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Resumen: Introducción: La tos es una respuesta fisiológica de protección de la vía aérea, produce aerosoles que se identifican por imagen y alcanza una velocidad de hasta ocho metros por segundo. La extubación produce tos, hipertensión, taquicardia, apnea y laringoespasmo, existen métodos para minimizar su aparición. Debido a la pandemia de COVID-19 se han utilizado como profilaxis del reflejo tusígeno, la lidocaína intravenosa y el bloqueo del nervio laríngeo superior. El objetivo fue compararlos en la inhibición de la tos. Material y métodos: Se seleccionaron pacientes entre 18-60 años, cirugía electiva con anestesia general balanceada, ASA 1-3, con intubación menor a tres horas. Se aleatorizó un total de 90 pacientes, 45 en cada grupo, se eliminó un total de 10 pacientes por presentar inestabilidad hemodinámica al final de la cirugía o por no administrar dosis intravenosa de lidocaína en el tiempo establecido. Resultados: No hubo diferencia estadísticamente significativa en el número de pacientes que presentaron tos en ambos grupos (13 vs 10, p = 0.4684), de éstos se obtuvo una diferencia estadísticamente significativa en el número de decibeles a favor del grupo de bloqueo (75.6 vs 67, p < 0.001). Conclusiones: El bloqueo (selectivo) presenta menos aerolización que la lidocaína intravenosa en la extubación.
Abstract: Introduction: Coughing is a physiological response to protect the airway, it produces aerosols that are identified by imaging reaching a speed of up to 8 meters per second. Extubation produces cough, hypertension, tachycardia, apnea and laryngospasm, there are methods to minimize its occurrence. Due to the COVID-19 pandemic, intravenous lidocaine and superior laryngeal nerve block have been used as cough reflex prophylaxis. The aim was to compare them in cough inhibition. Material and methods: Patients aged 18-60 years, elective surgery with balanced general anesthesia, ASA 1-3, with intubation less than 3 hours, were selected. A total of 90 patients were randomized, 45 in each group. A total of 10 patients were eliminated because they presented hemodynamic instability at the end of surgery, and because the intravenous dose of lidocaine was not administered within the established time. Results: There was no statistically significant difference in the number of patients who presented cough in both groups (13 vs 10, p = 0.4684), of these there was a statistically significant difference in the number of decibels in favor of the block group (75.6 vs 67, p < 0.001). Conclusions: Block presents less aerolization than intravenous lidocaine in extubation.
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Objective To investigate the effect of ultrasound-guided bilateral superior laryngeal nerve internal branch block combined with endotracheal surface anesthesia in patients with hypertensive cerebral hemorrhage for the duration of postoperative tube insertion.Methods A total of 100 emergency hypertensive intracerebral hemor-rhage surgical patients who visited our hospital from October 2021 to April 2023 were included as the research subjects.They were randomly divided into four groups,25 patients in each group.After surgery,group U received bilateral superior laryngeal nerve internal branch block under guidance of ultrasound combined with endotracheal surface anesthesia,group C1 received bilateral superior laryngeal nerve internal branch block under guidance of ultrasound,group C2 received endotracheal surface anesthesia,and group C3 did not undergo any procedure after surgery.Hemodynamic changes(HR,MAP,and SpO2)at different time points during the postoperative tube insertion in four groups of patients were recorded.The frequency of restlessness within 10 hours after surgery,the dosage of dexmedetomidine and urapidil,the volume of wound drainage,and the satisfaction of bed nurses were also recorded.Results There was no statistically significant difference in general conditions among the four groups(P>0.05).There was no statistically significant difference in HR and MAP at different time points in Group U(P>0.05),while the differences among the other three groups were statistically significant(P<0.05).At the same time point,the MAP and HR of group U and C1 were significantly lower than those of group C3(P<0.05),and the MAP of group U was significantly lower than that of group C2(P<0.05).There was no statistical difference in SPO2 among the four groups of patients at the same time point(P>0.05);The frequency of restlessness,dosage of dexmedetomidine and urapidil,and volume of wound drainage in the U and C1 groups were significantly lower than those in the C2 and C3 groups(P<0.05).Except for the difference in restlessness frequency(P<0.05),there was no statistical difference in other indicators between group U and C1;There was a statistical difference in satisfaction among the four groups of nurses(P<0.05,C3>C2>C1>U group).No nerve block related complications were observed in the U and C1 group.Conclusion Ultrasound-guided bilateral superior laryngeal nerve branch block combined with endotracheal surface anesthesia can maintain hemodynamics steadily of the postoperative patients in the NICU to varying degrees and reduce the frequency of postoperative restlessness,the dosage of sedative and anti-hypertensive drugs,while reducing the flow of wound drainage,and improve the satisfaction of bed nurses.
