Humans ; Recurrent Laryngeal Nerve ; pathology

OBJECTIVE: To explore the extralaryngeal furcation variation of the recurrent laryngeal nerve (RLN) in total thyroidectomy. METHOD: The clinical data of 216 RLNs from 108 patients undergone total thyroidectomy were retrospectively analyzed. RESULT: RLN was found during every operation and exposed in whole course until access into larynx. Twenty (9.26%) pieces of RLNs showed bifurcated or trifurcated RLNs before access into larynx. Ratio of furcation is lower than that reported before internationally. Bifurcations of RLNs on the left were more than that on the right. CONCLUSION The protection of RLN is important for thyroid operation, especially in total thyroidetomy. Variation of extralaryngeal furcation of RLN usually leads to injury of RLN. Understanding of variation of RLN could decrease nerve function related complication.
Humans ; Larynx ; Recurrent Laryngeal Nerve ; pathology ; Recurrent Laryngeal Nerve Injuries ; diagnosis ; Retrospective Studies ; Thyroid Gland ; surgery ; Thyroidectomy

OBJECTIVETo study the display of different types injuries of recurrent laryngeal nerve (RLN) in laryngeal electromyography (LEMG).

METHODSLEMGs of one hundred and forty-seven patients (147 sides) with traumatic unilateral vocal cord paralysis (UVCP) were studied. After LEMGs, the RLNs exploration operations were performed. The condition of RLNs injury and laryngeal muscles was observed and recorded during the operation.

RESULTSThe severe injuries of RLNs were found during operation. The types of injuries were listed as ligation (58 cases), adhesion (28 cases) and cut (61 cases). The waveform morphology of LEMG was recorded less in the patients with the RLNs cut than that in the patients with the RLN ligation or adhesion, respectively. 75.4% RLNs cut showed spontaneous waveform while 96.4% RLNs adhesion and 94.8% RLNs ligation. When the RLN was cut off, single pattern was showed oftener. When the RLN was adhered or ligated, mixed pattern was showed oftener. 92.9% RLN adhesion showed misdirect-regeneration-potentials while 70.7% RLN ligation and 24.6% RLN cut. There were significant difference between two types, but the compound muscular active potential (CMAP) amplitude wasn't significantly different. Evoked amplitude could be recorded in 91.4% patients with ligation and its amplitude was (23.6 +/- 8.1)%, in 85.7% patients with adhesion and its amplitude (16.3 +/- 5.2)%, in 29.5% patients with cut and its amplitude (2.6 +/- 4.2)%.

CONCLUSIONSThe display of different injuries of RLN in LEMG presents significant difference. If RLN was cut off, the CMAP might be recorded in most cases. The clinical injury of RLN often is followed by sub-clinic reinnervation.

Adult ; Aged ; Electromyography ; Female ; Humans ; Laryngeal Muscles ; injuries ; Male ; Middle Aged ; Recurrent Laryngeal Nerve ; physiopathology ; Recurrent Laryngeal Nerve Injuries ; Vocal Cord Paralysis ; pathology ; physiopathology ; Young Adult

