Recurrent laryngeal nerve injury can develop following cervical or thoracic surgery; however, few reports have described intraoperative recurrent laryngeal nerve monitoring. Consensus regarding the use of this technique during thoracic surgery is lacking. We used intraoperative recurrent laryngeal nerve monitoring in a patient with contralateral vocal cord paralysis who was scheduled for completion pneumonectomy. This case serves as an example of intraoperative recurrent laryngeal nerve monitoring during thoracic surgery and supports this indication for its use.
Consensus ; Humans ; Monitoring, Intraoperative ; Pneumonectomy ; Recurrent Laryngeal Nerve Injuries ; Recurrent Laryngeal Nerve* ; Thoracic Surgery ; Vocal Cord Paralysis* ; Vocal Cords*

Recurrent laryngeal nerve injury can develop following cervical or thoracic surgery; however, few reports have described intraoperative recurrent laryngeal nerve monitoring. Consensus regarding the use of this technique during thoracic surgery is lacking. We used intraoperative recurrent laryngeal nerve monitoring in a patient with contralateral vocal cord paralysis who was scheduled for completion pneumonectomy. This case serves as an example of intraoperative recurrent laryngeal nerve monitoring during thoracic surgery and supports this indication for its use.
Consensus ; Humans ; Monitoring, Intraoperative ; Pneumonectomy ; Recurrent Laryngeal Nerve Injuries ; Recurrent Laryngeal Nerve* ; Thoracic Surgery ; Vocal Cord Paralysis* ; Vocal Cords*

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

Humans ; Laryngeal Nerves ; Recurrent Laryngeal Nerve ; surgery ; Vocal Cord Paralysis ; surgery

OBJECTIVETo study the result of recurrent laryngeal nerve decompression in the treatment of functional disturbance of recurrent laryngeal nerve caused by thyroid surgery or thyroid benign tumors.

METHODSFrom October 2002 to June 2005, 9 cases of unilateral recurrent laryngeal nerve paralysis and 4 cases of glottic insufficiency were treated with recurrent laryngeal nerve decompression. Seven cases of the nerve paralysis were caused by the surgery of benign thyroid tumors resection which were done by general surgeons. The paralysis nerve were found ligated in 6 of the 7 cases, and nerve-scar adhesion was found in the other case. Beside nerve decompression, type I thyroplasty have been undertaken in the same time to 2 of the 7 cases with severe hoarseness. One case of thyroid adenoma and 1 case of nodular goiter with unilateral recurrent laryngeal nerve paralysis were treated with tumor resection and nerve decompression respectively. Four cases of glottic insufficiency, 3 cases of nodular goiter were treated with tumor resection and nerve decompression, and Hashimoto's thyroiditis in the other case was treated with partial lobe resection and nerve decompression. The recovery of function of recurrent laryngeal nerve were detected to the recovery of vocal cord mobility through electrolaryngoscope postoperatively.

RESULTSFor the 7 cases of recurrent laryngeal nerve paralysis after thyroid surgery, the motion of the paralysed vocal cord restored within 3 months in 6 cases with the interval of 1 week to 3 months between the two operations, no restoration was found in the other patient with an interval above 4 months between the two operations after 1 year follow-up. For the thyroid adenoma and nodular goiter with unilateral recurrent laryngeal nerve paralysis, the motion of paralysed vocal cord restored within 3 months respectively after decompression. The glottic closure recovered within 1 week after decompression in the 4 cases of the glottic insufficiency patient.

CONCLUSIONSExploration and decompression as soon as possible to the paralysed recurrent laryngeal nerve because of thyroid surgery are very important for the restoration of the function of the nerve. For the patient with serve hoarseness, nerve decompression and type I thyroplasty at the same time is recommended in an effort to relieve hoarseness as soon as possible. For the functional disturbance of recurrent laryngeal nerve with thyroid neoplasm patient, early exploration and decompression of the nerve is imperative.

Objective:To explore the clinical value of recurrent laryngeal nerve dissection in the surgical treatment for congenital pyriform sinus fistula（CPSF）. Methods:The clinical data of 42 patients with CPSF were retrospectively analyzed. All patients were diagnosed and treated in the First Affiliated Hospital of Guangdong Pharmaceutical University. Results:During the operation, all patients' recurrent laryngeal nerves were dissected successfully, and fistulas were resected completely,no patients had complication of recurrent laryngeal nerve's damage.There were no recurrence cases during the 13 to 48 months of follow-up. Conclusion:The trend of congenital pyriform sinus fistula is closely related to recurrent laryngeal nerve, it's important to dissect the recurrent laryngeal nerve during the operation for congenital pyriform sinus fistula.
Humans ; Neck ; Recurrent Laryngeal Nerve/surgery* ; Retrospective Studies ; Pyriform Sinus/surgery* ; Fistula/surgery*

