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Data and Picture Interpretation Stations: Cases 1–45
Published in Peter Kullar, Joseph Manjaly, Livy Kenyon, Joseph Manjaly, Peter Kullar, Joseph Manjaly, Peter Kullar, ENT OSCEs, 2023
Peter Kullar, Joseph Manjaly, Livy Kenyon, Joseph Manjaly, Peter Kullar, Joseph Manjaly, Peter Kullar
Unilateral vocal cord paralysis presents with dysphonia (often breathy voice), dysphagia and shortness of breath. It can result from direct trauma to vocal cord (such as intubation) or secondary to damage to the recurrent laryngeal nerve e.g. by cancer, trauma or surgery. The recurrent laryngeal nerve arises from vagus nerve and courses from the brainstem through the neck and chest. Diagnosis is usually made with clinic based flexible nasendoscopy. A CT scan from the skull base to diaphragm covers the entire length of the recurrent laryngeal nerve and is an important investigation in establishing a diagnosis. Speech and language therapy can improve voice projection and pitch control. Voice quality can also be improved by surgical medialisation procedures including vocal cord injections, thyroplasty and in some instances laryngeal reinnervation procedures.
Answers
Published in Andrew Schofield, Paul Schofield, The Complete SAQ Study Guide, 2019
Andrew Schofield, Paul Schofield
The recurrent laryngeal nerve is a branch of the vagus nerve. On the left, it extends down into the chest and courses under the arch of the aorta before ascending to the larynx. On the right, it runs under the subclavian artery. The recurrent laryngeal nerve supplies all the muscles of the larynx apart from the cricothyroid, which is supplied by the superior laryngeal nerve. The muscles supplied by the recurrent laryngeal nerve are responsible for the movements of the vocal cords; therefore, damage to the recurrent laryngeal nerve will cause vocal cord palsy. Unilateral vocal cord palsies can often be compensated by the other side, but bilateral vocal cord palsies may lead to airway occlusion, requiring urgent tracheostomy.
Baroreflex Failure
Published in David Robertson, Italo Biaggioni, Disorders of the Autonomic Nervous System, 2019
The superior laryngeal nerve exits just below the nodose ganglion and, through its internal and external branches, provides motor innervation to the cricothyroid muscle and sensory innervation of the mucous membrane of the larynx down to the vocal cords. The recurrent laryngeal nerve is the principal motor nerve to the larynx. It leaves the right vagus at a higher level than the left vagus, because it passes around and behind the right subclavian artery, whereas it loops around the aortic arch on the left. Some branches of the recurrent laryngeal nerve pass through the inferior cardiac rami to the heart.
Clinical Efficacy of Intraoperative Ultrasound for Prophylactic Lymphadenectomy of the Lateral Cervical Neck in Stage CN0 Papillary Thyroid Cancer: A Prospective Study
Published in Journal of Investigative Surgery, 2023
Yi Shen, Xiaoen Li, Lingling Tao, Yupan Chen, Rongli Xie
During thyroid surgery, removal or injury to the parathyroid glands can affect the blood supply to the parathyroid glands, leading to hypoparathyroidism and causing hypocalcemia [27]. According to the study’s findings, both groups’ parathyroid and blood calcium levels reduced one day after surgery compared to the preoperative period, and the Surgical + lymphatic dissection group’s serum calcium test results were considerably lower than those of the surgical group, suggesting that prophylactic lymph node dissection of the LCR is a possible way to affect parathyroid function and lead to a decrease in serum calcium. However, all patients within this study recovered from postoperative hypocalcemia manifestations within six months after surgery and did not develop permanent hypoparathyroidism. Thyroid surgery is highly likely to damage the recurrent laryngeal nerve, and the greater the extent of the surgery, the higher the risk of injury [28]. The results of this study showed that the incidence of hoarseness was significantly higher in the Surgical + lymphatic dissection group than in the surgical group, but all patients recovered from postoperative hoarseness within six months after surgery, and no permanent damage to the recurrent laryngeal nerve occurred.
Anatomy and motor function of extra-laryngeal branching patterns of the recurrent laryngeal nerve; an electrophysiological study of 1001 nerves at risk
Published in Acta Chirurgica Belgica, 2023
A comprehensive anatomic and functional knowledge of the recurrent laryngeal nerve (RLN) has paramount importance in the safety of thyroid surgery. Many branches of the RLN have been established by anatomical studies under direct or microscopic observation [1,2]. Extra-laryngeal terminal branching (ETB) is a macroscopic variation that is visible along its cervical course of the RLN [3,4]. The thyroid surgeon must preserve both anatomic and functional integrity of all terminal branches if present. RLNs with terminal branches have division points along their cervical course at variable locations, creating different combinations. Therefore, in the case of bifid RLN, the location of division points should be established in order to identify and expose all neural branches. The RLN always intersects the inferior thyroid artery (ITA) along its course [5,6]. Branched RLNs are tabulated into subgroups of various types so that the crossing of the ITA and nerve branches should be identified separately [6]. Intraoperative nerve monitoring (IONM) is widely accepted method to assess the motor function of the RLN. In case of bifid nerve, electrophysiological activity of nerve branches may establish functional variations of the RLN. Thus, the importance of this study is both to expose all anatomic aspects of ETB pattern of the RLN, and to detect functional variations of nerve branches through IONM. This study aims to evaluate the variations in anatomy and electrophysiological activity of the cervical segment of the RLN in a prospective, consecutive surgery cohort.
2022 Expert consensus on the use of laser ablation for papillary thyroid microcarcinoma
Published in International Journal of Hyperthermia, 2022
Lu Zhang, Wei Zhou, Jian Qiao Zhou, Qian Shi, Teresa Rago, Giovanni Gambelunghe, Da Zhong Zou, Jun Gu, Man Lu, Fen Chen, Jie Ren, Wen Cheng, Ping Zhou, Stefano Spiezia, Enrico Papini, Wei Wei Zhan
Expert Recommendation 21: In the rare event of local severe infection, the wound should be cleaned and drained, and systemic antibiotics should be administered. Recommendation strength: strong recommendation; low quality evidence.5. Injury of the recurrent laryngeal nerve is a rare complication with an incidence of approximately 0.7% [27]. The main manifestations are an abrupt hoarseness during PLA, and coughing when drinking. The majority of symptoms are self-limiting due to recovery of ipsilateral nerve and compensation of the contralateral nerve. Minor thermal stimulation to the recurrent laryngeal nerve can also result in the above symptoms, but they may spontaneously disappear within a few hours. To prevent recurrent nerve injury, the relationship between the target area of ablation and the recurrent laryngeal nerve should be carefully evaluated before PLA, and the range of ablation should be precisely controlled. Corticosteroids may be used to reduce nerve edema immediately after PLA; neurotrophic drugs can be also used. The vast majority of patients recover within a few weeks to several months.