scholarly journals Bilateral tapia syndrome after maxillomandibular advancement surgery

2021 ◽  
pp. 49-59
Author(s):  
Alexandre Augusto Ferreira da Silva ◽  
Roberto de Oliveira Rocha ◽  
Ronaldo Célio Mariano
Keyword(s):  
Preventive Measures ◽  
Nasotracheal Intubation ◽  
Signs And Symptoms ◽  
Laryngeal Nerve ◽  
Motor Deficit ◽  
Head Region ◽  
Maxillomandibular Advancement ◽  
Unusual Condition ◽  
Aesthetic Results ◽  
Recurrent Laryngeal Nerves

Lesions of the hypoglossal and laryngeal nerve, recurrent in its unilateral or bilateral extracranial pathways, cause a motor deficit in the tongue with transient, partial or total loss of speech, which may be associated with mild or severe dysphagia, characterizing Tapia syndrome. This unusual condition is usually related to airway manipulation during anesthetic-surgical surgery, and few cases in the literature are correlated with maxillofacial surgeries, which partly explains the ignorance of this complication by a significant number of professionals. We describe a case report of bilateral Tapia syndrome established after a procedure for maxillomandibular advancement. This is a 55-year-old male patient diagnosed with retrognatism and retromaxillism. The patient underwent a maxillomandibular advancement with nasotracheal intubation. He evolved with bilateral Tapia syndrome, recovering from the signs and symptoms of this complication, being reoperated to correct aesthetic results obtained in the first intervention that was below acceptable, not evolving after this second surgery with the syndrome. We conclude that preventive measures should be taken, such as avoiding sudden movements in the head region and prolonged hyperextension of the neck during surgery, minimizing the trauma of the tracheal cannula on the tissues covering the hypoglossal and recurrent laryngeal nerves.

COMPARISON OF ‘AIRWAY NERVE BLOCK’ VS ‘SPRAY-AS-YOU-GO’ METHOD USED FOR AWAKE FLEXIBLE BRONCHOSCOPIC INTUBATION IN COMBINATION WITH CONSCIOUS SEDATION – A PROSPECTIVE, RANDOMISED, SINGLE BLIND STUDY

2021 ◽  
pp. 3-6
Author(s):  
Devesh Kumar Gupta ◽  
Shinu Kaur ◽  
Deepti Gupta
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Endotracheal Tube ◽  
Nerve Block ◽  
Conscious Sedation ◽  
Nasotracheal Intubation ◽  
Superior Laryngeal Nerve ◽  
Laryngeal Nerve ◽  
The Mean ◽  
Lidocaine Spray ◽  
Single Blind

Introduction: Fibreoptic Intubation (FOI) is the gold standard for managing difcult airways. There are various approaches such as: Nebulization with lidocaine; 'Spray as you go'(SAYGO); Airway nerve block - blocking superior laryngeal nerve & recurrent laryngeal nerve & sedation. The present study aims to compare 'airway nerve block' (NB) and 'spray as you go'(SA) method for awake exible bronchoscopic intubation used in combination with conscious sedation. Methods: 60 patients of age group 18 – 65 years with difcult airway undergoing general anaesthesia with nasotracheal intubation, were randomly allocated into two groups. After premedication & nasal preparation, all patients received injection dexmedetomidine at a dose of 1µg/kg in 100ml of 0.9% NS over 10 minutes. In Group SA, 2ml lignocaine 4% was sprayed above and below the cords after visibility of glottic opening via working channel of the bronchoscope and 2 ml lignocaine 4% within trachea before insertion of endotracheal tube. In Group NB, bilateral superior laryngeal nerves & recurrent laryngeal nerve was blocked. Then a exible breoptic bronchoscope preloaded with a exometallic endotracheal tube of appropriate size was then inserted via nasal route. Results: The mean intubation time for Group NB [87.27 ± 7.58 sec] was shorter than that for Group SA [190.33 ± 9.14] (p<0.0001). Conclusion: Awake exible bronchoscopic intubation under sedation with airway nerve block provides better intubating conditions compared to SAYGO

scholarly journals Impact of educational intervention regarding anaemia and its preventive measures among pregnant women: an interventional study