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ABSTRACT:Background: Endotracheal intubation is gold standard of general anesthesia. various oral,Maxillofacial, Dental surgeries are carried out in high-risk patients having chances ofdifficult intubation. If we give sedation or general anesthesia, we can be trapped in criticalairway accidents.Aims & objectives: To access & compare efficacy of anatomical landmark guided/Ultrasound guided superior laryngeal nerve block associated with topical Anesthesia &transtracheal block for awake blind nasal intubation.Method:Group A: Anatomical landmark guided superior laryngeal nerve block given(n=30)Group B: ultrasound guided superior laryngeal nerve block(n=30)In both groups topical Anesthesia & transtracheal block for awake blind nasal intubation wasgiven.Results: upper airway block provide clinical ease to facilitate blind nasal awake intubation.ultrasound guided block has less adverse reactions.Conclusion: Both methods provide good quality of Endotracheal intubation, but ultrasoundguided block is more efficient & scientific method to block superior laryngeal nerve forawake nasal intubation.
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Awake fiberoptic assisted nasal intubation is the gold standard for securing airway in cases of oral malignancy posted for radical surgeries. Different techniques such as airway blocks, LA gargles, spray, nebulization along with light sedation are in practice. We wanted to evaluate the efficacy of airway blocks over airway spray for intubation conditions, time taken to intubation, patient comfort and complications. METHODSThis randomized, interventional and crossover study was conducted at Chirayu Medical College and Hospital. A total of 60 patients of ASA grade I-II with Mallampati score 3 & 4 undergoing wide local excision and neck dissection were selected after fulfilling of the selection criterion and were divided into two groups, Airway Block (AB, n-30) and Airway Spray group (AS, n-30). AB group received bilateral superior and transtracheal recurrent laryngeal nerve blocks and group AS local anaesthetic spray through the working channel of the fiberoptic scope. Haemodynamics, time taken for intubation, intubating conditions, patients’ comfort, and complications if any were noted. All data was tabulated and analysed using software SPSS 17.0. RESULTSMean total time taken for intubation in seconds was less. Intubating conditions were optimal in 90 % cases. 5-point comfort during and 3-point score immediately after intubation were excellent in AB compared AS group. Haemodynamically both the groups were comparable. CONCLUSIONSCombined block of the superior and recurrent laryngeal nerves provides optimal conditions to facilitate a successful fibreoptic assisted awake nasotracheal intubation in anticipated difficult airway
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En las cirugías sobre la glándula tiroides se ha prestado mucha atención al manejo del nervio laríngeo inferior y de las glándulas paratiroides, no así del ramo lateral del nervio laríngeo superior, el cual es satélite del pedículo vascular superior de la glándula tiroides. El manejo del polo superior de la glándula tiroides requiere de un conocimiento acabado de su anatomía topográfica del área y está determinada por sus relaciones más importantes, dadas por el citado nervio y la arteria tiroidea superior principalmente. En este trabajo se pretende estudiar estas relaciones en base a la disección meticulosa del triángulo laringo-esternotiroideo ("Triángulo de Joll") de 25 cadáveres adultos formolizados. Como hallazgo relevante se informa que los "nervios en riesgo", según la clasificación de Cernea, que se basa en una distancia menor a un centímetro en el entrecruzamiento del nervio con la arteria tiroidea superior con respecto al polo superior de la glándula tiroides, es del 52 % para el lado derecho y 44 % para el lado izquierdo del cuello. El origen bajo de la arteria a nivel de la bifurcación carotídea se presenta asociada a un mayor número de "nervios en riesgo" en el lado izquierdo. Según el punto de penetración del ramo lateral del nervio laríngeo superior en el músculo constrictor inferior de la faringe se establece la clasificación de Friedman, muy útil sobre todo en cirugías ayudadas por la neuroestimulación. En esta clasifiacción los "nervios en riesgo" son aquellos que transcurrren superficial al músculo, mientras que los "nervios protegidos" serían aquellos que perforan el músculo en su porción superior. En este trabajo los "nervios en riesgo" se presentaron del lado izquierdo en el 56 % de los casos y del derecho en el 60 %, mientras que los "nervios protegidos" en el 24 % y 16 %, respectivamente.
