin Verbe ◽  
...  
Keyword(s):  
Phrenic Nerve ◽  
Laryngeal Nerve ◽  
Inferior Laryngeal Nerve ◽  
Laryngeal Reinnervation ◽  
Laryngeal Disease ◽  
Cervical Approach ◽  
Phrenic Nerves ◽  
The Right ◽  
High Level ◽  
Automatic Ventilation

The aim of this study was to evaluate the feasibility of unilateral diaphragmatic reinnervation in humans by the inferior laryngeal nerve. This pilot study included chronically ventilated tetraplegic patients with destruction of phrenic nerve motoneurons.Five patients were included. They all had a high level of tetraplegia, with phrenic nerve motor neuron destruction. They were highly dependent on ventilation, without any possibility of weaning. They did not have other chronic pathologies, especially laryngeal disease. They all had diaphragmatic explorations to diagnose the destruction of the motoneurons of the phrenic nerves and nasoendoscopy to be sure that they did not have laryngeal or pharyngeal disease. Then, surgical anastomosis of the right phrenic nerve was performed with the inferior laryngeal nerve, by a cervical approach. A laryngeal reinnervation was performed at the same time, using the ansa hypoglossi.One patient was excluded because of a functional phrenic nerve and one patient died 6 months after the surgery of a cardiac arrest. The remaining three patients were evaluated after the anastomosis every 6 months. They did not present any swallowing or vocal alterations. In these three patients, the diaphragmatic explorations showed that there was a recovery of the diaphragmatic electromyogram of the right and left hemidiaphragms after 1 year. Two patients had surgical diaphragmatic explorations for diaphragmatic pacing 18–24 months after the reinnervation with excellent results. At 36 months, none of the patients could restore their automatic ventilation.In conclusion, this study demonstrated that diaphragmatic reinnervation by the inferior laryngeal nerve is effective, without any vocal or swallowing complications.

Pericardial mechanoreceptors with phrenic afferents

1993 ◽  
Vol 264 (6) ◽  
pp. H1836-H1846 ◽  
Author(s):  
D. R. Kostreva ◽  
S. P. Pontus
Keyword(s):  
Phrenic Nerve ◽  
Cardiac Rhythm ◽  
Afferent Activity ◽  
Fibrous Layer ◽  
Anesthetized Dogs ◽  
Anatomic Distribution ◽  
Phrenic Nerves ◽  
The Right

Pericardial mechanoreceptors with afferents in the phrenic nerves were studied in anesthetized dogs. The specific aims determined 1) if pericardial receptors with phrenic afferents exist in the dog; 2) the stimuli needed to activate these receptors; 3) the anatomic distribution of these pericardial receptors; and 4) which pericardial layer contains the receptors. Afferent activity was recorded from the phrenic nerves while the pericardium was probed. In 15 of 18 animals, pericardial receptors were found on the right side. In 12 of 18 animals pericardial receptors were located on the left side. Most of the mechanoreceptors were found in a band that paralleled the pericardiophrenic attachment, in the fibrous layer of the pericardium, overlying the atria and atrioventricular grooves. Some receptors had a cardiac rhythm, whereas others were stimulated by the inflating lung. None of the receptors were chemosensitive to capsaicin, bradykinin, or saline. This study is the first to demonstrate that the pericardium of the dog contains mechanosensitive receptors which are innervated by the phrenic nerve.

scholarly journals Non-recurrent inferior laryngeal nerve: a case report

2020 ◽  
Vol 7 (10) ◽  
pp. 3469
Author(s):  
Shah Urvin Manish ◽  
Boopathi Subbarayan ◽  
Saravanakumar Subbaraj ◽  
Tirou Aroul Tirougnanassambandamourty ◽  
S. Robinson Smile
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Nodular Goiter ◽  
Anatomical Variations ◽  
Laryngeal Nerve ◽  
Anatomical Landmarks ◽  
Inferior Laryngeal Nerve ◽  
Nonrecurrent Inferior Laryngeal Nerve ◽  
Aged Woman ◽  
Middle Aged Woman ◽  
The Right

The incidence of Non-recurrent laryngeal nerve (NRLN) is reported to be 0.6%-0.8% on the right side and in 0.004% on the left side. Damage to this nerve during thyroidectomy may lead to vocal cord complications and should therefore be prevented. A middle-aged woman with a nodular goiter who underwent subtotal thyroidectomy for multinodular colloid goiter. We encountered a non-recurrent laryngeal nerve on the right side in a patient during surgery. We were not able to find the inferior laryngeal nerve in its usual position using the customary anatomical landmarks. Instead, it was emerging directly from the right vagus nerve at a right angle and entering the larynx as a unique non-bifurcating nerve. Nonrecurrent inferior laryngeal nerve incidence is very rare, but when present, increases the risk of damage during thyroidectomy. Hence, it is very important to be aware of the anatomical variations of the inguinal lymph node (ILN) and the use of safe meticulous dissection while looking for the nerve during thyroidectomy. The use of Intra-operative neuro-monitoring (IONM) if available in thyroid surgery allows the surgeon to recognize and differentiate branches of the inferior laryngeal nerve (ILN) from sympathetic anastomoses, as well as NRLN during surgery.

