The value and related complications of lymph node dissection along bilateral recurrent laryngeal nerves in esophageal cancer patients / 中华肿瘤杂志

Esophageal cancer is one of the most common malignant tumors of digestive tract, lymph node metastasis is a frequently encountered metastasis in the esophageal cancer patients. The number of lymph node metastasis is reported as an important prognostic factor, and it also affects the choice of postoperative treatments in the esophageal cancer. It was reported that the recurrent laryngeal nerve lymph nodes are the most common sites of nodal metastasis and need to be completely dissected during the esophagectomy for thoracic esophageal cancers. Dissection of the lymph nodes along bilateral recurrent laryngeal nerves not only improves the accuracy of staging, but also improves postoperative survival of esophageal cancer patients due to reducing the local recurrence. However, it also brings problems such as injury of laryngeal recurrent nerves, and increases postoperative complications such as pulmonary complications and malnutrition due to aspiration and coughing. Therefore, it is necessary to preserve the structure and function of bilateral recurrent laryngeal nerves during esophagectomy through careful manipulations, and minimize the impact of complications in prognosis and quality of life from injury to the recurrent laryngeal nerve.

A Rare Case Of Bilateral Variant Ansa Cervicalis And Review Of Literature

Ansa cervicalis is a nerve loop that is embedded in the anterior wall of carotid sheath of the neck. It is formed bydescendent hypoglossi and descendens cervicalis. It supplies the infrahyoid muscles. During routine dissection,a rare variant in the morphology of Ansa cervicalis was observed in adult male cadaver. The variant ansacervicalis exhibited two loops, and was present bilaterally. The formation, course and relations of the nerve loopis complex. During literature search, we came across studies which propose different classifications. Hence wehave added a note on the different classifications.Ansa cervicalis is important since it can be used in nerve-nerve anastomosis, nerve-muscle pedicle implantationin relation to reconstructive surgeries of larynx. Hence, the knowledge of variations in the formation, anddistribution is relevant. It can affect the outcome during reinnervation surgeries following recurrent laryngealparalysis and surgeries around this area of neck.

Loud and clear: A case report on Ortner’s Syndrome (Cardiovocal Syndrome)

Introduction@#Ortner’s syndrome encompasses any intrathoracic process resulting to stretching of the recurrent laryngeal nerve. The stress to this nerve weakens the intrinsic muscles of the larynx and manifests as vocal hoarseness.@*Case@#A 46-year-old female was admitted due to progressive hoarseness. She tolerated this for six months until the onset of other symptoms like orthopnea, bipedal edema, and chest pain. She consulted various doctors and was initially diagnosed with chronic laryngitis from gastroesophageal reflux disease. She was given omeprazole and spironolactone that afforded little help. On examination, the precordium was dynamic with heaves and thrills, PMI was displaced, and systolic murmurs were heard. The ECG revealed left ventricular hypertrophy with left atrial abnormalities. Chest radiograph showed leftsided cardiomegaly. A 2D-echocardiogram divulged severe mitral regurgitation, anterior mitral valve leaflet thickening, and dilated left atrium. Therefore, the impression was Ortner’s syndrome, rheumatic heart disease. The patient underwent mitral valve replacement. She was given warfarin, bisoprolol, losartan, spironolactone, and vitamin B complex. At subsequent visits, she reported improvement in her voice. Penicillin injections were also given as secondary prophylaxis. A repeat 2D-echocardiogram displayed a decrease in size of the left atrium.@*Conclusion@#This case has emphasized three important points: First, a comprehensive history and physical examination is vital to reach the correct diagnosis. Second, once the common causes of hoarseness have been excluded yet symptoms persist, it is therefore prudent to look beyond the larynx. And third, the vocal cord paralysis experienced by the patient is just the tip of the iceberg. Her heart is the one dying to be heard.

Total and Near-total Thyroidectomy is Better Than Subtotal Thyroidecomy for the Treatment of Bilateral Bening Multinodular Goiter; A Prospective Analysis.

Objective: To analyze the safety and effectiveness of total thyroidectomy in the surgical management of bilateral benign multinodular goiter. Materials and Methods: A prospective review of patients with bilateral benign multinodular goiter undergoing subtotal thyroidectomy (Group 1), and near-total thyroidectomy and total thyroidectomy (Group 2) during 5-year period was undertaken. Patients’ demographics, indications for surgery, type of operation performed, final histological diagnosis and complications were recorded. Transient and permanent complications regarding hypoparathyroidism and recurrent laryngeal nerve paralysis were analyzed for each surgical procedure. Results: Out of a total of 207 patients, recurrence of benign multinodular goiter was recorded in 27 (30%) cases in group 1 while there was no recurrence in group 2 (p < 0.01). Completion thyroidectomies were performed in 31 (34%) patients in group 1 whereas none was required in group 2 (p < 0.01). Incidental thyroid malignancy was found to be 18% (n= 38/207) in this study which necessitated completion thyroidectomy in group 1 patients. Permanent hypoparathyroidism was documented in 4(4%) and 3(1.8%) and transient hypoparathyroidism in 5 (6%) and 4 (2.8%) cases in groups 1 and 2, respectively; p value not significant. Permanent hypoparathyroidism and transient RLN palsy were recorded in 9 (29%) and 8 (25%) patients, respectively in those patients who underwent second thyroid surgery (P < 0.05). Conclusion: Total or near-total thyroidectomy is effective and safe for the surgical treatment of bilateral multinodular goiter to prevent recurrence and to eliminate the need for completion thyroidectomy in case of final diagnosis of incidental thyroid malignancy.

Seihai-to Therapy in Two Cases of Relapsing Infection of Lower Airway Caused by Recurrent Laryngeal Nerve Paralysis / 日本東洋医学雑誌

We present here two cases of relapsing infection of the lower airway caused by the recurrent laryngeal nerve paralysis. Seihai-to offered useful palliation and symptom control in the two cases described below. Case 1 was a 50 year-old-man who received surgery and radiotherapy for a cervical tumor in 1970. Thereafter he suffered from cough reflex at meals and a hoarse voice. He has suffered from airway infection four or five times a year since 1992. In May 1995 he was hospitalized for pneumonia. Two more attacks of pneumonia followed in the next two months. Administration of Seihai-to provided a palliation period of 15 months at first and decreased frequency of recurrence to as few as three times during the follow-up period of 43 months; one was pneumonia and two were bronchitis. Case 2 was a 76-year-old man who received surgery and radiotherapy for lung cancer in the left upper lobe in 1984. Thereafter he suffered from cough, sputum, cough reflex at meals, and hoarse voice. Lower airway infection was exacerbated five or six times a year since 1984. He was hospitalized for pneumonia in May 1997 and March 1998, and came to our hospital asking for Kampo therapy in April 1998. Administration of Seihai-to improved his symptoms and achieved a palliation period of 8.5 months. The original text “Man-byo-kai-shun” mentioned that loss of voice is one of the indications of Seihai-to. We took notice of hoarse voice in the two cases at selection of formulae.