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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.
Abstract: Loss 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
TL;DR: In this paper , the authors assessed the outcomes of intraoperative repair of the recurrent laryngeal nerve (RLN) after thyroidectomies and found that immediate micro-surgical reconstruction of the RLN gave excellent postoperative voice quality.
Journal ArticleDOI
TL;DR: In this paper , the authors investigated how external hydrostatic compression of the laryngeal nerve affects the nerve's connective tissue and microstructure and found that the biomechanical response of the RLN to compressive pressure changed from being similar to being different between the right and left RLNs during development in the porcine model.
Book ChapterDOI
01 Jan 2019
TL;DR: A case of an RLN injury in thyroid surgery performed under the guidance of IONM is presented and nerve monitoring can still play an important role in cases of an inadvertent nerve injury.
Abstract: IONM assesses the motor function of the recurrent laryngeal nerve (RLN) while exposing the anatomical integrity, which does not always ensure the normal function. However, despite its advantages, IONM cannot always prevent injury to the nerve. Nevertheless, nerve monitoring can still play an important role in case of an inadvertent nerve injury. We present a case of an RLN injury in thyroid surgery performed under the guidance of IONM.
Book ChapterDOI
01 Jan 2019
TL;DR: Thyroidectomy should be carried out in a stepwise fashion with the goal of removing the gland and the cancer while limiting the risk of injury to the recurrent laryngeal nerve and parathyroid glands.
Abstract: Surgery remains the most important treatment modality for most types of thyroid cancer. Thyroid cancers have a remarkable spectrum of clinical behavior; well-differentiated subtypes have excellent 10-year survival rates after surgery in contrast to anaplastic thyroid cancer, which is highly lethal even with aggressive treatment. The extent of thyroidectomy and lymph node dissection should be guided by cancer subtype, preoperative workup including imaging, and disease extent. Thyroidectomy should be carried out in a stepwise fashion with the goal of removing the gland and the cancer while limiting the risk of injury to the recurrent laryngeal nerve (RLN) and parathyroid glands. The surgeon should be vigilant in identifying RLN anatomy variability, and using intraoperative nerve monitor (IONM) can be a helpful adjunct to the surgeon, particularly in complex dissections. Critical to postoperative management is the recognition and treatment of complications from thyroidectomy and lymph node dissection. Surgery for recurrent thyroid cancer can be challenging, but good surgical and oncologic outcomes can be achieved with optimal surgical planning.
Journal ArticleDOI
TL;DR: In this paper , a case report of the assessment and management of a 38-year old male patient with vocal cord paralysis was discussed, where the Numerical Pain Rating Scale (NPRS) was used to assess the level of pain while tape measure was used for measuring chest excursion.
Abstract: Background: Vocal cord paralysis is disabling and can lead to morbidities such as dysphagia, dysphonia and aspiration. It can also lead to loss of quality of lives and productivity in sufferers. An appropriate understanding of etiologies, signs and symptoms, diagnosis and management are essential in offering patients appropriate treatments. This article discussed a case report of the physiotherapy assessment and management of a patient with vocal cord paralysis. Case Presentation and Treatment Outcome: A case report of the assessment and management of a 38-year old male patient with vocal cord paralysis. Patient was referred from Ear, Nose and Throat (ENT) department to the physiotherapy department after an emergency tracheostomy done 2 months prior to referral. He was given appropriate physiotherapy intervention after a thorough assessment. Voice Handicap Index Score (VHIS) was used to assess voice projection of the patient. The Numerical Pain Rating Scale (NPRS) was used to assess the level of pain while tape measure was used to measure chest excursion. The CARE: CAse REport guideline for case reports was followed. All ethical procedures were followed as well. Treatment outcome revealed full AROM of the neck, increased chest excursion (from 2cm to 3.5cm), no hoarseness, no choking during deglutition and a Voice Handicap Index score of 25 after 10 treatment sessions. Pain level on Numerical Pain Rating Scale (NPRS) was reduced from 8/10 to 2/10. Conclusion: Physiotherapy is effective in the management of vocal cord paralysis. Early referral to Physiotherapy is advised for good prognosis. Adequate teamwork and proper communication pathways should be encouraged in hospitals for good treatment outcome.
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

1,187 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.

965 citations