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1.
Artigo em Chinês | MEDLINE | ID: mdl-33794611

RESUMO

Objective:To evaluate the risk factors for metastasis of the lymph nodes posterior to the right recurrent laryngeal nerve in thyroid micropapillary carcinoma(PTMC) by Meta-analysis. Methods:We searched domestic and foreign databases for relevant studies published up to June, 2020. Two independent reⅥewers performed literature screening and data extraction according to the inclusion and exclusion criteria. Then, Meta-analysis was performed using Revman 5.3 software. Results:A total of 5 articles were included, with a total of 1884 subjects.The results of the study showed that the rate of lymph node metastasis in PTMC Ⅵb area was 10.8% (203/1884). The risk factors for metastasis included patients' age <45 years old, male, right lobe tumor Diameter ≥0.5 cm, invading the envelope, Ⅵa lymph node metastasis. Conclusion:Ⅵb lymph node dissection is recommended when there exists age<45 years, male sex, right lobe tumor≥0.5 cm, capsular invasion or Ⅵa lymph node metastasis.


Assuntos
Carcinoma Papilar , Neoplasias da Glândula Tireoide , Carcinoma Papilar/cirurgia , Humanos , Linfonodos , Masculino , Pessoa de Meia-Idade , Esvaziamento Cervical , Nervo Laríngeo Recorrente , Estudos Retrospectivos , Fatores de Risco , Glândula Tireoide , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia
2.
BMC Surg ; 21(1): 172, 2021 Mar 30.
Artigo em Inglês | MEDLINE | ID: mdl-33785015

RESUMO

BACKGROUND: Systematic nodal dissection plays a crucial role in improving survival and staging in resectable non-small cell lung cancer (NSCLC) patients but at the cost of increasing the occurrence of recurrent laryngeal nerve injury. Technology should be improved to protect the recurrent laryngeal nerve (RLN) during surgery. METHODS: NSCLC patients who underwent video-assisted thoracic surgery (VATS) surgical treatment by the same surgeon at our hospital from January 2016 to December 2017 were included as the research subjects and were divided into an energy-device group and a non-energy-device group. Their procedures included anatomic pulmonary resection, normative N1 dissection, and systemic N2 dissection. RESULTS: The rate of metastatically involved recurrent laryngeal nerve lymph nodes (RLNLNs) was 5.19% (39/752). Dissection device, side of primary, FEV1, operative time and BMI were independent predictors of recurrent laryngeal nerve injury (RLNI) (hazard ratio (HR) = 3.576, 95% confidence interval (CI): 1.490-8.583, P = 0.004; HR = 0.175, 95% CI: 0.072-0.424, P = < 0.001; HR = 3.008, 95% CI: 1.30-6.927, P = 0.010; HR = 0.328, 95% CI: 0.136-0.794, P = 0.013; HR = 0.344, 95%CI: 0.147-0.801, P = 0.013, respectively). Patients in the non-energy-device group had significantly less RLNI than the energy-device group (P = 0.016) and nearly half of the non-thermal RLNI recovered in 2 weeks (P = 0.025) whereas most thermal RLNI required 3 months for recovery. CONCLUSIONS: Every station of RLNLN had some degree of cancer metastasis in NSCLC patients and when dissecting RLNLNs, dissection device was an independent and artificially controlled predictor of RLNI. Using a non-energy device is a feasible method to protect the RLN as well as an improved recovery time of RLNI.


Assuntos
Carcinoma Pulmonar de Células não Pequenas , Neoplasias Pulmonares , Linfonodos , Nervo Laríngeo Recorrente , Cirurgia Torácica Vídeoassistida , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Estudos de Viabilidade , Humanos , Neoplasias Pulmonares/cirurgia , Linfonodos/patologia , Linfonodos/cirurgia , Nervo Laríngeo Recorrente/patologia , Nervo Laríngeo Recorrente/cirurgia , Cirurgia Torácica Vídeoassistida/métodos
3.
Endocr Pract ; 27(1): 15-20, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33471728

