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Thyroidectomy
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
The superior pole vessels are then divided individually at the level of the thyroid capsule (Figure 63.3). This avoids injury to the superior laryngeal nerve. The gland is then rotated lateral to medial and the middle thyroid vein is divided again at the level of the thyroid capsule. Staying on the capsule of the gland, the remaining vasculature is controlled while identifying the superior and inferior parathyroid glands and the recurrent laryngeal nerves (Figure 63.4).
Cranial Neuropathies I, V, and VII–XII
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
The motor fibers of the vagus nerve arise from the nucleus ambiguus, which receives bilateral supranuclear innervation. These fibers supply all striated muscles of the larynx and pharynx, except the stylopharyngeus (supplied by CN IX) and the tensor veli palatini (supplied by V3 division of CN V).2 Three motor branches arise from the vagus nerve: the pharyngeal nerve, the superior laryngeal nerve, and the recurrent laryngeal nerve. The pharyngeal nerve travels between the internal and external carotid arteries, forms the pharyngeal plexus with the glossopharyngeal nerve, and innervates muscles of the pharynx and palate. The superior laryngeal nerve takes off distal to the pharyngeal branch and descends lateral to the pharynx. The external branch of the superior laryngeal nerve supplies the cricothyroid muscle. The third motor branch arising from the vagus nerve is the recurrent laryngeal nerve. The right and left recurrent laryngeal nerves follow different courses: the right recurrent laryngeal nerve descends anterior to the right subclavian artery and turns posteriorly under the artery to ascend in the tracheoesophageal sulcus, whereas the nerve on the left turns posteriorly around the aortic arch and ascends in the same sulcus on the left. Both recurrent branches then enter the larynx and supply all intrinsic muscles of the larynx except the cricothyroid muscle (supplied by the external branch of the superior laryngeal nerve).
Thyroid surgery
Published in Pallavi Iyer, Herbert Chen, Thyroid and Parathyroid Disorders in Children, 2020
Jessica Fazendin, Brenessa Lindeman
As described in the “Surgical technique” section, extreme care is taken to preserve the nerves within the neck during thyroid surgery. If the superior laryngeal nerve is injured, patients can experience alterations in voice pitch and occasional difficulties swallowing. If the RLN is injured on one side, patients will typically exhibit a hoarse or whisper-like voice that recovers in weeks to months in most cases. If both RLNs are injured, the patient could experience both vocal cords frozen in apposition to one another, creating an airway emergency necessitating temporary tracheostomy. In a recent high-volume, pediatric single-institution study, incidence of temporary hoarseness and permanent hoarseness was 1.9% and 0.4% respectively. Temporary hypocalcemia, reported as high as 7.9%, can also be experienced if there is stunning to the parathyroids during removal of the thyroid, with a small percentage of individuals experiencing permanent hypocalcemia. This can happen more frequently in younger patients, those with hyperthyroidism, and more extensive dissection as in lymphadenectomy procedures. In a minority of patients (1.3%), return to the operating room for hematoma evacuation is required (4). Thankfully, these complications have a very low incidence, and pediatric thyroid surgery has been shown to have excellent outcomes in the absence of long-term negative sequelae in the hands of an experienced, high-volume surgeon (5,6).
Chronic cough: Investigations, management, current and future treatments
Published in Canadian Journal of Respiratory, Critical Care, and Sleep Medicine, 2021
I. Satia, M. Wahab, E. Kum, H. Kim, P. Lin, A. Kaplan, P. Hernandez, J. Bourbeau, L. P. Boulet, S. K. Field
A recent meta-analysis identified 4 studies which were all retrospective chart reviews and included a total of 73 patients.91 Experimental intervention included superior laryngeal nerve (SLN) block via injection of local anesthetic (lidocaine or bupivacaine) and corticosteroid (triamcinolone acetonide or methylprednisolone), bilateral thyroarytenoid BTX injection, and vocal fold augmentation with methylcellulose or hyaluronic acid. Overall, the studies demonstrate high risk of bias, lack of controls, and weaknesses with imprecision and indirectness as the cough severity index (CSI) was used which was designed specifically for upper airway symptoms only or unvalidated subjective tools. Two studies of SLN block demonstrated improvements in the CSI of −12.20 and −16.30.92,93 Electromyography (EMG)-guided thyroarytenoid (TA) Botulinum Toxin A injection demonstrated a self-reported improvement in cough of 50% or more in half after the first injection.94 Vocal fold augmentation injection with hyaluronic acid in patients with chronic cough and glottic insufficiency demonstrated an improvement in CSI of −6.4 after 1 month.95
Surgical Outcomes and Efficacy of Isthmusectomy in Single Isthmic Papillary Thyroid Carcinoma: A Preliminary Retrospective Study
Published in Journal of Investigative Surgery, 2021
Hee Won Seo, Chang Myeon Song, Yong Bae Ji, Jin Hyeok Jeong, Hye Ryoung Koo, Kyung Tae
There have been many discussions about whether total thyroidectomy, lobectomy or isthmusectomy are effective treatments in patients with single isthmic PTC. The benefits of total thyroidectomy are that it can treat multiple tumors that have not been found before surgery, RAI ablation can be used for diagnosis and treatment after surgery, and thyroglobulin can be used as a recurrence index for follow-up. However, injuries to the recurrent laryngeal nerve, superior laryngeal nerve, and parathyroid gland as well as the incidence of complications are known to be more likely than in other surgical methods.11,12 In contrast, in cases of thyroid isthmusectomy, the incidence of hypothyroidism is less likely as normal thyroid tissue is preserved, and there is less possibility of nerves and parathyroid injury than total thyroidectomy. However, there is a possibility of recurrence due to the remaining occult carcinoma at the bilateral thyroid lobes.
A spontaneous partially thrombosed ductal aneurysm presenting with left recurrent laryngeal nerve palsy
Published in Acta Oto-Laryngologica Case Reports, 2020
Abhilasha Goswami, Anandita Das
Vocal cord paralysis – definition and anatomy: The vocal cords, more often called the vocal folds due to its resemblance to folds of tissue, are located in a subsite of the larynx called the glottis. The glottis comprises of the true vocal cords, the anterior commissure, and the posterior commissure. Histologically, the vocal cords are composed of five layers. From superficial to deep, these layers are – 1) stratified squamous non-keratinizing epithelium, 2) superficial layer of the lamina propria (Rienke’s space), 3) intermediate layer of lamina propria, 4) deep layer of lamina propria, and 5) vocalis muscle. The movement of the vocal cords is controlled by the intrinsic muscles of the larynx. The recurrent laryngeal nerve supplies all the intrinsic muscles of the larynx, except the cricothyroid, which is supplied by the internal division of the superior laryngeal nerve. Vocal cord paralysis is an inability to move the muscles of the vocal cords. It may be unilateral or bilateral. Paralysis of one vocal cord (unilateral vocal cord paralysis) can impair voice and sometimes swallowing. Paralysis of both vocal cords (bilateral vocal cord paralysis) can compromise the airway and breathing.