Left recurrent laryngeal nerve injury.
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Humans↗
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[Speech visualization for evaluation of iatrogenic recurrent laryngeal nerve injuries].
A study was conducted to investigate the intra operative laryngeal recurrent nerve injury and subsequent vocal disturbances. The recovery of voice condition in group of 20 patients with unilateral laryngeal nerve injury was examined by the whole range of both presurgical and postsurgical tests. Patients were selected from a group a 1867 surgical treated in 3-rd Department of Surgery Jagiellonian University School of Medicine in years 1988-1993. We recorded and analysed 1100 words with identical acoustic test. The research was conucted in 3-4 days, 3 moths, 6 months and 1 year after operation in a non-echo chamber with special equipment in the Department of Mechanic and Vibro-Acoustic of the Academy of Mining and Metallurgy in Krakow, Poland. On the basis of obtain results, we found that recovery of voice, in one year after surgery, occurs in 87.5% patients with laryngeal recurrent nerve injury.
Follow-Up Studies↗
Laryngeal recurrent nerve injury in surgery for benign thyroid diseases: effect of nerve dissection and impact of individual surgeon in more than 27,000 nerves at risk.
OBJECTIVE: To evaluate the effect of recurrent nerve dissection on the incidence of recurrent laryngeal nerve injury (RLNI) and to analyze the performance of individual surgeons. SUMMARY BACKGROUND DATA: Dissection of the recurrent nerve is mandatory in total thyroidectomy, but its relative merit in less extensive resections is not clear. The reported rates of RLNI differ widely; this may reflect a variation in the performance of individual surgeons. METHODS: The authors studied the incidence of RLNI in primary surgery for benign thyroid disease during three periods in a single center. In period 1 (1979-1990; 9,385 consecutive patients, 15,865 nerves at risk), the recurrent nerve was not exposed. In period 2 (1991-1998; 6,128 patients, 10,548 nerves at risk), dissection of the recurrent nerve was the standard procedure. Global outcome and individual performance in these two periods were compared and presented to the surgeons. The effect of this quality control procedure was tested in 1999 (period 3; 930 patients, 1,561 nerves at risk). RESULTS: Exposure of the recurrent nerve significantly reduced the global rate of postoperative and permanent RLNI. Some but not all surgeons improved their results by recurrent nerve dissection (e.g., permanent RLNI rates ranged from 0% to 1.1%). The documented significant differences in individual performances did not affect the outcome in period 3. The extent of nerve dissection was a source of variability; the rate of permanent RLNI averaged 0.9%, 0.3%, and 0.1% for surgeons who only localized, partially exposed, and completely dissected the recurrent nerve, respectively. CONCLUSIONS: Recurrent nerve dissection significantly reduces the risk of RLNI. Extensive dissection facilitates visual control of nerve integrity during resection and is therefore superior to a more limited exposure of the nerve. Quality control can improve the global outcome and identify the variability in individual performance. This cannot be eliminated by merely confronting surgeons with comparative data; hence, it is important to search for the underlying causes.
Adolescent↗
[Nerve exploration and decompression for traumatic recurrent laryngeal nerve injuries induced by thyroid gland surgery].
OBJECTIVE: To show the findings of recurrent laryngeal nerve injury exploration and find out therapeutic effects, indications and timing of nerve decompression for traumatic recurrent laryngeal nerve injury induced by thyroid gland surgery. METHODS: In this study there were 87 patients with recurrent laryngeal nerve injury, including 65 for nerve exploration and 22 for nonsurgical treatment. During nerve exploration, the types, severity of laryngeal nerve injuries and laryngeal muscular mass were studied. Nerve decompression was performed in these 14 patients whose compressing sutures or compression due to cicatricial hypertrophy were received nerve decompression. RESULTS: Injuries caused by thyroid gland operations mostly are of suture ligation (43%) and nerve severance (48%); simple scar compression was found only in 6 cases (9%). Atrophy of the laryngeal muscles was not very serious in patients with a course less than 6 months. In 10 patients with a course less than three months, nerve decompression restored normal functional abductor and abductor motion of the vocal cord in 9 patients and had no effects in one. Although functional motion of vocal cord was not seen in one case with a course less than 3 months and 4 cases between 3 and 5 months, the mass and tension of the reinnervated vocal cord became much the same as the contralateral normal vocal cord, thus resuming symmetric vibration of the vocal cords and physiological phonation. Although nonsurgical treatment improved severe hoarseness, it didn't restore normal functional motion of the vocal cord and normal voice. CONCLUSIONS: Nerve exploration showed a primary rule for recurrent laryngeal nerve injury induced by thyroid gland surgery. Early and mid-stage recurrent laryngeal nerve exploration and decompression may restore normal motion of the glottis, and it suggested laryngeal delayed reinnervation may help patients with a course more than 6 months.
