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Journal ArticleDOI

Recovery of laryngeal function after intraoperative injury to the recurrent laryngeal nerve

02 Apr 2015-Gland surgery (AME Publications)-Vol. 4, Iss: 1, pp 27-35

TL;DR: This review aims to provide an update on the current understandings of surgically-induced injury to the laryngeal nerves to clarify any differences between the transient and permanent injury of the RLN.

AbstractLoss of function in the recurrent laryngeal nerve (RLN) during thyroid/parathyroid surgery, despite a macroscopically intact nerve, is a challenge which highlights the sensitivity and complexity of laryngeal innervation. Furthermore, the uncertain prognosis stresses a lack of capability to diagnose the reason behind the impaired function. There is a great deal of literature considering risk factors, surgical technique and mechanisms outside the nerve affecting the incidence of RLN paresis during surgery. To be able to prognosticate recovery in cases of laryngeal dysfunction and voice changes after thyroid surgery, the surgeon would first need to define the presence, location, and type of laryngeal nerve injury. There is little data describing the events within the nerve and the neurobiological reasons for the impaired function related to potential recovery and prognosis. In addition, very little data has been presented in order to clarify any differences between the transient and permanent injury of the RLN. This review aims, from an anatomical and neurobiological perspective, to provide an update on the current understandings of surgically-induced injury to the laryngeal nerves.

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Citations
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Journal ArticleDOI
16 Mar 1984-JAMA
TL;DR: This 672-page volume written by a single author contains 26 chapters in seven parts and three appendices and is intended for practicing electromyographers and all those concerned with electrodiagnostic tests in clinical practice.
Abstract: This 672-page volume written by a single author contains 26 chapters in seven parts and three appendices. Part 1 deals with basic anatomy and physiology of the neuromuscular system and basics of electrodiagnosis, including recording apparatus. The next three parts contain nerve conduction studies, tests for neuromuscular transmission, and electromyography, including single-fiber electromyography. Part 5 contains reviews of blink reflex, F wave, H-reflex, and somatosensory evoked potentials. The disorders of the spinal cord, peripheral nervous system, neuromuscular junction, myopathies, and abnormal muscle activity are discussed in the last two parts. The appendices cover a historical review of electrodiagnosis, the fundamentals of electronics, instrumentation, and a glossary of terms approved by the American Association of Electrodiagnosis and Electromyography. The book is intended for practicing electromyographers and all those concerned with electrodiagnostic tests in clinical practice. The author's extensive experience in electrophysiological studies prompted him to write this book. The notable feature

152 citations


Journal ArticleDOI
TL;DR: The results indicate that RLN lesion leads to increased frequency of aspiration, and increased esophageal dysfunction, with significant variation in these basic patterns at all levels, and suggests that neurological variation underlies this pattern.
Abstract: Recurrent laryngeal nerve (RLN) injury in neonates, a complication of patent ductus arteriosus corrective surgery, leads to aspiration and swallowing complications. Severity of symptoms and prognosis for recovery are variable. We transected the RLN unilaterally in an infant mammalian animal model to characterize the degree and variability of dysphagia in a controlled experimental setting. We tested the hypotheses that (1) both airway protection and esophageal function would be compromised by lesion, (2) given our design, variability between multiple post-lesion trials would be minimal, and (3) variability among individuals would be minimal. Individuals' swallowing performance was assessed pre- and post-lesion using high speed VFSS. Aspiration was assessed using the Infant Mammalian Penetration-Aspiration Scale (IMPAS). Esophageal function was assessed using two measures devised for this study. Our results indicate that RLN lesion leads to increased frequency of aspiration, and increased esophageal dysfunction, with significant variation in these basic patterns at all levels. On average, aspiration worsened with time post-lesion. Within a single feeding sequence, the distribution of unsafe swallows varied. Individuals changed post-lesion either by increasing average IMPAS score, or by increasing variation in IMPAS score. Unilateral RLN transection resulted in dysphagia with both compromised airway protection and esophageal function. Despite consistent, experimentally controlled injury, significant variation in response to lesion remained. Aspiration following RLN lesion was due to more than unilateral vocal fold paralysis. We suggest that neurological variation underlies this pattern.

24 citations


Cites background from "Recovery of laryngeal function afte..."

  • ..., stretch, crush, sectioning) in patients means that the source of variation in response to nerve injury is unknown [6, 7]....