2017 ◽  
Vol 6 (12) ◽  
pp. 5317 ◽  
Author(s):  
Pankajkumar B. Nimbalkar ◽  
Jaldhara N. Patel ◽  
Nilesh Thakor ◽  
Mansi Patni
Keyword(s):  
Pregnant Women ◽  
Preventive Measures ◽  
Signs And Symptoms ◽  
Contributory Factor ◽  
Interventional Study ◽  
Post Intervention ◽  
Medical College ◽  
Maternal Morbidity And Mortality ◽  
Before And After ◽  
Baseline Knowledge

Background: Iron deficiency anaemia (IDA) is the most common nutritional deficiency in pregnancy and major contributory factor to maternal morbidity and mortality. Objective of present study was to assess knowledge of pregnant women regarding anaemia and its preventive measures before and after educational interventional training.Methods: The present study was an interventional study undertaken in purposively selected pregnant women attending the out patient Department of Obstetrics and Gynecology Department of GMERS Medical College, Gandhinagar During the month of October 2017. Total 100 pregnant women were included after written informed consent. Baseline knowledge of pregnant women regarding anaemia and its preventive measures was assessed by pre-designed, pre-tested and semi structured questionnaire. Single educational interventional training for 45 minutes was given to selected pregnant women. Post– intervention knowledge of pregnant women for the same was assessed after training. Thus, collected data was analyzed /using Epi info 7.Results: Baseline knowledge of the pregnant women regarding causes, signs and symptoms of anemia and dietary sources of iron was 21%, 23% and 40% respectively which was significantly increased to 64%, 66% and 72% respectively after the intervention. Baseline knowledge of the pregnant women regarding factors which inhibit and increase iron absorption was 25% and 4% respectively which was significantly increased to 55% and 41 % respectively after the intervention. Baseline knowledge of the pregnant women regarding treatment of anaemia was 30% which was significantly increased to 79 % after the intervention.Conclusions: There was significant improvement in the knowledge regarding anaemia and its preventive measures among pregnant women after our single educational session.

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.

Bruxism Related to Violin Playing

2008 ◽  
Vol 23 (1) ◽  
pp. 12-15
Author(s):  
F J Rodríguez Lozano ◽  
M R Sáez Yuguero ◽  
A Bermejo Fenoll
Keyword(s):  
Preventive Measures ◽  
Signs And Symptoms ◽  
Musical Instrument ◽  
Control Group ◽  
Health Education Program ◽  
Professional Musicians ◽  
Chi Squared ◽  
Clinical Phenomenon ◽  
Violin Playing ◽  
Random Control

The violinist's profession involves situations of stress and tension, and bruxism is a clinical phenomenon that is occurring among these musicians with increasing frequency. Materials and Methods: We studied a group of 41 violinists from the region of Murcia in Spain, who completed clinical questionnaires designed to detect bruxism. The results were compared with those from a random control group who did not play any musical instrument. The SPSS 13.0 software package was used for statistical analysis. Evaluations were done with Pearson's chi-squared test. Results: In the study group, 73% were diagnosed with bruxism, whereas in the control group, only 34% suffered from this complaint. We found a statistically significant relationship (p<0.05) between violinists and the parafunctional bruxism habit. Conclusions: It could be said that violin playing can be a factor that predisposes or triggers the appearance of signs and symptoms of bruxism. It is necessary to establish a health education program and preventive measures for professional musicians in order to avoid the development or worsening of bruxism and related problems.