Adult↗
[Laryngeal reinnervation for unilateral traumatic recurrent laryngeal nerve injuries].
OBJECTIVE: To investigate 5 procedures of laryngeal reinnervation for unilateral vocal cord paralysis induced by traumatic recurrent laryngeal nerve injury. METHODS: 35 cases were selected for our study, all patients had unilateral recurrent laryngeal nerve injury, including 8 for nerve decompression, 6 for end to end anastomosis of recurrent laryngeal nerve, 16 for main branch of ansa cervicalis anastomosis to recurrent laryngeal nerve, 3 for nerve muscular pedicle and 2 for nerve implantation. All cases have been subjected to preoperative and postoperative voice recording, acoustic analysis, videolaryngoscopy, strobscopy and electromyography. RESULTS: It is found the adductory and abductory motion of the vocal cord restored in 5 cases with less than 4 months course who received nerve decompression. Although functional motion of vocal cord was not seen in two patients who received nerve decompression with a course longer than 4 months and one less than 4 months, and in all cases who received ansa cervicalis anastomosis and end to end anastomosis of recurrent laryngeal nerve, these procedures resulted in medialization of vocal cord and the mass and tension of the reinnervated vocal cord may become much the same as the contralateral normal vocal cord, thus resuming symmetric vibration of the vocal cords and physiological phonation. Nerve muscular pedicle technique and nerve implantation enabled adductory muscles to be reinnervated, thus improving severe hoarseness, but they didn't restore normal voice. CONCLUSIONS: (1) Nerve decompression seems to be the best procedure in laryngeal reinnervation; (2) Main branch of ansa cervicalis technique raises satisfactory reinnervation of adductor muscles; (3) Selection of the laryngeal reinnervation protocols should depend on the course, severity and type of nerve injury.
Adult↗
[Repair of recurrent laryngeal nerve injuries after thyroidectomy].
OBJECTIVE: In order to investigate the opportunity of repair and prognosis of recurrent laryngeal nerve injuries after thyroidectomy. METHODS: Twelve cases with recurrent laryngeal nerve injuries after thyroidectomy were immediately and delayed operated on nerve repair and reinnervation. In immediate operation, 5 cases were repaired by direct recurrent laryngeal nerve suture, and 1 case was treated by transposition of the phrenic nerve to the recurrent laryngeal nerve and sutured the adductor branch to the branch of ansa cervicalis. In delayed operation, 3 cases were treated by anastomosis the main trunk of ansa cervicalis to the adductor branch of recurrent laryngeal nerve, and 3 cases were operated on neuromuscular pedicle to reinnervate posterior cricoarytenoid muscle. RESULTS: Followed up 6 months, the effect was excellent in 1 case who was immediately operated by selective reinnervation of the abductor and adductor muscles of the larynx, better in 9 cases, and poor in 2 cases who were delayed operated over 12 months. CONCLUSION: It can be concluded that the earlier reinnervation is performed, the better prognosis is.
Adult↗
Left recurrent laryngeal nerve injury following internal mammary artery bypass.
To our knowledge, recurrent laryngeal nerve injury has not been reported previously as a complication of internal mammary artery mobilization for coronary artery bypass. We recently experienced this complication and are presenting a case history of the problem and comments.
Humans↗
Recurrent laryngeal nerve injury following thyroid operations.
Preoperative and postoperative laryngoscopy should be performed with thyroid operations. A prospective study of 121 thyroid operations from June 1970 to December 1974 was analyzed. There was a 4.2 per cent recurrent laryngeal nerve injury incidence in 217 nerves at risk, four of nine injuries being permanent. Of 217 superior laryngeal nerves at risk, 1.4% were injured, one of three permanently. Previous thyroid operations may place the laryngeal nerves at a greater risk. Transient edema of the laryngeal nerve in 13.4% of the patients was believed due to endotracheal intubation. There seemed to be no difference in the incidence of injury whether the nerves were seen or palpated. It is recommended that indirect laryngoscopy be performed in the course of evaluating thyroid disorders.
Humans↗
Laryngeal abductor function after recurrent laryngeal nerve injury in cats.