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Journal ArticleDOI
TL;DR: To retrospectively determine optimal timing for initiation of nimodipine within a cohort of patients with acute vocal fold paralysis, data are presented on patients diagnosed with VFP in the 1990s.
Abstract: Objectives/hypothesis To retrospectively determine optimal timing for initiation of nimodipine within a cohort of patients with acute vocal fold paralysis (VFP). Study design Retrospective patient review. Methods Subjects were divided into three groups: initiation within 15 days postinjury (n = 19), between 15 and 30 days postinjury (n = 23), or greater than 30 days postinjury (n = 11). Results Fifty-one patients (53 paralyzed vocal folds [VFs]) met entrance criteria and were offered and started off-label nimodipine treatment. Thirty-six of 53 VFs recovered purposeful motion (67.9%). There was no significant difference in the rate of VF recovery among patients who began nimodipine within 15 days (68.4%), patients who started nimodipine between 15 and 30 days (73.9%) of nerve injury (P = .1405), and patients who initiated nimodipine after 30 days postinjury (54.5%). Conclusions Nimodipine treatment for acute VFP yielded equal VF motion recovery rates regardless of when the medication was initiated. Time to recovery of motion was not different between groups studied.

23 citations


Journal ArticleDOI
TL;DR: Cont-IONM is feasible and safe to use during transoral endoscopic thyroidectomies and may assist in the early detection of adverse EMG changes, thereby preventing paralysis of the RLNs.
Abstract: The novel concept of continuous intraoperative neuromonitoring (Cont-IONM) through stimulation of the vagal nerve has been used in thyroidectomies to prevent imminent injury of the recurrent laryngeal nerve (RLN). This article reports on this technology and the results of using transoral Cont-IONM in natural orifice transluminal endoscopic surgery for thyroid disease. Cont-IONM of the RLN was achieved through automatic cyclical stimulation of the vagal nerve using a C2 monitor and delta stimulating electrode. During the operation, three vestibular incisions were made, and the stimulating electrode was transorally inserted, with its cable line lying outside the trocar. The vagal nerve was gently dissected, looped, and then enveloped by the electrode cuff. Electromyography (EMG) of the vocalis muscle was performed, and the alarm was set to activate when the EMG amplitude reduced by 50% and latency was prolonged by 10%. Demographic data and outcome variables, including incremental time required to achieve Cont-IONM, were obtained. A total of 20 patients (28 nerves at risk) undergoing a transoral endoscopic thyroidectomy vestibular approach were enrolled in this study. All Cont-IONM procedures were successfully completed. In all patients, the stimulation was set at 0.7 milliamps every 1 s, and Cont-IONM use was unassociated with any untoward neural, cardiovascular, or gastrointestinal sequelae. On average, the ipsilateral Cont-IONM procedure required 10.33 ± 2.57 min to complete. Except for one instance, no significant problems occurred with electrode displacement. In one patient, a combined EMG event occurred, which improved after releasing the thyroid retractor, and the patient had no vocal cord paralysis postoperatively. Cont-IONM is feasible and safe to use during transoral endoscopic thyroidectomies and may assist in the early detection of adverse EMG changes, thereby preventing paralysis of the RLNs.

20 citations


References
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Book
01 Jan 1983
TL;DR: This book provides a comprehensive review of most peripheral nerve and muscle diseases, including specific techniques and locations for performing each test, and is of value to neurologists and physiatrists who are interested in neuromuscular disorders and noninvasive electrodiagnostic methods.
Abstract: With each subsequent edition, Dr. Kimura has built upon his extensive experience teaching electromyography (EMG) around the world and has transferred his knowledge to the book. It is intended for clinicians who perform electrodiagnostic procedures as an extension of their clinical examination, and will be of value to neurologists and physiatrists who are interested in neuromuscular disorders and noninvasive electrodiagnostic methods, particularly those practicing electromyography (EMG). The book provides a comprehensive review of most peripheral nerve and muscle diseases, including specific techniques and locations for performing each test.New to this edition:intra-operative monitoringstudies for the pediatric and geriatric populationsdata analysis and reporting, which should help facilitate daily practice

1,503 citations


Journal ArticleDOI
01 Dec 1951-Brain

1,022 citations


"Recovery of laryngeal function afte..." refers background in this paper

  • ...These classifications were first made by Seddon in 1942 (46) and later modified by Sunderland in 1951 (47)....

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PatentDOI
TL;DR: Basal lamina grafts for reconnecting severed nerves are prepared from muscle by removing cellular material therefrom while preserving the tubular structure of the basal lamina, eventually reestablishing nerve function through the regenerated graft.
Abstract: Basal lamina grafts for reconnecting severed nerves are prepared from muscle by removing cellular material therefrom while preserving the tubular structure of the basal lamina. When connected to nerve stumps the basal lamina surfaces promote axon regeneration therethrough, eventually reestablishing nerve function through the regenerated graft.

953 citations