RESUMO

OBJECTIVE: Some surgeons believe that dissection posterior to the right recurrent laryngeal nerve lymph node (PRRLN-LN) is unnecessary for the low metastasis rate and high complication risk. However, persistent metastatic lymph nodes may have a higher recurrence rate, surgical risk, and complications. Thus, it is important to distinguish patients who require PRRLN-LN dissection. To identify the risk factors for lymph nodes posterior to the right recurrent laryngeal nerve metastasis (LN-prRLN) and establish a scoring system to help determine whether PRRLN-LN dissection is required in patients with papillary thyroid carcinoma. METHODS: 821 participants were randomly allocated to the development and validation cohorts in a 2:1 ratio. A nomogram-based predictive model for LN-prRLN was established based on the risk factors identified in the development cohort. RESULTS: LN-prRLN was diagnosed pathologically in 124 of 821 patients (15.1%) from the entire cohort. Multivariate analysis identified age (odds ratio [OR], 0.964; 95% CI, 0.945-0.983; P < .001), tumor size (OR, 1.536; 95% CI, 1.135-2.079; P = .005), extrathyroidal extension (OR 2.271, 95% CI, 1.368-3.770; P = .002), clinically involved right central compartment lymph node metastasis (OR 1.643, 95% CI, 1.055-2.559; P = .028), and right lateral lymph node metastasis (OR 4.271, 95% CI, 2.325-7.844; P < .001) as the predictors of LN-prRLN. A risk model was established and well validated. Calibration curves to evaluate the nomogram in both the development and validation cohorts revealed a concordance index of 0.756 ± 0.058 and 0.745 ± 0.042, respectively. CONCLUSION: Our scoring system may be useful for helping the surgeons decide which patients should undergo the dissection of PRRLN-LN.


Assuntos
Carcinoma Papilar , Carcinoma , Neoplasias da Glândula Tireoide , Carcinoma/cirurgia , Carcinoma Papilar/epidemiologia , Carcinoma Papilar/cirurgia , Humanos , Linfonodos , Esvaziamento Cervical , Recidiva Local de Neoplasia , Nervo Laríngeo Recorrente , Estudos Retrospectivos , Câncer Papilífero da Tireoide/epidemiologia , Neoplasias da Glândula Tireoide/epidemiologia , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia
5.
Rev Med Suisse ; 16(709): 1845-1848, 2020 Oct 07.
Artigo em Francês | MEDLINE | ID: mdl-33026725

RESUMO

The surgical management of unilateral and bilateral vocal cord paralysis depends on the severity of the condition, the potential for spontaneous recovery, the patient's age and vocal expectations. Standardized re-innervation surgeries, unilateral non-selective and bilateral selective, are viable alternatives to static procedures currently under evaluation in prospective studies. Neurorraphy of the ansa cervicalis loop to the recurrent laryngeal nerve allows lasting vocal recovery and potentially superior results to medialization and thyroplasty, by maintaining the visco-elastic properties of the vocal cord and preventing its atrophy. Selective bilateral reinnervation shows potential for recovery of inspiratory abduction with improved respiratory function without vocal deterioration.


Assuntos
Laringe/cirurgia , Nervo Laríngeo Recorrente/cirurgia , Paralisia das Pregas Vocais/cirurgia , Prega Vocal/cirurgia , Humanos , Estudos Prospectivos
6.
Rev Med Suisse ; 16(709): 1849-1852, 2020 Oct 07.
Artigo em Francês | MEDLINE | ID: mdl-33026726

RESUMO

For safe procedures, the surgeon performing thyroid gland surgeries must know precisely the anatomical relationships of the inferior laryngeal nerve with other cervical structures, in particular the inferior laryngeal artery and its branches. Classic descriptions of these relationships are based almost exclusively on the observation of Caucasian populations. However, this study shows that there are important differences between Caucasian and Sub-Saharian ethnic group, differences that any surgeon having the opportunity to operate in Africa should know to limit the risk of iatrogenic nerve damage and its morbid consequences.


Assuntos
Grupo com Ancestrais do Continente Africano , Artérias/cirurgia , Grupos Étnicos , Nervo Laríngeo Recorrente/cirurgia , Glândula Tireoide/cirurgia , África/etnologia , Grupo com Ancestrais do Continente Europeu , Humanos , Laringe/irrigação sanguínea , Laringe/cirurgia
7.
PLoS One ; 15(8): e0237231, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32853250

RESUMO

In this study, we examined the effect of differing gap lengths on regeneration of transected recurrent laryngeal nerves using silicon tubes containing type I collagen gel and the ability of this regeneration to result in restoration of vocal fold movements in rats. We simulated nerve gaps in Sprague-Dawley rats by transecting the left recurrent laryngeal nerves and bridged the nerve stumps using silicon tubes containing type 1 collagen gel. Three experimental groups, in which the gap lengths between the stumps were 1, 3, or 5 mm, were compared with a control group in which the nerve was transected but was not bridged. After surgery, we observed vocal fold movements over time with a laryngoscope. At week 15, we assessed the extent of nerve regeneration in the tube, histologically and electrophysiologically. We also assessed the degree of atrophy of the thyroarytenoid muscle (T/U ratio). Restoration of vocal fold movements was observed in 9 rats in the 1-mm group, in 6 rats in the 3-mm group, and in 3 rats in the 5-mm group. However, in most rats, restoration was temporary, with only one rat demonstrating continued vocal fold movements at week 15. In electromyograph, evoked potentials were observed in rats in the 1-mm and 3-mm groups. Regenerated tissue in the tube was thickest in the 1-mm group, followed by the 3-mm and 5-mm groups. The regenerated tissue showed the presence of myelinated and unmyelinated nerve fibers. In assessment of thyroarytenoid muscle atrophy, the T/U ratio was highest in the 1-mm group, followed by the 3-mm and 5-mm groups. We successfully regenerated the nerves and produced a rat model of recurrent laryngeal nerve regeneration that demonstrated temporary recovery of vocal fold movements. This rat model could be useful for assessing novel treatments developing in the future.