OBJECTIVE: To determine the influence of severity of neural injury of t he recurrent laryngeal nerve on recovery of laryngeal abductor function and the importance of synkinesis. DESIGN: The recovery of laryngeal abductor function was studied in 30 cats after crushing (second-degree injury) or transection followed by neurorrhaphy (fifth-degree injury) of the recurrent laryngeal nerve, with a reinnervation period of 10 weeks. MAIN OUTCOME MEASURES: Recovery of laryngeal abductor function was evaluated by videolaryngoscopy of spontaneous laryngeal abduction during respiration and electromyography of the posterior cricoarytenoid and vocalis muscles. Neural lesions were applied unilaterally, and recovery of laryngeal function was compared with the contralateral unimpaired hemilarynx. Reinnervation was confirmed by histologic examination. RESULTS: After the recurrent laryngeal nerve was crushed, laryngeal abductor function was similar to normal after a 10-week reinnervation period in 19 of the 20 cats; after neurorrhaphy, no notable recovery of laryngeal abduction resulted in any of 10 cats. Electromyographic recordings disclosed synkinesis after neurorrhaphy and recovery of normal activity patterns after crush injuries. CONCLUSIONS: Severity of neural injury to the recurrent laryngeal nerve influences the recovery of laryngeal abductor function. Damage to the endoneurium leads to misdirection of regenerating axons, inappropriate reinnervation, and synkinesis. No effective laryngeal function can then be expected.
Animals↗
Microsurgical technique as a method for prevention of recurrent laryngeal nerve injury in thyroid surgery. Review of seven consecutive cases.
INTRODUCTION: Vocal cord paresis or paralysis due to iatrogenic injury of the recurrent laryngeal nerve is one of the main problems in thyroid surgery. Although many procedures have been introduced to prevent the nerves from lesion the incidence of recurrent laryngeal nerve palsy varies between 1.5-14%. The aim of the study was to evaluate the role of the microsurgical technique as a method, which can help the surgeon to identify the recurrent laryngeal nerve in the operative field. MATERIAL AND METHODS: Fourteen nerves in 7 patients were identified with Zeiss multidiscipline universal surgical microscope with a 250-mm ocular lens. All were female patients with mean age of 35 years (Range 16-53) and diagnosis papillary cancer. They were admitted and operated in the Department of Ear, Nose, and Throat Diseases of the Higher Medical Institute in Plovdiv, Bulgaria. RESULTS: In all patients the recurrent laryngeal nerves were successfully identified along their whole length from the inferior thyroid artery to their entering the laryngeal muscles. None of the patients had temporary or permanent vocal cord palsy. CONCLUSION: Microsurgical technique could be a procedure of great value for prevention of the recurrent laryngeal nerves during thyroid surgery, especially in reoperations, thyroid cancer or retrosternal goitre.
Adolescent↗
Adenoviral GDNF gene transfer enhances neurofunctional recovery after recurrent laryngeal nerve injury.
To assess the possibility of gene therapy for recurrent laryngeal nerve (RLN) injury, we examined functional and histological recovery after glial cell line-derived neurotrophic factor (GDNF) gene transfer in a rat RLN crush model. Adenoviral vector encoding beta-galactosidase gene (AxCALacZ) or human GDNF gene (AxCAhGDNF) was injected into the crush site of the RLN. Neurons in the nucleus ambiguus on the crushed side were labeled with X-gal or GDNF immnohistochemistry after AxCALacZ or AxCAhGDNF injection. Reverse transcription-polymerase chain reaction analysis revealed expression of human GDNF mRNA transcripts in brainstem tissue containing the nucleus ambiguus on the crushed side after AxCAhGDNF injection. Animals injected with AxCAhGDNF displayed significantly improved motor nerve conduction velocity of the RLN and recovery rate of vocal fold movement at 2 and 4 weeks after treatment as compared to controls. AxCAhGDNF-injected animals showed a significantly larger axonal diameter and improved remyelination in crushed RLN as compared to controls. Adenoviral GDNF gene transfer may thus promote laryngeal function recovery after RLN injury. Inoculation of adenoviral vector containing the GDNF gene at the site of damage soon after nerve injury may assist patients with laryngeal paralysis caused by nerve injury during head and neck surgery.
Adenoviridae↗
[Recurrent laryngeal nerve injury following thyroid surgery].