Identification and preservation of External Branch of the Superior Laryngeal Nerve during thyroid surgeries at NMCTH

2017 ◽  
Vol 13 (3) ◽  
pp. 306-310 ◽  
Author(s):  
Rupesh Raj Joshi ◽  
Anupama Shah Rijal ◽  
Kundhan Kumar Shrestha ◽  
Anup Dhungana ◽  
Shova Maharjan
Keyword(s):  
Case Series ◽  
Superior Laryngeal Nerve ◽  
Thyroid Neoplasms ◽  
Laryngeal Nerve ◽  
Type I ◽  
Tertiary Centre ◽  
External Branch ◽  
Common Diagnosis ◽  
Recurrent Laryngeal Nerves ◽  
Nerve Identification

Background & Objectives:The most common reason for thyroid surgery is the presence of benign or malignant nodules. Subjective voice disturbance after thyroidectomy is very common, even without injury to the recurrent laryngeal nerves. One possible cause for postoperative dysphonia is injury to the External branch of superior laryngeal nerve (EBSLN). Cernea classification, which we followed in this study, is one of the most popular worldwide classifications of the EBSLN. The study was conducted with objectives to identify and classify EBSLN according to Cernia classification in Nepalese population and help surgeons understand the anatomy of the EBSLN and to preserve the nerve during thyroidectomy. Materials & Methods:A prospective observational case series of seventy-nine patients, who were diagnosed with thyroid neoplasms and underwent thyroid surgeries at the tertiary centre of Kathmandu between 1st January 2015 to 31st December 2016. All procedures were performed by transverse collar incision. We classified the anatomy of the EBSLN using Cernea classification.  Results:There were total of 79 patients. Most common diagnosis and surgery were colloid goitre and hemithyroidectomies respectively. A total of 94 EBSLNs were evaluated.  Cernia Type I was observed in 27.66%, type IIa in 46.80%, and type IIb in 14.89%. Incidences of types IIa and IIb, which put patients at greater risk for intra-operative injury, were observed in 61.69% in our study. The nerve could not be identified in 10.64%. Conclusion:It is possible to increase the rate of nerve identification and avoid the nerve injury even in the absence of sophisticated equipment.

scholarly journals Involvement of hypoglossal and recurrent laryngeal nerves on swallowing pressure

2018 ◽  
Vol 124 (5) ◽  
pp. 1148-1154 ◽  
Author(s):  
Takanori Tsujimura ◽  
Taku Suzuki ◽  
Midori Yoshihara ◽  
Shogo Sakai ◽  
Naomi Koshi ◽  
...  
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Hypoglossal Nerve ◽  
Sensory Information ◽  
Upper Esophageal Sphincter ◽  
Laryngeal Nerve ◽  
Nerve Transection ◽  
Swallowing Function ◽  
Esophageal Sphincter ◽  
Recurrent Laryngeal Nerves ◽  
Swallowing Pressure

Swallowing pressure generation is important to ensure safe transport of an ingested bolus without aspiration or leaving residue in the pharynx. To clarify the mechanism, we measured swallowing pressure at the oropharynx (OP), upper esophageal sphincter (UES), and cervical esophagus (CE) using a specially designed manometric catheter in anesthetized rats. A swallow, evoked by punctate mechanical stimulation to the larynx, was identified by recording activation of the suprahyoid and thyrohyoid muscles using electromyography (EMG). Areas under the curve of the swallowing pressure at the OP, UES, and CE from two trials indicated high intrasubject reproducibility. Effects of transecting the hypoglossal nerve (12N) and recurrent laryngeal nerve (RLN) on swallowing were investigated. Following bilateral hypoglossal nerve transection (Bi-12Nx), OP pressure was significantly decreased, and time intervals between peaks of thyrohyoid EMG bursts and OP pressure were significantly shorter. Decreased OP pressure and shortened times between peaks of thyrohyoid EMG bursts and OP pressure following Bi-12Nx were significantly increased and longer, respectively, after covering the hard and soft palates with acrylic material. UES pressure was significantly decreased after bilateral RLN transection compared with that before transection. These results suggest that the 12N and RLN play crucial roles in OP and UES pressure during swallowing, respectively. We speculate that covering the palates with a palatal augmentation prosthesis may reverse the reduced swallowing pressure in patients with 12N or tongue damage by the changes of the sensory information and of the contact between the tongue and a palates. NEW & NOTEWORTHY Hypoglossal nerve transection reduced swallowing pressure at the oropharynx. Covering the hard and soft palates with acrylic material may reverse the reduced swallowing function caused by hypoglossal nerve damage. Recurrent laryngeal nerve transection reduced upper esophageal sphincter negative pressure during swallowing.

