Anatomy of the thyroarytenoid branch of the recurrent laryngeal nerve.

OBJECTIVE: To determine the position and anatomic variability of the thyroarytenoid (TA) branch of the recurrent laryngeal nerve (RLN). METHODS: The RLN on 13 human cadaver specimens (24 sides) was dissected to the termination of the TA branch in the TA muscle. A pin was placed at the inferior aspect of the thyroid cartilage at the inferior tubercle. Using a caliper, the distance from the pin to the TA branch of the RLN was measured. The direction of the nerve and number of branches were recorded. RESULTS: The average distance to the TA branch of the RLN is 4.23 mm with a standard deviation of 2.86 mm. The median distance is 3.75 mm. Most of the specimens fell in a range of 1 to 4 mm. Overall, 54% of the nerves traveled in a horizontal direction, but vertical and oblique orientations were observed. About 20% of specimens demonstrated branching of the TA nerve. CONCLUSION: Measuring 4 mm from the inferior tubercle along a perpendicular line from the thyroid tubercle on the inferior border of the thyroid cartilage provides a good estimate of the location of the TA branch of the RLN. This information is useful when creating a posterior thyrotomy for TA neurectomy for patients with adductor spasmodic dysphonia. Knowledge of the course and possible branching of the nerve, will aid in localizing the nerve as well as ensuring adequate resection.

Prescribing guidelines for ENT medications during pregnancy.

Profound physiologic changes occur during pregnancy, and they can alter the pharmacodynamics of an administered drug. Almost 85% of women take at least one prescription medication during a pregnancy. Nearly every drug administered to a mother crosses the placenta, and fetal drug levels can reach 50 to 100% of maternal serum concentrations. Because many otolaryngologic conditions are associated with pregnancy, it is essential that otolaryngologists who care for gravid patients know which drugs are safe and avoid unnecessary prescriptions so that the best care can be delivered to the pregnant patient without harming her unborn child. In this article, we discuss the relative safety and efficacy of various types of drugs frequently prescribed for pregnant women by otolaryngologists.

Tracheal cartilaginous sleeve in Crouzon syndrome.

Tracheal cartilaginous sleeve (TCS) is a congenital malformation characterized by fusion of the tracheal arches that may be isolated to a few tracheal arches, include the entire trachea, or extend beyond the carina into the bronchi. TCS has been reported only in children with craniosynostosis. Seven cases of TCS and Crouzon syndrome (CS) are mentioned in the literature. In addition to our case study, a review of the literature on TCS in CS, a classification of TCS and treatment options will be provided. Tracheotomy and frequent airway endoscopy coupled with a keen understanding of the shifting sites of obstruction will permit longterm survival in patients with TCS and CS.