Extrapleural pneumonectomy
Larry R. Kaiser, Sarah K. Thompson, Glyn G. Jamieson in Operative Thoracic Surgery, 2017
The recurrent laryngeal nerve is a structure that if injured during the operation leads to increased aspiration risk because of the inability to completely appose the vocal cords to protect the airway. This is due to the fact that the paralyzed vocal cord remains in the abducted position and cannot meet the other vocal cord to completely close the glottis opening. Careful dissection is critical to avoid injuring this nerve, particularly during a left EPP when the dissection approaches the vagus nerve along the transverse aortic arch, where the recurrent laryngeal nerve originates. If a breathy cough or any voice changes are noted in the postoperative period, immediate evaluation of the vocal cords should be performed with direct laryngoscopy, as these could be signs of vocal cord paresis or paralysis. This complication is treated with vocal cord medialization and a swallow evaluation prior to permitting an oral diet.
Data and Picture Interpretation Stations: Cases 1–45
Peter Kullar, Joseph Manjaly, Livy Kenyon, Joseph Manjaly, Peter Kullar, Joseph Manjaly, Peter Kullar in ENT OSCEs, 2023
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.
The larynx
Rogan J Corbridge in Essential ENT, 2011
The recurrent laryngeal nerve (Figure 5.18) is a branch of the vagus nerve and, due to its embryological development, has an unusually long course, especially on the left side. On this side, it runs around the arch of the aorta before passing upwards over the pleura and into the neck. Here it runs in a groove between the trachea and oesophagus, before finally entering the larynx. As a result of its great length, the nerve is frequently damaged in diseases of, or surgery to, any of its close relations, i.e. the lungs, oesophagus and thyroid gland, and is at risk in many intrathoracic operations. Before thyroid surgery, the vocal cord mobility should be checked to establish whether or not there is any pre-existing palsy.
The non-recurrent inferior laryngeal nerve: The clinical and surgical implication
Published in Acta Oto-Laryngologica Case Reports, 2021
Cissé Naouma, Koné Fatogoma Issa, Haïdara Abdoul Wahab, Kassim Diarra, N’faly Konaté, Kalifa Coulibaly, Siaka Soumaoro, Boubacary Guindo, Singaré Kadidiatou, Timbo Samba Karim, Mohamed Amadou Kéïta
The recurrent laryngeal nerve is a cervical branch of the vagus nerve that supplies motor, sensory and parasympathetic nerve fibers to the larynx [1,2]. Non-recurrence of the nerve is a rare anatomical variant [3]. The first case was reported in 1823 by Stedman [4]. This variation is constantly associated with vascular malformations due to an abnormality in the development of the sixth brachial arch [5,6]. One series found a non-recurrent lower right laryngeal nerve at 0.6% in 4921 right cervical dissections and a non-recurrent lower left laryngeal nerve at 0.04% in 4673 left cervical dissections [3,6]. The circumstances of discovery is either:By indirect signs. The symptom ‘dysphagia lusoria’ is an impairment of swallowing due to compression from an aberrant right subclavian artery (arteria lusoria). it‘s most often associated with the non-recurrent inferior laryngeal nerve [1,2,5]. Preoperative imaging using ultrasound, computed tomography and angiography allows us to find predictive signs of the non-recurrent laryngeal nerve, notably an aberrant right subclavian artery, a right retro-oesophageal or pre-oesophageal artery, a situs invertus [5–7].Intraoperative which is the most frequent.
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
Unilateral vocal cord paralysis – clinical implication: Unilateral vocal cord palsy (UVCP) causing hoarseness may result from involvement of the recurrent laryngeal nerve anywhere along its course – from the brainstem to its distal margins. The left recurrent laryngeal nerve is more often involved than the right due to its longer course and extension into the mediastinum. The left recurrent laryngeal nerve arises from the Vagus nerve, loops around the arch of the aorta, passes through the triangle (aortic triangle) formed by the aortic arch, the ligamentum arteriosum and the pulmonary artery, and ascends up into the neck in the tracheo-esophageal groove. The nerve finally enters the larynx posteriorly, near the cricothyroid joint. At the aortic triangle, the distance between the aorta and the left pulmonary artery is only 4.0 mm, making the nerve vulnerable at this point. When identified, UVCP must be thoroughly evaluated, as there are a number of possible causes leading to it. Around 40% of UVCP is caused by surgical injury – more often caused by surgical procedures, like carotid endarterectomy, anterior approaches to the cervical spine, and surgeries of the heart or great vessels [1]. Around 20% cases of UVCP were idiopathic [1]. Malignancy outside the larynx (most commonly bronchogenic carcinoma) was the third most common cause of UVCP, accounting for 14% of cases [1]. Traumatic injury, most frequently intubation related, accounts for 6% of all cases of UVCP [1]. Less common causes of UVCP include central nervous system disease, infection, inflammation, radiation therapy, and aortic aneurysm [1].
A comparative study of short-term efficacy and safety for thyroid micropapillary carcinoma patients after microwave ablation or surgery
Published in International Journal of Hyperthermia, 2019
Jianming Li, Yujiang Liu, Jibin Liu, Peipei Yang, Xiangdong Hu, Linxue Qian
We defined locoregional recurrence as recurrence in thyroid tissue. Lymph node recurrence was defined as either cytological evidence of disease in the central or lateral neck compartment or evidence of disease on US. A diagnosis of recurrent PTMC was based on evidence of disease in the ablated area of the thyroid bed confirmed by FNAC and/or US. Distant metastasis was defined as evidence of disease outside the neck. Complications—transient or persistent hypoparathyroidism confirmed by serum calcium levels <8.5 mg/dl (2.12 mmol/l); symptoms of hypocalcemia; transient or persistent recurrent laryngeal nerve injury (presenting as voice change, hoarseness)—were carefully monitored after the procedures and at each follow-up assessment. If suspected, recurrent laryngeal nerve injury was confirmed by laryngoscopy.
Related Knowledge Centers
- Carotid Sheath
- Cricothyroid Muscle
- Jugular Foramen
- Pharyngeal Arch
- Posterior Cricoarytenoid Muscle
- Larynx
- Vagus Nerve
- Cranial Nerves
- Subclavian Artery
- Cardiac Plexus