In surgeries on the thyroid gland, much attention has been given to the management of the inferior laryngeal nerve and parathyroid glands, but not the external branch of the given by the aforementioned nerve and the superior thyroid artery. This paper intends to study these relationships based on the meticulous dissection of the larynx-sternothyroid triangle ("Joll triangle") of 25 formolized adult corpses. As a relevant finding, it is reported that the " nerves at risk" according to the Cernea classification, which is based on the distance less than one centimeter at the intersection of the nerve with the superior thyroid artery with respect to the upper pole of the gland, is 52 % for the right side and 44 % for the left side of the neck. The low origin of the artery at the level of the carotid bifurcation is associated with a greater number of "nerves at risk" on the left side. According to the penetration point of the external branch of the superior laryngeal nerve in the inferior pharyngeal constrictor muscle, the Friedman classification is established, very useful especially in surgeries aided by neurostimulation. In this classification the "nerves at risk" are those that run superficially to the muscle, while the protected nerves would be those that pierce the muscle in its upper part. In tis work, the "nerves at risk" presented on the left side in 56 % of the cases and the right side in 60 %, while those "protected" in 24 % and 16 % respectively.
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Humains , Mâle , Femelle , Glande thyroide/vascularisation , Nerfs laryngés/anatomie et histologie , Artères , Cadavre , Études transversalesRésumé
Objective To explore the value of monitoring techniques of the external branch of superior laryngeal nerve (EBSLN) in thyroid surgery and to study its protective effects on vocal function after thyroid surgery.Methods We retrospectively analyzed the clinical data of 139 patients who underwent primary surgery of papillary thyroid cancer with neurological monitoring from Jun.2017 to Mar.2018 in the General Surgery Department of PLA General Hospital.The tumors of 31 cases were located in the upper pole of the gland and elsewhere in 108 cases.The patients' vocal function was assessed at one week and one month after surgery.The rate of EBSLN identified visually and by the intraoperative nerve monitoring (IONM) were counted.EBSLN recognition efficiency and prevalence of EBSLN damage during the operation of tumor in upper pole of thyroid and in other location were compared.Results In the 139 patients,there were 218 upper poles(218 EBSLN) treated intraoperatively,of which 145 were recognized visually (126(57.8％) confirmed by IONM,and 203(93.1％) were identified by IONM,OR=8.27(x2=59.345,P=0.00).The percentage of EBLSN located in the upper pole accurately identified by the naked eye was 20/46(43.5％) while by IONM was 43/46(93.4％).The percentage of EBSLN at the other position accurately identified visually was 106/172(61.6％),and by IONM was 160/172(93.0％).The number of visually identified cases in different locations showed significantly differences according to the chi-square test (x2=4.901,P=0.027),and no significant difference by IONM identification according to chi-square test (x2=0.012,P=0.914).Five patients had a low voice at one week postoperatively and low voice and vocalization change were not observed after one month.Conclusions IONM can effectively increase the proportion of intraoperative EBSLN identification to ensure the safety of surgery.The difficulty of visual identification of EBSLN during the surgery of tumor in upper pole is greater than that in other locations.IONM can provide more evidences for nerve protection and reduce the risk of injury.
