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Dos Santos Menezes Siqueira GV, Dos Santos Rodrigues MH, Santos CNN, Gonçalves PE, Garção DC. Anatomical variations of recurrent laryngeal nerve: a systematic review and meta-analyses. Surg Radiol Anat 2024; 46:353-362. [PMID: 38329522 DOI: 10.1007/s00276-023-03293-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 12/27/2023] [Indexed: 02/09/2024]
Abstract
PURPOSE The aim of this systematic review and meta-analysis was to systematically review and perform a meta-analysis on the anatomical variations of the RLN. METHODS We performed online research for studies that addressed anatomical variations of the RLN and laterality, published between 2015 and 2021. We found 230 articles, and nine were included. RESULTS Eight variations were found, with Type I prevailing (41.17%; 95% CI 19.44-64.88), extra laryngeal divergence of the RLN. The other types were: II-fan shape; III-distance greater than 5 mm to the cricothyroid joint; IV-thickening and adipopexy in the elderly; V-non-recurrent laryngeal nerve; VI-intracranial branch; VII-tortuous ascending RLN; and VIII-combination between the inferior branch of the NV and the ascending trunk of the RLN. Types I (p = 0) and III (p < 0.01) prevailed on the left and types II (p < 0.01) and V (p < 0.01) on the right. CONCLUSIONS It was observed that variations occurred due to the path of the RLN to the entrance to the larynx, its shape, and the age of the evaluated individual. The most frequent variation and side were, respectively, Type I, extra laryngeal divergence and left.
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Affiliation(s)
| | | | - Caio Nemuel Nascimento Santos
- Department of Morphology, Federal University of Sergipe, Marechal Rondon Jardim Avenue, Rosa Elze, São Cristóvão, Sergipe, 49100-000, Brazil
| | - Paulo Eduardo Gonçalves
- Department of Morphology, Federal University of Sergipe, Marechal Rondon Jardim Avenue, Rosa Elze, São Cristóvão, Sergipe, 49100-000, Brazil
| | - Diogo Costa Garção
- Department of Morphology, Federal University of Sergipe, Marechal Rondon Jardim Avenue, Rosa Elze, São Cristóvão, Sergipe, 49100-000, Brazil
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Martins NMDS, Novalo-Goto ES, Diz-Leme ICM, Goulart T, Ranzatti RP, Leite AKN, Dedivitis RA, Matos LL. Patient Perception of Swallowing after Thyroidectomy in the Absence of Laryngeal Nerve Injury. ORL J Otorhinolaryngol Relat Spec 2020; 82:274-284. [PMID: 32683362 DOI: 10.1159/000508683] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 05/14/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Swallowing and voice alterations may manifest in patients with thyroid disease, especially after thyroidectomy. OBJECTIVE To identify the prevalence of patients with complaints of swallowing disorders after thyroidectomy and to evaluate patients' perceptions regarding swallowing before and after the procedure. METHODS A prospective longitudinal study was performed with 26 consecutive patients undergoing a private service thyroidectomy, in which the presence of swallowing dysfunction was evaluated using validated questionnaires that addressed the perception of swallowing by patients before (on the day of surgery) and after the surgery (on the first postoperative day). RESULTS Of the 26 patients, 18 (69.2%) were subjected to total thyroidectomy and 8 to partial thyroidectomy. Analysis of the domains of the Swallowing Handicap Index questionnaire showed higher scores when evaluated on the first postoperative day, demonstrating a significant worsening in swallowing after the procedure. The same result was demonstrated for the final score of swallowing perception, with 15.3 and 30.8% of patients reporting moderate alterations before and after the thyroidectomy, respectively, and 11.5% reporting the alterations as severe. Swallowing and vocal symptoms on the first postoperative day were more prevalent in the procedure than previously mentioned. Eight patients (30.8%) noted swallowing alterations before the procedure, compared with 80.8% (21 cases) after thyroidectomy. CONCLUSION There was a prevalence of 42.3% in swallowing complaints on the first postoperative day, regardless of the lesion in the laryngeal innervation, and this prevalence was significantly higher than that prior to the procedure.
