Intraoperative Study of 1988 Recurrent Laryngeal Nerves / 昆明医科大学学报

Objective To study the anatomical relationship between the recurrent laryngeal nerve(RLN)and the inferior thyroid artery,to investigate the prophylactic measures on how to avoid iatrogenic injures while exposing the RLN during thyroid operation.Methods Retrospectively reviewed the clinical data of 1 345 patients accepted thyroid operation with RLN exposing.Results A total of RLN 1 988 were observed,874 on the left and 1 114 on the right(including 2 non-recurrent laryngeal nerve).On the left side,the nerve passed anterior to the artery in 32.8%,posterior to it in 26.7%,and between the branches of the artery in 41.6%.On the left side,the nerve was found coursing anterior to the artery in 36.2%,posterior to it in 28.2%,and between the branches in 35.3%.6 nerves were iatrogenic injured,4 cases were temporary injured and 2 were permanent.Conclusions Although the anatomical relationship between the RLN and the inferior thyroid artery are variable,iatrogenic injures of the nerve can be avoid by exposing it,and an experienced surgeon with good knowledge of RLN anatomical characteristics and skilled surgical techniques was needed.

Respiratory Difficulty at a Postanesthesia Care Unit after Total Thyroidectomy: A case report / 대한마취과학회지

We had a case of respiratory difficulty following total thyroidectomy due to bilateral vocal cord palsy. The patient was a 49-year-old female undergoing total thyroidectomy for papillary carcinoma of the thyroid. Anesthesia was performed uneventfully. Spontaneous respiration resumed after reversal of the neuromuscular blockade. However, after arriving at the postanesthesia care unit, she developed hypertension, anxiety, tachypnea, and inspiratory stridor during deep inspiration. Because the patient maintained adequate oxygen saturation, we confirmed bilateral vocal cord palsy by fiberoptic laryngoscopy. During the operation, the surgeon experienced difficulty dissecting the bilateral recurrent laryngeal nerves from the surrounded tumor. So we consider that direct nerve injury was responsible for the bilateral vocal cord palsy. Movement of the right vocal cord recovered a week later.

Respiratory Difficulty at a Postanesthesia Care Unit after Total Thyroidectomy: A case report / 대한마취과학회지

We had a case of respiratory difficulty following total thyroidectomy due to bilateral vocal cord palsy. The patient was a 49-year-old female undergoing total thyroidectomy for papillary carcinoma of the thyroid. Anesthesia was performed uneventfully. Spontaneous respiration resumed after reversal of the neuromuscular blockade. However, after arriving at the postanesthesia care unit, she developed hypertension, anxiety, tachypnea, and inspiratory stridor during deep inspiration. Because the patient maintained adequate oxygen saturation, we confirmed bilateral vocal cord palsy by fiberoptic laryngoscopy. During the operation, the surgeon experienced difficulty dissecting the bilateral recurrent laryngeal nerves from the surrounded tumor. So we consider that direct nerve injury was responsible for the bilateral vocal cord palsy. Movement of the right vocal cord recovered a week later.

Comparative analysis of early and mid-stage nerve decompression and nerve anastomosis for traumatic recurrent laryngeal nerve injuries / 中华创伤杂志

Objectives To explore therapeutic effect,indication and timing of nerve decompression for traumatic recurrent laryngeal nerve injury inducing vocal cord paralysis. Methods A total of 42 patients with recurrent laryngeal nerve injury inducing vocal cord paralysis within six months, were divided into nerve decompression group (15 cases), end to end anastomosis of recurrent laryngeal nerve group (six cases) and nonsurgical treatment (21 cases). Nerve decompression was performed in the patients who were operatively found to have compressing sutures or compression due to cicatricial hypertrophy. Results In 13 patients with a course less than four months, nerve decompression restored normal functional adductory and abductory motion of the vocal cord in 11 patients and motionless in two. Although functional motion of vocal cord was not seen in two patients with a course less than four months and two longer than four months, the mass and tension of the reinnervated vocal cord became much the same as the contralateral normal vocal cord, thus resuming symmetric vibration of the vocal cords and physiological phonation. End-to-end anastomosis of recurrent laryngeal nerve failed to restore motion of the glottis. Nevertheless, the procedures enabled adductory muscles to be reinnervated and then restored normal voice. Although nonsurgical treatment improved severe hoarseness, the vocal cord didn't restore normal functional motion of the vocal cord and normal voice. Conclusions Early and mid-stage recurrent laryngeal nerve decompression may restore normal motion of the vocal cord. End-to-end anastomosis of recurrent laryngeal nerve enables adductory muscles to be reinnervated and thus restores normal voice.