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Vagal paragangliomas (VPGLs) represent 70% of humans, providing motor fibers to the larynx. The patient recovered uneventfully and was discharged on the 3rd postoperative day. These tumors are therapeutically challenging owing to their proximity to vital neck and skull base structures. Early detection decreases surgical morbidity and mortality. Preservation of viable neural tissue is important in advanced disease.
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Humains , Adulte d'âge moyen , Artère carotide externe , Tête , Nerfs laryngés , Larynx , Mortalité , Cou , Paragangliome , Base du crâne , Nerf vagueRésumé
OBJECTIVE: To explore the feasibility of different operative approaches for the treatment of upper thyroid gland. METHODS: The clinical data of 87 patients underwent lobectomy in Department of Oncological Surgery, the First Affiliated Hospital of Bengbu Medical College from January 2016 to December 2018 were analyzed retrospectively.Preoperative ultrasound was used to evaluate the location of the tumor in the upper thyroid gland or thyroid gland hypertrophy.According to the operative approach,87 cases were divided into two groups including 42 cases of the cricothyroid approach and 45 cases of viacervical strap muscles approach. The intraoperative exposure of superior laryngeal nerve and postoperative complications of superior laryngeal nerve function and parathyroid gland were compared. RESULTS: Compared with the superior laryngeal nerve finding rate(83.3%)in the cricothyroid approach,the superior laryngeal nerve finding rate was higher(95.6%)(P0.05). CONCLUSION: The viacervical strap muscles approach compares the cricothyroid approach to the laryngeal nerve with a high rate of finding and a short searching time. Applying viacervical strap muscles approach in the case of an upper thyroid tumor and glandular hypertrophy helps to expose the upper pole and protect the external nerve branch of the larynx.
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Objective To discuss the microsurgical anatomy of carotid bifurcation and external branch of the superior laryngeal nerve (EBSLN),and to explore the operative techniques in carotid endarterectomy.Methods The carotid bifurcation (20 sides) of 10 cadaveric heads was studied by using microanatomy from January 2017 to January 2018.The distance between bifurcation of carotid artery to peripheral bone structure,and the distances between point of EBSLN to medial margin of the carotid artery to mandibular angle,most prominent point of the larynx,apex of the mastoid,and bifurcation of carotid artery were measured.Results (1) The vertical distance from carotid bifurcation to larynx point and mandibular angle was 24.32 (18.8-35.78) mm and 13.55 (9.26-19.60) mm.The straight distance from carotid bifurcation to mastoid tip was 68.59 (49.48-76.94) ram.According to the vertical distance of larynx point to carotid bifurcation,the height of bifurcation of the carotid artery was consistent with the results of wain measurement (K=0.90),and the difference was statistically significant (P＜0.05).(2) The distances between the point of EBSLN to medial margin of the carotid artery to carotid artery bifurcation,upper thyroid artery bifurcation,mandibular angle and mastoid process were 17.81 (15.24-25.58) mm,19.42 (17.08-29.12) mm,20.51 (17.98-22.20) mm,71.00 (69.00-74.50) mm in normal bifurcations.Those in the high bifurcation specimens were 6.40 (2.44-9.20) mm,8.84(4.74-10.88) mm,12.15(10.64-13.54),60.90 (59.80-66.50) mm,respectively.Conclusions The position of the laryngeal prominence is fixed,which can be used as a marker for surgical incision.When the vertical distance from the larynx point to the bifurcation of the carotid artery is greater than or equal to 2.5 cm,it is highly bifurcated;the bifurcation is normal when less than 2.5 cm.In patients with normal carotid bifurcation,1.5 cm of the carotid artery bifurcation can be used as a safety mark limit during the operation.For patients with high carotid artery,the EBSLN is almost parallel to or down the superior thyroid artery,and it should be closely attached to the bifurcation of the carotid artery and the outer membrane of the superior thyroid artery,and there is no safety margin.