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Affiliation(s)
| | | | | | | | | | - Ana Kober Nogueira Leite
- Head and Neck Surgery Department, Instituto do Câncer do Estado de São Paulo (Icesp), School of Medicine, University of São Paulo, São Paulo, Brazil
| | | | - Leandro Luongo Matos
- Head and Neck Surgery Department, Instituto do Câncer do Estado de São Paulo (Icesp), School of Medicine, University of São Paulo, São Paulo, Brazil,
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Gurleyik E, Dogan S, Cetin F, Gurleyik G. Visual and electrophysiological identification of the external branch of superior laryngeal nerve in redo thyroid surgery compared with primary thyroid surgery. Ann Surg Treat Res 2019; 96:269-274. [PMID: 31183330 PMCID: PMC6543049 DOI: 10.4174/astr.2019.96.6.269] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 04/04/2019] [Accepted: 04/12/2019] [Indexed: 11/30/2022] Open
Abstract
Purpose Thyroid reoperations are surgically challenging because of significant anatomical variance. Visual and functional identification of the external branch of the superior laryngeal nerve (EBSLN) were studied in 2 groups of patients who underwent primary and redo thyroid surgery. Methods This study was conducted on 200 patients: 100 patients with redo and 100 patients with primary thyroid surgery. In addition to visual identification, nerve branches were functionally identified by intraoperative nerve monitoring (IONM). Visual, functional, and total identification rates of the EBSLN in both primary and redo surgery were determined and compared between the 2 groups. Results We attempted to identify 138 and 170 EBSLNs at risk in redo and primary surgery, respectively. Visual identification rates were 65.3% and 30.4% (P < 0.001) in primary and redo surgery groups, respectively. In total, 164 (96.5%) and 97 EBSLNs (70.3%) were identified in primary and redo surgery, respectively (P < 0.001), including the use of IONM. In primary surgery group, 53 nonvisualized EBSLNs of 164 identified nerves (32.3%) were determined by IONM alone. In redo surgery group, 55 of 97 identified nerves (56.7%) were determined by IONM alone (P < 0.001). Conclusion Both visual and total identification rates of the EBSLN are significantly decreased in reoperative thyroidectomy. IONM increases the total identification rate of the EBSLN in primary and redo thyroid surgery. Electrophysiological monitoring makes a substantial contribution to the identification of the EBSLN both in primary and especially in redo thyroid surgery.
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Affiliation(s)
- Emin Gurleyik
- Department of Surgery, Duzce University, Medical Faculty, Duzce, Turkey
| | - Sami Dogan
- Department of Surgery, Duzce University, Medical Faculty, Duzce, Turkey
| | - Fuat Cetin
- Department of Surgery, Duzce University, Medical Faculty, Duzce, Turkey
| | - Gunay Gurleyik
- Department of Surgery, Health Sciences University, Haydarpasa Numune Hospital, Istanbul, Turkey
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Kim MH, Noh J, Pyun SB. Comparison of Clinical Characteristics Between Patients With Different Causes of Vocal Cord Immobility. Ann Rehabil Med 2017; 41:1019-1027. [PMID: 29354579 PMCID: PMC5773422 DOI: 10.5535/arm.2017.41.6.1019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 04/27/2017] [Indexed: 11/05/2022] Open
Abstract
Objective To analyze the clinical characteristics between neurogenic and non-neurogenic cause of vocal cord immobility (VCI). Methods The researchers retrospectively reviewed clinical data of patients who underwent laryngeal electromyography (LEMG). LEMG was performed in the bilateral cricothyroid and thyroarytenoid muscles. A total of 137 patients were enrolled from 2011 to 2016, and they were assigned to either the neurogenic or non-neurogenic VCI group, according to the LEMG results. The clinical characteristics were compared between the two groups and a subgroup analysis was done in the neurogenic group. Results Among the 137 subjects, 94 patients had nerve injury. There were no differences between the neurogenic and non-neurogenic group in terms of demographic data, underlying disease except cancer, and premorbid events. In general characteristics, cancer was significantly higher in the neurogenic group than non-neurogenic group (p=0.001). In the clinical findings, the impaired high pitched 'e' sound and aspiration symptoms were significantly higher in neurogenic group (p=0.039 for impaired high pitched 'e' sound; p=0.021 for aspiration symptoms), and sore throat was more common in the non-neurogenic group (p=0.014). In the subgroup analysis of neurogenic group, hoarseness was more common in recurrent laryngeal neuropathy group than superior laryngeal neuropathy group (p=0.018). Conclusion In patients with suspected vocal cord palsy, impaired high pitched 'e' sound and aspiration symptoms were more common in group with neurogenic cause of VCI. Hoarseness was more frequent in subjects with recurrent laryngeal neuropathy. Thorough clinical evaluation and LEMG are important to differentiate underlying cause of VCI.