OBJECTIVE: To locate the recurrent laryngeal nerve fascicles in vagus and investigate the effect of the split-vagus nerve procedure to repair the paralyzed vocal cord in rats. METHOD: The method of dissection and acetylcholinesterase histochemical staining of neural fibers were used to locate the recurrent laryngeal nerve fascicles in vagus. Then 60 SD rats were divided into three groups. In experimental group right recurrent laryngeal nerve were incised and anastomosed to recurrent laryngeal nerve fascicles in vagus by means of the split-vagus nerve procedure. In control group right recurrent laryngeal nerve were incised and sutured immediately by means of end-to-end nerve anastomosis. In normal group rats were not treated by any elements. Three months later, rats from each group were examined for vocal cord movement and nerve regeneration by using fibrolaryngoscope and nerve electromyography. RESULT: The recurrent laryngeal nerve fascicles is in the medial-anterior segment of the vagus and its diameter is about one-fourth as large as the vagus. Three months after operation, the effect of the split-vagus nerve procedure bad not significant difference compared with the control group (P > 0.05). CONCLUSION The location of the recurrent laryngeal nerve fascicles in vagus provides important anatomical guideline for surgery. The split-vagus nerve procedure has a similar treatment effect compared with end-to-end nerve anastomosis. This microsurgical technique provides a new method for repairing recurrent laryngeal nerve.
Animals ; Nerve Regeneration ; Rats ; Rats, Sprague-Dawley ; Recurrent Laryngeal Nerve ; surgery ; Vagus Nerve ; surgery ; Vocal Cord Paralysis ; surgery

OBJECTIVE: To explore the methods of the larygeal recurrent nerve dissection in different and difficult thyroid surgery, so as to minimize damage and improve the safety of the operation. METHOD: The process and methods in different laryngeal recurrent nerve dissection about 52 hospitalized patients from 2010 to 2012 were retrospectively analyzed. These cases include large nodular goiter, nodular goiter behind the sternum or located in the lower pole of the thyroid gland, thyroid cancer, tumors of parathyroid gland, etc. We studied the conditions of lesions involving the laryngeal recurrent nerve and the defensive measures to protect the nerve. RESULT: The laryngeal recurrent nerve was dissected successfully in 50 cases, except 2 cases whose laryngeal recurrent nerve were violated by thyroid cancer. CONCLUSION When we dissect the laryngeal recurrent nerves in different and difficult thyroid, the glands and tumors were mostly needed to be freed and turned inward and forward. After that, the laryngeal recurrent nerves can be dissected successfully with the markers of tracheoesophageal groove, inferior thyroid artery and/or angle under the thyroid cartilage.
Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Recurrent Laryngeal Nerve ; surgery ; Retrospective Studies ; Thyroid Gland ; surgery

OBJECTIVE: To discuss the safe approach to exposure of the recurrent laryngeal nerve (RLN) in thyroid second operation. METHOD: The data of 153 patients with thyroid second operation were analyzed retrospectively to compare the effectiveness of superior and inferior approach in the exposure of RLN. RESULT: A total of 177 RLNs were exposed in 153 cases. Among those 39 RLNs were exposed by superior approach, 34 by inferior approach after failure of superior approach, and 104 by inferior approach. CONCLUSION In thyroid second operation, inferior approach is a safe and efficient method to expose RLN. Trachea and esophagus are the most important anatomical landmarks to look for the left RLN. Innominate artery and common carotid artery are the most important anatomical landmarks to look for right RLN.
Carotid Artery, Common ; Esophagus ; Humans ; Recurrent Laryngeal Nerve ; surgery ; Reoperation ; Retrospective Studies ; Thyroid Gland ; surgery ; Trachea

OBJECTIVE: To compare the advantages and disadvantages of real time recurrent laryngeal nerve (RLN) monitoring and conventional exposure during thyroid operation by Meta analysis. METHOD: The published articles of randomized controlled clinical trials were searched in data bases to compare the therapeutic outcomes of using real-time RLN monitoring and conventional exposure in thyroid surgery. The quality of the searched original studies was assessed and the outcomes which are in line with the requirements were analyzed. RESULT: Six articles met the inclusion criteria, which contained 12,646 RLN in total. There were 5,535 cases in the RLN monitoring group and 7,111 cases in the conventional exposure group. The results of Meta analysis showed that: the transient injury rate of the RLN in the monitoring group (OR=0.60, 95% CI=0.49-0.73, P<0.01) was lower than that in the conventional exposure group, but the permanent injury rate of the RLN in two groups had no statistical difference (OR=0.90, 95 % CI= 0.57-1.40, P>0.05). The RLN identification rate also had no statistical difference between the two groups (OR=9.79, 95% CI=0.17-548. 64, P>0.05). CONCLUSION The transient injury rate of the RLN is lower in the monitoring group than that in conventional exposure group, but the permanent injury rate and the RLN identification rate had no statistical difference between the two groups. The intraoperative nerve monitoring was useful in the prevention of the RLN injury in thyroid surgery.
Humans ; Monitoring, Intraoperative ; Parathyroid Glands ; Quality of Life ; Recurrent Laryngeal Nerve ; Recurrent Laryngeal Nerve Injuries ; prevention & control ; Thyroid Gland ; surgery ; Thyroidectomy ; adverse effects