BACKGROUND AND OBJECTIVES: Completion thyroidectomy (CT) is defined as the resection of residual thyroid tissue following the initial operation of less than a total thyroidectomy. But completion thyroidectomy is a rare surgical procedure associated with increased morbidity and is related to recurrent laryngeal nerve injury and hypoparathyroidism. The purpose of present study is to evaluate the various clinical and pathological situation of completion thyroidectomy (CT) and the safety of completion thyroidectomy (CT) according to various parameters. SUBJECTS AND METHOD: From February 2001 through July 2005, 32 consecutive cases who underwent completion thyroidectomy (CT) were retrospectively analyzed. Prophylactic CT was performed in 17 cases and therapeutic CT was performed in 15 cases. Their mean follow-up was 19.8+/-0.6 months (3-44 months). The various parameters were retrospectively analyzed between two groups. These parameters included the time interval between the first and second operations, complication associated with CT, duration of hospital stay, preoperative imaging, preoperative fine needle aspiration cytology, frozen biopsy and permanent pathology. RESULTS: Prophylactic CT was composed of ten cases of follicular carcinoma and seven cases of papillary carcinoma. Therapeutic CT was composed of four cases of papillary carcinoma, one case of follicular carcinoma and 10 cases of benign nodule. The time interval between the first and second operations was 48.9+/-1.3 days (prophylactic CT) and 15.1+/-.8 years (therapeutic CT). The duration of hospital stay was not significantly different between two groups. Transient hypocalcemia occurred in 11.8% (2/17, prophylactic CT) and 13.3% (2/15, therapeutic CT), respectively. Permanent hypocalcemia occurred in 5.9% (1/17, prophylactic CT) and 6.7% (1/15, therapeutic CT). Recurrent laryngeal nerve injury occurred in 0% (0/17, prophylactic CT) and 13.3% (2/15, therapeutic CT) Hypocalcemia was not significantly different between two groups, but the difference of recurrent laryngeal nerve injury was significant. CONCLUSION: Completion thyroidectomy might be a safe operation with minimal morbidity. However, in those therapeutic CT cases where previous operation records are unavailable, special care was needed in preserving the recurrent laryngeal nerve and parathyroid gland. We also suggest that even in unilateral thyroidectomy, the parathyroid gland should be preserved.
Biopsy ; Biopsy, Fine-Needle ; Carcinoma, Papillary ; Follow-Up Studies ; Hypocalcemia ; Hypoparathyroidism ; Length of Stay ; Parathyroid Glands ; Pathology ; Recurrent Laryngeal Nerve ; Recurrent Laryngeal Nerve Injuries ; Retrospective Studies ; Thyroid Gland ; Thyroidectomy*

OBJECTIVE: To investigate the clinical feature,diagnostic and therapeutic methods of ultimobranchial fistula and cyst of thyroid. METHOD: Four cases of ultimobranchial fistula and cyst of thyroid in our hospital were reported and the relevant literatures were reviewed. RESULT: The branchial fistula and cyst of four cases were adhered to thyroid,with unclear anatomical landmarks, the function of recurrent laryngeal nerve were bad before the operation in two cases. The nerve of four cases were retained, the function of thyriod and parathyroid gland were normal and no recurrence were found. CONCLUSION Ultimobranchial fistula and cyst of thyroid is rare and is easier to be misdiagnosed and wrong treated. Surgical excision is effective for it and recurrent laryngeal nerve should be protected when performing the operation.
Cysts ; Diagnostic Errors ; Fistula ; Humans ; Parathyroid Glands ; Recurrent Laryngeal Nerve ; Thyroid Diseases ; pathology ; surgery

OBJECTIVE: To investigate the influence of denervation on myofiber morphology of the adductor and the abductor in patients with recurrent laryngeal nerve (RLN) paralysis and to provide experimental evidence for the clinical feasibility of RLN repair. METHOD: Adductor muscles were acquired from the lateral cricoarytenoid muscle (LCAM) and abductor muscles from the posterior cricoarytenoid muscle(PCAM). Normal human PCAM and LCAM are treated as control group (n = 7). Thirty-eight cases of PCAM with damaged RLN were divided into five groups according to the duration of their RLN damage: 0.5-1 year (7 cases), > 1-2 years (10 cases), > 2-3 years (8 cases), > 3-6 years (8 cases) and > 6 years (5 cases); twenty-nine cases of LCAM were also divided into five groups: 0.5-1 year (7 cases), > 1-2 years (6 cases); > 2-3 years (6 cases), > 3-6 years (6 cases) and > 6 years group(4 cases). They were all stained with HE and Masson three-color staining, the fiber cross-sectional area of muscle tissue and collagen connective tissue were quantitative analyzed. The changes of myofiber morphology of adductor and abductor muscles after the loss of the RLN were analyzed with image analysis system. RESULT: The transverse areas of myofibers gradually decreased and those of collagen fibers gradually increased with the prolongation of denervation. (1) Difference between the denervated groups of LCAM of 0.5-1 year, > 1-2 years and > 2-3 years groups were not significant (P > 0.05). Fiber cross-sectional area of > 3-6 years group decreased most obviously with significantly difference compared with > 2-3 years group (P < 0.05); (2) There were obvious difference between the control group, 0.5-1 year group, > 1-2 years group, > 2-3 years group and > 3-6 years of PCAM(P < 0.05); (3) There was no significant difference between the group of > 3-6 years and > 6 years of two kinds of laryngeal intrinsic muscle (P > 0.05); (4) Fiber cross-sectional area of each group of the LCAM after 1 year denervation were significantly greater than that of the PCAM under same conditions (P < 0.05). CONCLUSION The influence of denervation on myofiber morphology following denervation is different between the abductor and adductor owing to the different fiber type composition and functional properties. The rate of muscle atrophy of the adductor is slower than that of the abductor. To restore the structure and function of denervated laryngeal muscles better, the recurrent laryngeal nerve injury repair surgery for PCA muscle function recovery should be carried out within 1 year after denervation while the surgery for LCA muscle function recovery should be carried out within 3 years after denervation.
Case-Control Studies ; Denervation ; Humans ; Laryngeal Muscles ; innervation ; pathology ; Myofibrils ; pathology ; Neurosurgical Procedures ; Recurrent Laryngeal Nerve ; pathology ; Staining and Labeling ; Vocal Cord Paralysis ; pathology ; surgery