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Affiliation(s)
- Min-Hyun Kim
- Department of Physical Medicine and Rehabilitation, Korea University College of Medicine, Seoul, Korea
| | - Junsoo Noh
- Department of Physical Medicine and Rehabilitation, Korea University College of Medicine, Seoul, Korea
| | - Sung-Bom Pyun
- Department of Physical Medicine and Rehabilitation, Korea University College of Medicine, Seoul, Korea.,Brain Convergence Research Center, Korea University Anam Hospital, Seoul, Korea
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Seifpanahi S, Izadi F, Jamshidi AA, Torabinezhad F, Sarrafzadeh J, Mohammadi S. Role of the Internal Superior Laryngeal Nerve in the Motor Responses of Vocal Cords and the Related Voice Acoustic Changes. Iran J Med Sci 2016; 41:374-81. [PMID: 27582586 PMCID: PMC4967481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Repeated efforts by researchers to impose voice changes by laryngeal surface electrical stimulation (SES) have come to no avail. This present pre-experimental study employed a novel method for SES application so as to evoke the motor potential of the internal superior laryngeal nerve (ISLN) and create voice changes. METHODS Thirty-two normal individuals (22 females and 10 males) participated in this study. The subjects were selected from the students of Iran University of Medical Sciences in 2014. Two monopolar active electrodes were placed on the thyrohyoid space at the location of the ISLN entrance to the larynx and 1 dispersive electrode was positioned on the back of the neck. A current with special programmed parameters was applied to stimulate the ISLN via the active electrodes and simultaneously the resultant acoustic changes were evaluated. All the means of the acoustic parameters during SES and rest periods were compared using the paired t-test. RESULTS The findings indicated significant changes (P=0.00) in most of the acoustic parameters during SES presentation compared to them at rest. The mean of fundamental frequency standard deviation (SD F0) at rest was 1.54 (SD=0.55) versus 4.15 (SD=3.00) for the SES period. The other investigated parameters comprised fundamental frequency (F0), minimum F0, jitter, shimmer, harmonic-to-noise ratio (HNR), mean intensity, and minimum intensity. CONCLUSION These findings demonstrated significant changes in most of the important acoustic features, suggesting that the stimulation of the ISLN via SES could induce motor changes in the vocal folds. The clinical applicability of the method utilized in the current study in patients with vocal fold paralysis requires further research.
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Affiliation(s)
- Sadegh Seifpanahi
- Department of Speech and Language Pathology, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Farzad Izadi
- Division of Laryngology, Rasoul Akram Medical Complex, Iran University of Medical Sciences, Tehran, Iran
| | - Ali-Ashraf Jamshidi
- Department of Physical Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran,Correspondence: Ali-Ashraf Jamshidi, PhD; Department of Physical Therapy, School of Rehabilitation Sciences, Shahnazari St., Mirdamad Blvd., P.O. Box: 15875-4391, Tehran, Iran Tel/Fax: +98 21 22228051-2 (345)
| | - Farhad Torabinezhad
- Department of Speech and Language Pathology, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Javad Sarrafzadeh
- Department of Physical Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Siavash Mohammadi
- Department of Speech and Language Pathology, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
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Kim SJ, Lee KE, Oh BM, Oh EM, Bae DS, Choi JY, Myong JP, Youn YK. Intraoperative neuromonitoring of the external branch of the superior laryngeal nerve during robotic thyroid surgery: a preliminary prospective study. Ann Surg Treat Res 2015; 89:233-9. [PMID: 26576402 PMCID: PMC4644903 DOI: 10.4174/astr.2015.89.5.233] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 06/24/2015] [Accepted: 06/25/2015] [Indexed: 11/30/2022] Open
Abstract
Purpose The aim of this study was to evaluate the feasibility of monitoring external branch of the superior laryngeal nerve (EBSLN) during robotic thyroid surgery. Methods A total of 10 patients undergoing bilateral axillo-breast approach (BABA) robotic thyroid surgery were enrolled. The nerve integrity monitor (NIM Response 2.0 System) was used for EBSLN monitoring. We performed voice assessments preoperatively and at 1 and 3 months postoperatively using Voice Handicap Index-10 (VHI-10), maximal phonation time (MPT), phonation efficient index (PEI), and laryngeal electromyography (EMG). Results A total of 19 EBSLNs were at risk and 14 EBSLNs (73.7%) were identified using neuromonitoring. VHI-10 showed a change of voice over time (0.1 vs. 3.6 vs. 1.3); however, this was not statistically significant. VHI-10 scores normalized at 3 months postoperatively compared to the preoperative scores. MPT (a) (16.0 vs. 15.6 vs. 15.4), and MPT (e) (20.1 vs. 15.4 vs. 18.5) showed no significant differences preoperatively compared to the values obtained 1 and 3 months postoperatively. There was a significant change of PEI over time (4.8 vs. 1.1 vs. 4.6) (P = 0.036); however, the values normalized at 3 months postoperatively. Laryngeal EMG results showed 4 cases (21.2%) of neuropathy of EBSLNs at 1 month postoperatively, and electrodiagnostic studies revealed nearly complete recovery of the function of EBSLNs in 4 patients at 3 months postoperatively Conclusion It is suggested that neuromonitoring of EBSLNs during BABA robotic thyroid surgery is feasible and might be helpful to preserve voice quality.