scholarly journals Prevalence of the Right Nonrecurrent Inferior Laryngeal Nerve in a Series of 100 Total Thyroidectomies

2018 ◽  
Vol 36 (1) ◽  
pp. 149-158
Author(s):  
Blás Antonio Medina-Ruíz ◽  
Marta Osorio-Fleitas ◽  
María Belen Persano ◽  
Héctor Ricardo Dami ◽  
Ricardo Blasdimir Vega ◽  
...  
Keyword(s):  
Laryngeal Nerve ◽  
Inferior Laryngeal Nerve ◽  
Nonrecurrent Inferior Laryngeal Nerve ◽  
The Right

P2625Pathophysiology of diaphragm involvement in systolic heart failure: insights from diaphragm ultrasound and phrenic nerve stimulation studies

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J Spiesshoefer ◽  
I T Tuleta ◽  
A G Giannoni ◽  
M B Boentert
Keyword(s):  
Heart Failure ◽  
Phrenic Nerve ◽  
Systolic Heart Failure ◽  
Exercise Intolerance ◽  
Design Data ◽  
Diaphragm Function ◽  
Phrenic Nerves ◽  
And Gender ◽  
The Right ◽  
Conductive Properties

Abstract Background Diaphragm ultrasound allows for assessment of both diaphragm excursion and thickness. Cervical and cortical magnetic stimulation (CEMS and COMS) with recording of the diaphragmatic compound motor action potential (CMAP) is diagnostically useful to evaluate the conductive properties of the inspiratory pathway. Systolic heart failure (HF) is characterized by a loss of systolic pump function. Diaphragm weakness in HF has been reported to potentially contribute to exercise intolerance Methods 14 patients with systolic HF (11 men, 3 women; 64±12 years, NYHA 2±0.9, LVEF 36.1±5.6%) and 12 healthy controls matched for age and gender (4 men, 8 women; 56±8 years) underwent spirometric lung function testing and assessment of diaphragm excursion (during tidal breathing, TB, voluntary sniff, VS and deep breathing, DB) and thickness of the right hemidiaphragm by ultrasound. COMS and CEMS of the phrenic nerves with simultaneous bilateral recording of the diaphragm CMAP using surface electrodes was performed in 9 patients. Results Compared to controls, HF patients showed reduced forced vital capacity (75.46±18.05% vs. 107.62±17.13%, p<0.05). Diaphragm excursion amplitude was significantly reduced in HF patients (4.29±1.35 cm vs. 7.34±2.10 cm, p<0.05). Diaphragm contractility was impaired too, as reflected by the diaphragm thickening ratio (DTR; 2.01±0.46 vs. 2.53±0.74, p<0.05). Diaphragm CMAP following COMS and CEMS of the phrenic nerves revealed normal latencies in HF patients compared to controls (COMS Latency; 19.05±2.37 msec vs. 18.97±3.59 msec, p= n. s.). Conclusions Diaphragm involvement in systolic HF is reflected by reduced FVC and impaired ultrasound parameters of diaphragm function. Diaphragmatic pathology is likely to be myopathic because magnetic phrenic nerve conduction studies show no abnormalities. Diaphragm ultrasound may be useful as a diagnostic tool for assessment of diaphragm function in systolic HF. Acknowledgement/Funding This study was supported by Sanofi-Genzyme, Neu-Isenburg, Germany. The funders had no role in study design, data collection and analysis, preparation.

scholarly journals The Rare Coincidence: Nonrecurrent Laryngeal Nerve Pointed by a Zuckerkandl's Tubercle

2012 ◽  
Vol 2012 ◽  
pp. 1-3 ◽  
Author(s):  
Emin Gurleyik ◽  
Sami Dogan ◽  
Omer Gunal ◽  
Mevlut Pehlivan
Keyword(s):  
Multinodular Goiter ◽  
Laryngeal Nerve ◽  
Inferior Laryngeal Nerve ◽  
Adjacent Structures ◽  
Toxic Multinodular Goiter ◽  
Posterior Extension ◽  
Right Lobe ◽  
Nonrecurrent Laryngeal Nerve ◽  
The Right ◽  
Case Based