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Objective To investigate the effect of ultrasonograpy (US )-guided bilateral superior laryngeal nerve (SLN)block by different concentrations of lidocaine combined with intrave-nous anesthesia for polypectomy of vocal cord by laryngoscope.Methods Sixty patients,aged 18-65 years, ASA physical status Ⅰ or Ⅱ, scheduled for elective polypectomy of vocal cord by laryngoscope were divided into 3 groups (n=20 each)using a random number table:US-guided bilat-eral SLN block by 2% lidocaine (group A),S-guided bilateral SLN block by 1% lidocaine (group B), and traditional SLN block by 2% lidocaine (group C).HR,MAP,SpO2and plasma concentration of NE were detected at the time of patients entering the operating room (T0),immediately after intuba-tion(T1),suspensing laryngoscopy (T2),5 min after suspensing laryngoscopy (T3),immediately af-ter extubation(T4),5 min after extubation(T5).Extubation time and side effects such as dysphagia and dyspnea in two hours after extubation were recorded as well.Results HR and MAP in the three groups at T1-T5were increased compared to T0(P<0.05).Compared with group C,HR and MAP in groups A and B were decreased at T1-T5(P<0.05).Plasma concentration of NE of groups A and B was more significantly decreased than group C (P<0.05),and extubation time of groups A and B was less than that of group C (P <0.05 ).Conclusion US-guided bilateral SLN block by 1% lidocaine has definite effect and better comfort level,with stable haemodynamics and less extubation time.
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Objective To investigate the application of intraoperative neuromonitoring (IONM) during thyroidectomy for external branch of superior laryngeal nerve(EBSLN).Methods From Jan.2017 to Jun.2017,138 patients undergoing thyroidectomy were randomly divided into monitor group (n=69) and the control group (n=69).The monitor group were used IONM for EBSLN,while the control group were used conventional area protection.Results The overall incidence of EBSLN injury was 1.4％(1/69) in the monitor group,and the overall incidence of EBSLN injury was 11.6％(8/69) in the control group.There was statistical significance between the two groups.Conclusion The application of IONM in thyroidectomy can exactly identify EBSLN,and reduce the possibility of EBSLN injury remarkably.
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Laryngeal nerves injury,including recurrent laryngeal nerve (RLN) and superior laryngeal nerve,is one of the most terrible complications of thyroid surgery.External branch of superior laryngeal nerve (EBSLN) is adjacent to the upper pole of thyroid gland,which make it vulnerable to be injured during the ligation of the superior thyroid vessels.As a result,patients would have phonating dysfunction,especially the changes in the voice quality alongside the alterations in the high pitched sound production ability.Intraoperative neural monitoring technique applying neural electrophysiology method to detect and protect the nerve and assess its function during the operation decreases the occurrence of EBSLN injury and improves the living quality.This article is going to make a review of the progress of the application.
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Objective To investigate the feasibility and advantages of the treatment of the unilateral thyroid through small incision approach under the ill side necklace. Methods A retrospective analysis was performed on the clinical data of seventy?five patients with unilateral benign thyroid tumor from January 2015 to October 2017 treated in People's Hospital of Jishan with the small incision approach under the ill side necklace. The exposure of recurrent laryngeal nerve and superior laryngeal nerve and related complications after operation were statistically analyzed. Results The exposure rate of recurrent laryngeal nerve was 86. 7％ ( 65/75),and the exposure rate of the superior laryngeal nerve was 69. 3％ (52/75). All the patients had no incision bleeding,laryngeal edema,aspiration or permanent hoarseness and other complications. Conclusion Unilateral thyroidectomy is a safe and feasible treatment with small incision,small injury and easy operation.
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Recurrent laryngeal nerve injury during thyroid surgery has captured the attention of all thyroid surgeons,but protection of the external branch of the superior laryngeal nerve(EBSLN)is often ignored.Injury to the EBSLN can cause hoarseness,sound fatigue, decreased frequency range,and other symptoms.Many difficulties exist in identifying the EBSLN;therefore,most surgeons are unable to perform routine exposure and protection of the EBSLN during operation for thyroid cancer.Intraoperative neurological monitoring has the potential to identify EBSLN and evaluate its functional integrity.Revealing EBSLN routinely,along with neurological monitoring during thyroid surgery can significantly reduce the incidence of postoperative neurological injury and improve operation safety.