The permanent lesion of damaged recurrent laryngeal nerve (RLN) often manifests as an irreversible dysfunction of phonation and is the most common complication following thyroid surgery. The frequency of this complication ranges from 0.5 to 5% in different thyroid surgery centres and increases in case of both recurrent goiter and complete thyroidectomy due to thyroid cancer. The RLN lesion varies from irreversible, persistent and transient dysfunction with good prognosis of complete recovery. The time of RLN function recovery ranges from several weeks to two years (mainly 6 months). The aim of this study was to evaluate early and persistent RLN paralysis. We operated in our clinic 2323 patients between 1994 and 1997. 2137 patients were operated for the first time due to benign goiter. On the 3rd post-operative day 190 patients (8.9%) presented RLN paralysis of different grade. The follow-up examination (indirect laryngoscopy) was performed in 100 patients with early RLN paralysis in the period between 6 months and 3 years after surgery. The complete RLN recovery was diagnosed in 78%. The permanent paralysis was diagnosed in 1.9% of operated patients. In the light of law and medical aspects we suggest obligatory laryngological examination with the evaluation of vocal cords mobility before surgery and on the 3rd post-operative day in order to identify early RLN lesion. Permanent RLN paralysis may be diagnosed on the basis of multiple laryngological examination in the period between 3 and 24 months after surgery.
Adolescent↗
Recurrent laryngeal nerve injury with the laryngeal mask.
We report a case of recurrent laryngeal nerve injury after anesthesia with the LMA and review the published cases of major pharyngolaryngeal morbidity. Prevention of this and other pharyngolaryngeal injuries probably depends on the skilled application of the correct insertion technique and the use of low intracuff pressures and volumes.
Aged↗
[Laryngeal reinnervation for unilateral recurrent laryngeal nerve injuries caused by thyroid surgery].
OBJECTIVE: To explore the protocols and effects of laryngeal reinnervation for unilateral recurrent laryngeal nerve (RLN) injury caused by thyroid surgery. METHODS: Different protocols of laryngeal reinnervation were performed upon 29 patients with unilateral recurrent laryngeal nerve injury caused by thyroid surgery, just coming on to with a course of 2 years, including nerve decompression upon 8 cases, end to end anastomosis of recurrent laryngeal nerve upon 6 cases, and anastomosis of main branch of ansa cervicalis to recurrent laryngeal nerve upon 15 cases. All were been subjected to preoperative and postoperative voice recording, acoustic analysis, videolaryngoscopy, stroboscopy and electromyography. RESULTS: Nerve decompression had restored the normal functional adductory and abductory motion of the vocal cord in 5 patients with a course of less than four months. Although functional motion of vocal cord had not been recovered in three patients who received nerve decompression, 2 being with a course of longer than 4 months and one with a course of less than 4 months, and in all cases who received ansa cervicalis anastomosis and end to end anastomosis of recurrent laryngeal nerve, these procedures resulted in medialization of vocal cords except in two cases, one receiving ansa cervicalis anastomosis, and the other receiving end to end anastomosis of RLN. Acoustic parameters (Jitter, Shimmer, NNE) measured 6 months after operation of any kind all returned to normal, however, without significant difference among different groups (P > 0.05). The amplitude of evoked potential of reinnervated laryngeal muscles was significantly greater in the group of nerve decompression than in the group of end to end anastomosis of RLN and group of ansa cervicalis anastomosis (both P < 0.05). However, the amplitude of evoked potential of reinnervated laryngeal muscles between the latter two groups was not significantly different (P > 0.05). Except in one case in the end to end anastomosis of RLN group and one case in the ansa cervicalis anastomosis group, the mass and tension of the reinnervated vocal cord became much the same as the contralateral normal vocal cord and symmetric vibration of the vocal cords and physiological phonation were recovered in all cases. CONCLUSION: (1) Nerve decompression is the best procedure in laryngeal reinnervation. (2) Main branch of ansa cervicalis anastomosis and end to end anastomosis of RLN effectively restore the laryngeal vocalization. (3) Selection of the laryngeal reinnervation protocols should depend on the course, severity and type of nerve injury.
Adult↗
VATS with a supraclavicular window for huge substernal goiter: an alternative technique for preventing recurrent laryngeal nerve injury.
A careless attempt to remove a huge substernal goiter using the cervical approach can lead to recurrent laryngeal nerve injury, which has been consistently reported after the surgery. We present an alternative and less invasive technique combining video-assisted thoracoscopic surgery (VATS) with a supraclavicular approach. This technique seems to offer improved exposure and reliable control of the neuro-vascular structures in the anterior mediastinum when resecting a huge substernal goiter that may prevent nerve injury.
Aged↗
[Surgical treatment of recurrent laryngeal nerve injury caused by thyroid operation].