The safety of thyroid operations mainly depends on complete anatomical knowledge. Anatomical and embryological variations of the inferior laryngeal nerve (ILN), of the thyroid gland itself and unusual relations between ILN and the gland threaten operation security are discussed. The patient with toxic multinodular goiter is treated with total thyroidectomy. During dissection of the right lobe, the right ILN which has nonrecurrent course arising directly from cervical vagus nerve is identified and fully isolated until its laryngeal entry. At the operation, we observe bilateral Zuckerkandl's tubercles (ZTs) as posterior extension of both lateral lobes. The left ILN has usual recurrent course in the trachea-esophageal groove. The right ZT is placed between upper and middle third of the lobe points the nonrecurrent ILN. The coincidence of non-recurrent ILN pointed by a ZT is rare anatomical and embryological feature of this case. Based on anatomical and embryological variations, we suggest identification and full exposure of ILN before attempting excision of adjacent structures, like the ZT which has surgical importance for completeness of thyroidectomy.

Comprehensive Comparison of Right and Left Recurrent Laryngeal Nerves in the Tracheoesophageal Groove

2020 ◽  
pp. 155698452097658
Author(s):  
Michael J. Herr ◽  
J. Macy Cottrell ◽  
Madison Kahl ◽  
Darryl S. Weiman
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Tracheal Ring ◽  
Laryngeal Nerve ◽  
Educational Beliefs ◽  
Significant Difference ◽  
Human Cadavers ◽  
Cervical Approach ◽  
Recurrent Laryngeal Nerves ◽  
The Right ◽  
Tracheoesophageal Groove

Objective A left-sided cervical approach to esophageal mobilization is considered safer given the perceived oblique path and more lateral orientation of the right recurrent laryngeal nerve (RLN) in the tracheoesophageal groove. Given the risk of recurrent laryngeal nerve, the current study investigated if there are differences in right and left RLN location in the tracheoesophageal groove. Methods Right and left RLNs were carefully exposed in human cadavers. Comparison of location was determined at tracheal rings 2, 4, and 6 using 3 parameters: depth of the RLN from the anterior margin of the tracheal ring, lateral distance of the RLN from the posterior margin of the tracheal ring, and distance of the RLN to the anterior midline trachea following the curvature of the trachea. Statistical analysis was used to determine differences between the right and left sides. Results Compared with the right RLN, the left RLN was slightly over 1 mm deeper at the second tracheal ring. Despite this trend, there was no significant difference in RLN location between individual sides or as an aggregate for any of the 3 parameters at tracheal rings 2, 4, or 6. Conclusions Careful characterization of RLN location precludes avoiding hoarseness, aphonia, and vocal cord paralysis. Counter to common surgical perception and educational beliefs, this study demonstrated that right and left RLN anatomical courses do not significantly differ along the trachea. Therefore, ensnarement on either side during a blind mobilization of the cervical esophagus is equally likely to occur.

Phrenic nerve conduction times and twitch pressures of the human diaphragm

1985 ◽  
Vol 58 (5) ◽  
pp. 1496-1504 ◽  
Author(s):  
D. K. McKenzie ◽  
S. C. Gandevia
Keyword(s):  
Phrenic Nerve ◽  
Simultaneous Recording ◽  
Emg Activity ◽  
Conduction Time ◽  
Transdiaphragmatic Pressure ◽  
Surface Electrodes ◽  
Midclavicular Line ◽  
Phrenic Nerves ◽  
The Mean ◽  
The Right

A multilumen catheter was modified to allow simultaneous recording of transdiaphragmatic pressure (Pdi) and the electromyographic (EMG) activity of the diaphragm. The catheter was used in 20 healthy males to measure the conduction time of the phrenic nerves and the twitch pressure of each hemidiaphragm during single supramaximal shocks delivered to the phrenic nerve in the neck. Diaphragmatic EMG was also recorded with surface electrodes at various sites on the chest wall. The mean conduction time to the crural fibers was 6.82 +/- 0.64 ms on the right and 7.93 +/- 0.85 ms on the left, whereas that to the costal fibers adjacent to the midclavicular line was 7.68 +/- 0.56 ms on the right and 7.92 +/- 0.92 ms on the left. Significant correlations were found between the conduction time of each phrenic nerve and the height and the age of the subjects. Conduction times measured at different EMG recording sites varied by as much as 2 ms. This variability, and that of previously reported values for phrenic conduction time, may be largely accounted for by differences in the conduction distances that were measured to each site in three cadavers. The evoked change in Pdi had a mean rise time of 92 ms and an amplitude of approximately 10 cmH2O.

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