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Objective To observe the effects of ultrasound-guided laryngeal nerve block combined with intratracheal surface anesthesia on the intubation reaction of double-lumen endotracheal tube in elderly hypertensive patients.Methods Sixty elderly hypertensive patients,including 37 males and 23 females, with ASA physical statusⅡor Ⅲ,aged 65-85 years,scheduled for thoracic surgery under general anesthesia requiring one-lung ventilation,were equally and randomly divided into either laryngeal nerve block combined with intratracheal surface anesthesia group (group S)or general anesthesia group (group C).Internal jugular vein blood samples were taken to measure the plasma concentrations of epinephrine (E)and norepinephrine (NE) when patients entering the operating room (T0 ),before intubation (T1 ),immediately after intubation (T2 ),at 1 min (T3 ),3 min (T4 ),5 min (T5 )and 10 min (T6 )after intubation.Adverse e-vents,such us hypertension and tachycardia,were recorded during induction and intubation.Results Com-pared with T0 ,the plasma concentrations of E and NE were significantly increased at T2-T5 in group C (P<0.05 or P <0.01),while there were no such significant changes in group S.The plasma concentration of E and NE at T2-T5 in group S were significantly lower than that in group C (P <0.05 or P <0.01).The incidence of hypertension in group S was significantly lower than that in group C during induction of intuba-tion (0% vs 37%,P <0.01).There were no hypotension,tachycardia and bradycardia during induction and intubation in both groups.Conclusion Ultrasound-guided laryngeal nerve block combined with intratra-cheal surface anesthesia can effectively inhibit the intubation reaction of double-lumen endotracheal tube in elderly hypertensive patients,which is helpful for maintaining the hemodynamic stability during anesthesia induction.
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Objective To observe the efficacy of the ultrasound-guided superior laryngeal nerve block for awake orotracheal fiberoptic intubation.Methods Forty patients with limited cervical activity scheduled for elective surgery under general anesthesia,23 males and 17 females,aged 18-65 years,ASA physical status Ⅰ or Ⅱ were chosen.According to random number table method,they were randomly divided into two groups (n =20).Group N received superior laryngeal nerve block u-sing the acupoint-located method by anatomical landmark,and group D was under ultrasound-guided, combined with airway anesthesia.Awake orotracheal fiberoptic intubation was then performed.Intu-bation time and the changes of MAP,HR,Ramsay sedation score were recorded at the time of bur-glary (T0 ),before the endotracheal tube into the mouth (T1 ),endotracheal tube into the glottis im-mediately (T2 ),5 min after intubation (T3 ).Ramsay score was rated to assess the patients'comfort and tolerance,complications during intubation process were documented,the patient's satisfaction was received.Results Compared with the group N,the intubation time of group D was significantly shorter [(0.5±0.1)min vs (1.0±0.2)min,P <0.05].In group N,MAP and HR were obviously higher during intubation with lower Ramsay sedation score at T2 compared with group D (P <0.05). Patients in group D had lower comfort score and tolerance grade during intubation (P <0.05).The incidence of nausea,vomiting,restlessness and pharyngalgia were significantly lower in group D (P< 0.05 ).Besides, patients during intubation in group D were more satisfactory (P < 0.05 ). Conclusion Ultrasound-guided superior laryngeal nerve block for awake orotracheal fiberoptic intuba-tion could provide an ideal sedative effect,maintain stable circulation and keep patients tolerable.