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Affiliation(s)
- Su-Jin Kim
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Kyu Eun Lee
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Eun Mee Oh
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Dong Sik Bae
- Department of Surgery, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - June Young Choi
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jun Pyo Myong
- Department of Department of Occupational and Environmental Medicine, Seoul St. Mary's Hospital, The Catholic University College of Medicine, Seoul, Korea
| | - Yeo-Kyu Youn
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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Deniwar A, Kandil E, Randolph G. Electrophysiological neural monitoring of the laryngeal nerves in thyroid surgery: review of the current literature. Gland Surg 2015; 4:368-75. [PMID: 26425449 DOI: 10.3978/j.issn.2227-684x.2015.04.04] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Recurrent laryngeal nerve (RLN) injury is one of the most common complications of thyroid surgery. RLN injury can cause vocal cord paralysis, affecting the patient's voice and the quality of life. Injury of the external branch of the superior laryngeal nerve (EBSLN) can cause cricothyroid muscle denervation affecting high vocal tones. Thus, securing the laryngeal nerves in these surgeries is of utmost importance. Visual identification of the nerves has long been the standard method for this precaution. Intraoperative neuromonitoring (IONM) has been introduced as a novel technology to improve the protection of the laryngeal nerves and reduce the rate of RLN injury. The aim of this article is to provide a brief description of the technique and review the literature to illustrate the value of IONM. IONM can provide early identification of anatomical variations and unusual nerve routes, which carry a higher risk of injury if not detected. IONM helps in prognosticating postoperative nerve function. Moreover, by detecting nerve injury intraoperatively, it aids in staging bilateral surgeries to avoid bilateral vocal cord paralysis and tracheostomy. The article will discuss the value of continuous IONM (C-IOMN) that may prevent nerve injury by detecting EMG waveform changes indicating impending nerve injury. Herein, we are also discussing anatomy of laryngeal nerves and aspects of its injury.
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Affiliation(s)
- Ahmed Deniwar
- 1 Department of Surgery, School of Medicine, Tulane University, New Orleans, USA ; 2 Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, USA
| | - Emad Kandil
- 1 Department of Surgery, School of Medicine, Tulane University, New Orleans, USA ; 2 Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, USA
| | - Gregory Randolph
- 1 Department of Surgery, School of Medicine, Tulane University, New Orleans, USA ; 2 Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, USA
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Canty DJ, Poon L. Superior laryngeal nerve block: an anatomical study comparing two techniques. J Clin Anesth 2014; 26:517-22. [PMID: 25439414 DOI: 10.1016/j.jclinane.2014.03.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Revised: 03/03/2014] [Accepted: 03/10/2014] [Indexed: 11/28/2022]
Abstract
STUDY OBJECTIVE To determine whether an anterior approach is as successful as the conventional posterior approach to superior laryngeal nerve block. DESIGN Prospective observational study. SETTING University anatomy laboratory. PATIENTS 20 formalin-fixed adult human cadavers. MEASUREMENTS Simulated superior laryngeal nerve blocks were performed by a single operator using 3 mL of 0.01% analine blue dye with a 23-gauge Quincke tip needle. Two different landmark techniques were used on each undissected cadaver: 1) the conventional posterior approach using the hyoid bone as a palpable landmark, with injection at the posterior third of the thyrohyoid membrane; and 2) the anterior approach, using the anterior thyroid notch of the thyroid cartilage, with injection at the anterior third of the thyrohyoid membrane. The spread of analine dye was observed. An injection was deemed successful if the entire paraglottic space was stained or the superior laryngeal nerve stained as it entered the paraglottic space. MAIN RESULTS Both techniques were equally successful after 40 injections. CONCLUSION There was no significant difference in success in staining the superior laryngeal nerve in human cadavers between the conventional posterior approach and an anterior approach.
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Affiliation(s)
- David Jeffrey Canty
- Senior Lecturer, Department of Surgery, University of Melbourne, Level 6 Centre for Medical Research, Royal Parade, Parkville, VIC 3050, Australia; Consultant Anaesthetist, Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Corner Royal Parade and Grattan Street, Parkville, Victoria, 3050, Australia.
| | - Laurence Poon
- Consultant Anaesthetist, Epworth Hospital, 89 Bridge Road, Richmond, VIC 3121, Australia
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