BACKGROUND AND OBJECTIVES: The main indication for thyroidectomy are thyroid cancer, multinodular goiter, and Graves' disease. Most important complications of thyroidectomy are recurrent laryngeal nerve injury and hypoparathyroidism. The risk of complication depends on the extent of the operation, and skill and experiences of surgeon. The purpose of this study is to determine the incidence and predictive factors for complication after thyroidectomy. MATERIALS AND METHOD: We examined the records of 233 patients who underwent thyroidectomy at the Department of Otolaryngology, Hanyang University from 1994 to 2001. The postoperative complication including hypocalcemia, recurrent laryngeal nerve palsy and hematoma was identified and analysed. The rate of recurrent laryngeal nerve palsy was calculated on the number of nerve at risk of injury. There were 135 unilateral and 98 bilateral procedures. Nerves at risk is 329. The hypocalcemia was defined as a ionized calcium fell below 1.01 mEq/L. RESULTS: Among 233 patients, 3 patients (1.3%) had permanent hypocalcemia and 57 patients (24.5%) had transient hypocalcemia. According to surgical procedure total thyroidectomy with neck dissection was associated with an increased risk of transient hypocalcemia (63.6%). The incidence of temporary and permanent recurrent laryngeal nerve palsy was 0.9% (3/329) and 0.3% (1/329), respectively. The postoperative hematoma occurred in 7 patients (3%). CONCLUSION: The most frequent complication after thyroidectomy is transient hypocalcemia. Based on our results, thyroidectomy is a relatively safe procedure. Complications can be kept to a minimum by a through knowledge of the anatomy, by understanding thyroid pathology, and by meticulous hemostasis and delicate surgical technique.
Calcium ; Goiter ; Graves Disease ; Hematoma ; Hemostasis ; Humans ; Hypocalcemia* ; Hypoparathyroidism ; Incidence ; Neck Dissection ; Otolaryngology ; Pathology ; Postoperative Complications ; Recurrent Laryngeal Nerve Injuries* ; Recurrent Laryngeal Nerve* ; Thyroid Gland ; Thyroid Neoplasms ; Thyroidectomy ; Vocal Cord Paralysis

A 56 years old female was admitted to our department with complaint of a painless cervical mass. Clinical feature:there was a painless mass above left lobe of thyroid gland, which was about 3.0 cm x 2.5 cm in size, and could move with swallowing action. B-mode ultrasound features: there was a solid mass in left lobe of thyroid gland, which was about 3.2 cm. Nodule was found in isthmus, accompanied with lymphadenovarix on the left neck possibly be MCA. fT3: 4.64 pmol/L, fT4:16.56 pmol/L,TSH:3.74 mIU/L, anti-TG:17.75 U/ml, anti-TPO:40.77 U/ml. Pathological result of the neoplasm: papillocarcinoma. Clinical diagnosis: papillary thyroid carcinoma.
Carcinoma ; diagnosis ; pathology ; Carcinoma, Papillary ; diagnosis ; pathology ; Deglutition ; Female ; Humans ; Middle Aged ; Neck ; pathology ; Parathyroid Glands ; pathology ; Recurrent Laryngeal Nerve ; pathology ; Thyroid Cancer, Papillary ; Thyroid Neoplasms ; diagnosis ; pathology