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Objectives To investigate the methods of protecting external branch of the superior laryngeal nerve (EBSLN)in carotid endarterectomy and to observe the effect of using these methods in clinical surgery. Methods EBSLN (20 sides)of 10 heads of corpse were studied by using microanatomy from January 2013 to December 2013. The occurrence probability of EBSLN on the lower edge of posterior belly of digastric muscle,medial edge of external carotid artery and upper edge of superior thyroid artery in anatomy triangle was analyzed. The distances from the midpoint of the EBSLN to carotid bifurcation, mandibular angle and mastoid tip were measured. Sixty-five patients with carotid endarterectomy in Tianjin Huanhu Hospital from December 2013 to November 2014 were treated with the protective methods of the relevant EBSLN by using anatomy triangle as a mark. Whether the patients had injury symptoms of EBSLN were followed up after procedure. Results (1)The occurrence probability of 20-side EBSLN in anatomy triangle was 95%(19 sides). The midpoint of EBSLN in the anatomy triangle at the posterior mandibular angle was median 0. 34 (-1. 62 to 2. 43)cm,at the inferior mandibular angle was 1. 28 (-1. 33 to 3. 42) cm,at anterior mastoid tip was 2. 84 (0. 51 to 5. 14)cm,at inferior was 4. 51 (2. 82 to 6. 39)cm,and at anterior superior of the carotid bifurcation was 1. 64 (0. 57 to 3. 78)cm. (2)65 patients who underwent carotid endarterectomy used the protective methods of intraoperative EBSLN. There was no manifestation of EBSLN injury at 3 weeks to 9 months after procedure. Conclusion In carotid endarterectomy,taking an anatomic triangle as a symbol,it is no more than 2 cm of the anterior superior of carotid bifurcation during the separation process. As for the patients with higher or lower position of carotid bifurcation,in the range of crossing rear mandibular angle 0. 50 cm or below the mastoid tip 4. 50 cm for arterial separation should be avoided,and this can effectively protect EBSLN.
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After thyroid surgery, voice change occurs very frequently, in more than 30% of cases. In addition to injury to the recurrent laryngeal nerve (RLN) or the external branch of superior laryngeal nerve (EBSLN), vocal fold edema due to excessive tracheal traction or disrupted laryngeal venous drainage, and laryngotracheal fixation following injury to extralaryngeal musculature can cause post-thyroidectomy voice change. Although complete recovery can be expected mostly in 3 months, dysphonic patients should be evaluated pre and postoperatively by laryngoscopy or laryngeal stroboscopy. The present review discusses the evaluation of voice change, the anatomy of RLN and EBSLN and common cause of voice change after thyroid surgery. Furthermore, we represent how to preserve RLN, SLN including intraoperative nerve monitoring.
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Humains , Drainage , Oedème , Nerfs laryngés , Laryngoscopie , Nerf laryngé récurrent , Stroboscopie , Glande thyroide , Thyroïdectomie , Traction , Plis vocaux , VoixRésumé
Objective To discuss the methods of the prevention of the superior laryngeal nerveinjury at endoscopic thyroidectomy through subclaviclar approach.Methods The clinical data of 100 patients with thyroid diseases received endoscopic thyroidectomy through subclavicular approach were analyzed retrospectively.Nodular goiter in 69 cases,adenoma in 18 cases,simple goiter in 13 cases.Line side lobe resection in 35 cases,the side lobe subtotal in 8 cases,the side lobe resection + subtotal contralateral lobe in 48 cases,bilateral subtotal gland in 9 cases.Results All 100 patients after surgery pronounced normal,no tone deep,choking water,etc,patients 7-30 d laryngoscope review found no abnormalities.Conclusion Thyroidectomy through subclavicular approach under endoscope is calleidic thyroidectomy,effectively avoid permanent superior laryngeal nerve injury.
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ObjectiveTo evaluate the intraoperative neuromonitoring of the external branch of the superior laryngeal nerve (EBSLN) during Micooli's endoscopic thyroidectomy in order to avoid nerve injury.MethodsIn this study,36 patients with 56 nerves at risk were enrolled from February 2011 to September 2011.A positive signal is determined by observing contractions of the cricothyroid muscle to locate the EBSLN.The relationship between EBSLN and the upper pole of the thyroid or the inferior constrictor muscle was studied.The VHI-10 table was used for evaluation pre- and postoperatively. ResultsAll 56 nerves were located successfully,26 nerves(46.4％ ) crossed the superior thyroid artery more than 1 cm apart from the upper pole of the thyroid gland,while the other 30 nerves(53.6％ ) did less than 1 cm.In cases where the diameter was longer than 5 cm,the nerves crossed the artery at less than 1.0 cm from the upper pole in 73％ cases(P =0.006).There was no significant difference between VHI-10 results before and after surgery (P ＞ 0.05). ConclusionsIntraoperative neuromonitoring is useful and helpful in avoiding nerve injury by locating EBSLN.