A non-recurrent laryngeal nerve is a rare anatomical variant that entails considerable risk for iatrogenic injury during thyroid surgery. We encountered a patient with a non-recurrent laryngeal nerve that went unnoticed on preoperative imaging but was discovered incidentally during robotic thyroidectomy. A 44 year old woman presented at our department with papillary thyroid microcarcinoma, diagnosed by ultrasonography-guided fine needle aspiration cytology. During robotic right thyroidectomy and central lymph node dissection, we could not detect any structure resembling the recurrent laryngeal nerve around the inferior thyroid artery. Thus, we suspected the existence of a non-recurrent laryngeal nerve, and successfully identified a nerve entering the larynx directly from the vagus nerve without recurring. A three-dimensional high magnification view via a robotic endoscope can aid thyroid surgeons to safely identify and preserve a non-recurrent laryngeal nerve.
Arteries ; Biopsy, Fine-Needle ; Endoscopes ; Female ; Humans ; Laryngeal Nerves* ; Larynx ; Lymph Node Excision ; Recurrent Laryngeal Nerve ; Robotics ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy* ; Vagus Nerve

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

No abstract available.
Paralysis* ; Vagus Nerve*

No abstract availabe.
Vagus Nerve Stimulation*

There are virtually no cognitive and systemic side-effects associated with vagus nerve stimulation (VNS), which makes it a valuable treatment modality for patients with a poor tolerance to antiepileptic drugs. The safety of VNS therapy have been established in clinical studies, but there are few reports on the cardiac side effect associated with the intraoperative lead testing for implantation of the device for VNS. We report a patient with refractory epilepsy who experienced a complete atrioventricular block intraoperatively as a result of inadvertently high current intensity during the initial testing for implantation of a left vagus nerve stimulator.
Anticonvulsants ; Atrioventricular Block ; Epilepsy ; Humans ; Vagus Nerve Stimulation* ; Vagus Nerve*

Patients under 65 with perforated duodenal ulceration received vagotomy as method of Taylor or Hill barker in ViÖt §øc during 1992-1998. The results of nervous anatomy and clinical practice has shown that vagal structure in the below of diaphragm was various: 45% of anterior vagus had 2-3 stems, 29% of posterior vagus had 2 stems, 30% of vagus had vago accessorius which lies along with left of esophago abdominal wall, there were changes of number of stem latarjet. The operation as Hill Barker can reduced peptic acid better than this as Taylor
Vagus Nerve ; anatomy & histology ; Vagotomy

The authors report a case of glossopharyngeal neuralgia which was successfully treated with intracranial section of the glossopharyngeal and upper two rootlets of the vagus nerves. Despite of the complete section of these nerves, corresponding sensory or motor deficit was not developed. And the histories of this surgery were reviewed.
Glossopharyngeal Nerve Diseases ; Neuralgia* ; Vagus Nerve

The nonrecurrent laryngeal nerve is a rare anomaly that may increase the risk of nerve injury during thyroid surgery. We experienced a case of nonrecurrent laryngeal nerve seen in a 35-year-old woman with adenomatous hyperplasia on her right thyroid. The nonrecurrent laryngeal nerve was incidentally found during the right thyroid lobectomy. It directly branched from the right vagus nerve and followed a transverse path parallel to the trunk of the inferior thyroid artery. The right lobectomy was performed with a careful preservation of the nerve. Postoperatively, the review of CT scan which was taken preoperatively revealed an aberrant right subclavian artery, which arose from the aortic arch and crossed behind the esophagus. To avoid an inadvertent injury to the nonrecurrent laryngeal nerve during thyroid surgery, it is important to be aware of the possibility of a nonrecurrent laryngeal nerve, particularly when an aberrant right subclavian artery is recognized preoperatively.
Adult ; Aorta, Thoracic ; Arteries ; Esophagus ; Female ; Humans ; Hyperplasia ; Laryngeal Nerves* ; Subclavian Artery ; Thyroid Gland ; Tomography, X-Ray Computed ; Vagus Nerve

Vagal paragangliomas (VPGLs) represent <5% of all head and neck paragangliomas (PGLs) and show a 17% to 20% risk of malignancy. We present a rare case of a 50-year-old gender with a left VPGL in her neck. To date, approximately 200 cases have been reported. The tumor showed web-like adhesions and arterial supply from the external carotid artery. We performed en bloc resection including a part of the vagus nerve. The superior laryngeal nerve was preserved with the “human communicating nerve” which maintains neural communication in >70% of humans, providing motor fibers to the larynx. The patient recovered uneventfully and was discharged on the 3rd postoperative day. These tumors are therapeutically challenging owing to their proximity to vital neck and skull base structures. Early detection decreases surgical morbidity and mortality. Preservation of viable neural tissue is important in advanced disease.
Carotid Artery, External ; Head ; Humans ; Laryngeal Nerves ; Larynx ; Middle Aged ; Mortality ; Neck ; Paraganglioma ; Skull Base ; Vagus Nerve

Vagal nerve stimulation is an important therapy for medically refractory epilepsy and major depression. Additionally, it may prove effective in treating obesity, Alzheimer's disease, and some neuropsychiatic disorders. As the number of approved indications increases, more patients are becoming eligible for surgical placement of a vagal nerve stimulator. Vagus nerve stimulator placement typically requires general anesthesia, and patients with previously implanted devices may present for other surgical procedures requiring anesthetic management. We have experienced anesthesia for 18 patients, which will be considered to help in anesthesia for vagus nerve stimulator in the future.
Alzheimer Disease ; Anesthesia ; Anesthesia, General ; Depression ; Epilepsy* ; Humans ; Obesity ; Vagus Nerve Stimulation ; Vagus Nerve*