OBJECTIVE: To investigate the morphological alteration and the protein expression of TGF-beta1 in long-term denervated posterior cricoarytenoid muscles (PCAMs) and to find the appropriate time point of reinnervation in long-term denervated PCAMs. METHOD: Thirty-eight patients with vocal paralysis were recruited into four groups, the 6-12 months denervation group, the 1-2 years denervation group, the 2-3 years denervation group and the over 3 years denervation group. Twelve adults served as a control group. The morphological alteration was evaluated using Trichrome Masson staining and the change in expression of TGF-beta1, a fibrosis related factor, were observed using immunofluorescence stain and Western blot. RESULT: The scars of myofibers were decreased, but the scars of collagen fibers were increased with the denervated time course extension. The ratio of scars of myofibers to scars of collagen fibers were progressively decrease with increased time course of denervation and more decrease within 2 years. There was still 48% scar of myofibers remained after 3 years of denervation. TGF-beta1 showed no staining in innervated, however, by 6-12 months and 1-2 years of muscle denervation there was a significant accumulation of TGF-beta1 protein in endochylema of myofiber. After 2 year of denervation, expression of TGF-beta1 protein in endochylema of myofiber, was decreased significantly, but after 3 year of denervation, there were no expression of TGF-beta1 protein in endochylema. In Western blot, the change in protein expression of TGF-beta1 was observed an 4.5-fold (P<0.01) increase from 6-12 months denervated muscles to innervated muscles, 11.4-fold (P<0.01) increase from 1-2 years denervated muscles to innervated muscles, 11.4-fold (P<0.01) increase from 2-3 years denervated muscles to innervated muscles (P<0.01). After 3 years, the protein expression of TGF-beta1 decreased, 0.5-fold to innervated muscles. CONCLUSION The morphological alteration and change in expression of TGF-beta1, a important factor of myelofibrosis, indicated there was a high amplitude of myelofibrosis within 2 years, but there is a morphological basis of muscles to regain their function within 3 years denervated muscles.
Adolescent ; Adult ; Aged ; Female ; Fibrosis ; Humans ; Laryngeal Muscles ; metabolism ; pathology ; Male ; Middle Aged ; Muscle Denervation ; Recurrent Laryngeal Nerve Injuries ; Transforming Growth Factor beta1 ; metabolism ; Young Adult

OBJECTIVE: The significance of lymph node dissection in the VI area of cN0 thyroid papillary carcinoma. METHOD: Collect 150 cases of patients diagnosed with cNO thyroid papillary carcinoma and they were performed thyroid gland lobe and isthmic portion excision including lateral VI area lymph node cleaning. The specimens were pathologic examined to determinate the size, the position, invasion of thyroid papillary carcinoma,the number and metastasis of lymph node, etc. RESULT: In the 150 patients performed the lymph node VI area groups cleaning, 93 cases had VI area of lymph node metastases, so the transfer rate was 62.0%. In the VI area, metastasis rate of tracheal side lymph nodes was 62.0% (93/150), lymph node before throat group was 4.67% (7/150), lymph node before trachea group was 3.33% (5/150), lymph nodes near the trachea laryngeal recurrent nerve ventral group was 52.0% (78/150), and next to the trachea laryngeal recurrent nerve dorsal lymph node group was 21.33% (32/ 150). CONCLUSION In CN0 thyroid papillary carcinoma, VI zone of lymph node metastasis rate is high, and region VI lymph node metastasis rate from high to low in order for: paratracheal lymph node, prelaryngeal lymph node, pretracheal lymph node. The metastasis rate of paratracheal throat back nerve ventral lymph node was the highest in central lymph node.
Carcinoma ; pathology ; surgery ; Carcinoma, Papillary ; pathology ; surgery ; Humans ; Lymph Nodes ; pathology ; Lymphatic Metastasis ; Neck ; Neck Dissection ; Recurrent Laryngeal Nerve ; Thyroid Cancer, Papillary ; Thyroid Neoplasms ; pathology ; surgery