scholarly journals Does methylene blue help in the early identification of the recurrent laryngeal nerve?

2018 ◽  
Vol 7 (1) ◽  
pp. 8-11
Author(s):  
Sujan Singh Chhetri ◽  
Toran KC ◽  
Meera Bista ◽  
Nayan Bahadur Mahato
Keyword(s):  
Methylene Blue ◽  
Recurrent Laryngeal Nerve ◽  
Cross Sectional Study ◽  
Laryngeal Nerve ◽  
Anatomical Landmarks ◽  
Cross Sectional ◽  
Visual Identification ◽  
Recurrent Laryngeal Nerves ◽  
One Year ◽  
Visualization Techniques

Background: Identification of recurrent laryngeal nerve is of utmost importance during thyroid surgery. Different anatomical landmarks have been used to recognize and preserve the nerve. Injury may lead to vocal cord paralysis. Different adjuvant methods have been used to aid in the identification of the nerve.Objective: To determine whether methylene blue smear helps to identify the recurrent laryngeal nerve safely and efficiently.Methodology: Observational cross sectional study done in 30 patients who underwent different thyroidectomies within a duration of one year. Recurrent laryngeal nerve identified using methylene blue smear and compared with the conventional visualization techniques exercising different known anatomical landmarks. The duration and ease of identification of the nerve was noted and graded.Results: Total of 39 recurrent laryngeal nerves were identified from 28 females and two males. The duration and the ease of dissection of the nerve was inconstant. Earliest time for recognition of the nerve was one and half minutes while the slowest time was 12 minutes. Conclusion: No matter what techniques are used, visual identification and verification of the recurrent laryngeal nerve is of paramount importance. No techniques demonstrated added advantage to one another.

Laryngeal Reflex Mechanism during Deglutition—Observation of Subglottal Pressure and Afferent Discharge

1988 ◽  
Vol 99 (5) ◽  
pp. 465-471 ◽  
Author(s):  
Takemoto Shin ◽  
Tadatsugu Maeyama ◽  
Ikuro Morikawa ◽  
Toshiro Umezaki
Keyword(s):  
Pressure Transducer ◽  
Superior Laryngeal Nerve ◽  
Laryngeal Nerve ◽  
Sensory Nerves ◽  
Sensory Function ◽  
Human Beings ◽  
Reflex Mechanism ◽  
Laryngeal Nerves ◽  
Subglottal Pressure ◽  
Recurrent Laryngeal Nerves

In this investigation, particular attention was paid to elucidate the laryngeal reflex mechanism of protective closure and the sensory function of the larynx during deglutition. For this purpose, three different experimental procedures were adopted: (1) subglottal pressure of felines was measured during deglutition using a pressure transducer; (2) subglottal pressure of human beings was measured during deglutition using a pressure transducer; and (3) afferent discharges from superior and recurrent laryngeal nerves of felines were recorded. The following conclusions appear justified. (1) Feline and human subglottal pressure during deglutition showed the following pattern. The pressure rises with onset of deglutition, temporarily drops during laryngeal elevation, rises again during the downward movement of the larynx, and drops again at the end of the glutltion. This pattern was not affected by the resection of the unilateral recurrent laryngeal nerve. (2) The superior laryngeal nerve is involved in the sensory function of the pharynx, larynx, and trachea. At least two types of afferent discharges from superficial and infernal sensory nerves are suspected. Afferent discharges from the recurrent laryngeal nerves in the larynx and trachea are not as distinct as those of the superior laryngeal nerve, and this seems to correspond with various changes in the thorax. During deglutition, afferent discharges were recorded from superior to recurrent laryngeal nerves.