OBJECTIVE: To study the surgical treatment of recurrent laryngeal nerve (RLN) injury caused by thyroid operation. METHODS: From 1970 to 2001, 50 patients with RLN injury were caused by thyroid operation. The causes, location, type, operative procedures and follow-up were retrospectively analyzed. RESULTS: Unilateral RLN injury occurred in 46 cases and bilateral nerve injury in 4 cases. The RLN injuries were located within 2cm below the point of RLN entering to throat in 45 nerves (83.3%), other places in 6 nerves (11.3%), and unknown location in 3 nerves (5.4%). Transection of the nerve was found in 19 nerves (36.5%), suture or scare pressing the nerve in 35 nerves (64.8%). All the injured nerves were repaired surgically. Meanwhile all 4 patients with bilateral RLN injuries underwent tracheotomy. Of the 50 cases, 44 cases (88.0%) were followed up for more than 1.5 years. Among the 44 followed-up patients, phonation was restored to normal or obvious improvement in 42 cases (95.5%), and improvement in 2 (4.5%). Of the 35 patients with 39 nerves underwent indirect or direct laryngoscopy, the affected vocal cord movement entirely recovered in 21 cords (53.8%), partially recovered in 7 cords (17.9%), uncovered in 11 cords (28.3%). There was no relation between the recovery of phonation or vocal cord movement with the timing or the procedure of repairing operation. CONCLUSIONS: The location of most RLN injuries caused by thyroid surgery are just below the point of RLN entering to throat, and most are mechanical injury, and need operation to resolve the cause. Once the RLN injury is made, an operation should be performed as early as possible.
Adult↗
Recurrent laryngeal nerve injury and preservation in thyroidectomy.
OBJECTIVE: We aim to evaluate the rates of recurrent laryngeal nerve (RLN) injury after thyroidectomy and to put forward the factors influencing the risk of RLN injury during thyroid surgery. METHODS: We retrospectively analyzed the records of 418 patients who underwent thyroid surgery for thyroid disease at the Turkish State Railway Hospital, Ankara and Gazi University Hospital between 1989-2003 for RLN injury and factors affecting this complication. Moreover, we evaluated 6 different types of operations used during surgical practice. Indirect laryngoscopy was performed preoperatively and was repeated postoperatively for all patients. RESULTS: Three hundred and thirty-nine (81.1%) were females and 79 (18.9%) were male. Indications for surgery were multinodular goiter in 253 cases, solitary nodule in 69, hyperthyroidism in 68, thyroid carcinoma in 5 and recurrent goiter in 23 cases. Bilateral subtotal thyroidectomy was performed in 286 cases (68.4%), unilateral subtotal thyroidectomy in 52 (12.4%), unilateral total thyroidectomy in 25 (5.9%), bilateral total thyroidectomy in 22 (5.3%), nodule excision in 10 (2.4%) and completion thyroidectomy for recurrent goiter in 23 (5.5%) cases. Unilateral vocal cord problems occurred, 16 (3.8%) cases and in 6 (1.2%) cases it became permanent. The distribution of permanent RLN paralysis over the cases was 0.04% multinodular goiter, 2.9% hyperthyroidism and 8.7% recurrent goiter (p<0.05). Transient RLN paralysis rate was 2%, while permanent RLN paralysis rate was 0.03% for bilateral subtotal thyroidectomies. In addition, in unilateral total thyroidectomies, transient RLN paralysis was 12% while permanent paralysis was 4%. For bilateral total thyroidectomies, 13.6% was transient and 9% was permanent RLN paralysis and 13% was transient and 8.7% was permanent paralysis for completion cases (p<0.05). CONCLUSION: We can avoid RLN injury during thyroid surgery by identifying the nerve and following its course carefully. Intraparenchymal dissection or subtotal excision can be performed if failure to identify RLN occur, and new operative techniques and medical management of benign thyroid diseases should be considered.
Adolescent↗
Intraoperative electromyogram monitoring of the recurrent laryngeal nerve: experience with an intralaryngeal surface electrode. A method to reduce the risk of recurrent laryngeal nerve injury during thyroid surgery.
INTRODUCTION: A clinical method to localize the recurrent laryngeal nerve intraoperatively in order to minimize the risk of accidental injury is presented. METHODS AND RESULTS: By means of an electrode, the nerve was stimulated by a pulsed contact current. The resulting muscle potential was detected using an electrode placed in the larynx. We applied this technique during the time period between 1 January 1997 and 31 December 1998. In 96 cases of primary thyroid resection, the recurrent nerve was identified 167 times. The patients were operated on for nodular thyroid (n=85), Grave's disease (n=9) and malignant papillary goiter (n=2). Retrospectively, the rate of intraoperative nerve injury, equivalent to the rate of postoperative transient and permanent nerve palsy, was 1.04% in the 96 patients and 0.60% with respect to the 167 nerves at risk. The rate of failure of the method was 7.29%.
Electrodes, Implanted↗