scholarly journals Two Cases of Enlarged Zuckerkandl's Tubercle of the Thyroid Displacing the Recurrent Laryngeal Nerve Laterally

2011 ◽  
Vol 2011 ◽  
pp. 1-3 ◽  
Author(s):  
Emin Gurleyik
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Thyroid Tissue ◽  
Close Relation ◽  
Lateral Approach ◽  
Laryngeal Nerve ◽  
Follicular Neoplasm ◽  
Posterior Extension ◽  
Grade 3 ◽  
Recurrent Laryngeal Nerves ◽  
Anatomic Feature

The thyroid has many anatomic variations. Zuckerkandl's tubercle (ZT) is the posterior extension of lateral lobes. ZT has a relation with the recurrent laryngeal nerve (RLN). RLN lateral to ZT is an uncommon occurrence. This paper presents two cases of this uncommon situation. A 60-year-old female patient with large multinodular goiter was treated with total thyroidectomy. A 69-year-old male patient with follicular neoplasm was treated with total lobectomy. The inferior thyroid arteries and the recurrent laryngeal nerves were identified with usual lateral approach. A left ZT was found in case 1 and a right ZT in case 2. Distal parts of the RLNs were displaced laterally by enlarged ZTs in both cases. Grade 3 ZTs composed of thyroid tissue were placed between the trachea and the RLNs. The ZT is a common anatomic feature of the thyroid. Close relation of the tubercle with the RLN is an important surgical entity. The enlarged ZT seldom pushes the nerve laterally. The knowledge of the anatomy of ZT and its relation with the RLN including all variations is mandatory for safe thyroid operations.

Characteristic travelling patterns of non-recurrent laryngeal nerves

2014 ◽  
Vol 128 (6) ◽  
pp. 534-539 ◽  
Author(s):  
K H Hong ◽  
H T Park ◽  
Y S Yang
Keyword(s):  
Computed Tomography ◽  
Recurrent Laryngeal Nerve ◽  
Subclavian Artery ◽  
Vocal Fold ◽  
Laryngeal Nerve ◽  
New Classification ◽  
Laryngeal Nerves ◽  
Brachiocephalic Trunk ◽  
Recurrent Laryngeal Nerves ◽  
The Right

AbstractBackground:The non-recurrent laryngeal nerve is subject to potential injury during thyroid surgery. Intra-operative identification and preservation of this nerve can be challenging. Its presence is associated with an aberrant subclavian artery and the developmental absence of the brachiocephalic trunk. This study aimed to evaluate the incidence of non-recurrent laryngeal nerves and present a new classification system for the course of these nerves.Methods:Non-recurrent laryngeal nerves were identified on the right side in 15 patients who underwent thyroidectomy. The incidence of non-recurrent laryngeal nerves (during thyroidectomy) and aberrant subclavian arteries (using neck computed tomography) was evaluated, and the course of the nerves was classified according to their travelling patterns.Results:The overall incidence of non-recurrent laryngeal nerves was 0.68 per cent. The travelling patterns of the nerves could be classified as: descending (33 per cent), vertical (27 per cent), ascending (20 per cent) or V-shaped (20 per cent).Conclusion:Clinicians need to be aware of these variations to avoid non-recurrent laryngeal nerve damage. A retroesophageal subclavian artery (on neck computed tomography) virtually assures a non-recurrent laryngeal nerve. This information is important for preventing vocal fold paralysis. Following a review of non-recurrent laryngeal nerve travelling patterns, a new classification was devised.

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