Assuntos
Colágeno/uso terapêutico , Regeneração Nervosa , Traumatismos do Nervo Laríngeo Recorrente/terapia , Nervo Laríngeo Recorrente/fisiopatologia , Animais , Materiais Biocompatíveis/química , Colágeno/administração & dosagem , Modelos Animais de Doenças , Géis/administração & dosagem , Géis/uso terapêutico , Masculino , Regeneração Nervosa/efeitos dos fármacos , Ratos , Ratos Sprague-Dawley , Nervo Laríngeo Recorrente/fisiologia , Traumatismos do Nervo Laríngeo Recorrente/fisiopatologia , Silício/química
8.
Spine Deform ; 8(5): 1135-1137, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32350759

RESUMO

PURPOSE: The aim of the present work is to present a rare case of Tapia's syndrome (hypoglossal and recurrent laryngeal nerve apraxia) following cervical spine surgery with tracheostomy. METHODS: Clinical data were collected from patient's medical records. RESULTS: After uneventful cervical spine surgery with tracheostomy, the patient reported mild dysphagia and dysphonia. Clinical examination and electromyography confirmed unilateral hypoglossal and recurrent laryngeal disfunction, contralateral to surgical access. Neural damage was transitory and full functional recovery was achieved within 12 months. CONCLUSION: Tapia's syndrome can be a rare complication of cervical spine surgery with tracheostomy, due to multiple factors, including tracheostomy cuffed cannula and cervical spine position during surgery.


Assuntos
Apraxias/etiologia , Vértebras Cervicais/cirurgia , Doenças dos Nervos Cranianos/etiologia , Discotomia/efeitos adversos , Doenças do Nervo Hipoglosso/etiologia , Complicações Pós-Operatórias/etiologia , Nervo Laríngeo Recorrente , Traqueostomia/efeitos adversos , Feminino , Humanos , Pessoa de Meia-Idade , Síndrome
9.
BMC Surg ; 20(1): 86, 2020 May 04.
Artigo em Inglês | MEDLINE | ID: mdl-32366237

RESUMO

BACKGROUND: Double aortic arch (DAA) is a congenital anomaly of the aorta. Esophageal cancer with DAA is rare, and consequently, the appropriate surgical approach has not been standardized. Herein, we report the utilization of intraoperative neurological monitoring (IONM) system to preserve the function of the recurrent laryngeal nerve. CASE PRESENTATION: A 79-year-old man with esophageal cancer was diagnosed with DAA incidentally. The descending aorta was located on the right side of the thoracic vertebrae. Safe dissection of the mediastinal lymph nodes was difficult using the right transthoracic approach because of the anatomical abnormalities. During surgery, we used cervical mediastinoscopy combined with the IONM system to preserve the bilateral recurrent laryngeal nerves. Severe complications, including recurrent nerve palsy, were not observed postoperatively. CONCLUSION: IONM may be useful for evaluation of the function of the recurrent laryngeal nerve, and it would be suitable for atypical cases of esophageal cancer.


Assuntos
Neoplasias Esofágicas/cirurgia , Monitorização Intraoperatória/métodos , Anel Vascular/diagnóstico , Idoso , Aorta/anormalidades , Aorta Torácica/anormalidades , Humanos , Linfonodos/patologia , Masculino , Mediastinoscopia , Nervo Laríngeo Recorrente/fisiologia
10.
Gan To Kagaku Ryoho ; 47(3): 505-506, 2020 Mar.
Artigo em Japonês | MEDLINE | ID: mdl-32381930

RESUMO

Intraoperative identification of the parathyroid gland is very important during thyroid and parathyroid surgery.Recently, intrinsic fluorescence of the parathyroid gland was identified and reported.We report the case of a 45-year-old woman with thyroid papillary cancer.Before surgery, neck and chest CT showed a thyroid tumor(20mm)of the right lobe and an aberrant right subclavian artery.Her thyroid cancer(T1N1M0, Stage Ⅰ)was resected in December 2017(right lobectomy and lymph node dissection).During surgery, her parathyroid glands were visually inspected by the surgeon as well as by a ready-made photodynamic eye(PDE-neo)system.Diagnosis was performed using the intraoperative fast pathological method.Her inferior laryngeal nerve was non-recurrent(Toniato ⅡA).This photodynamic eye(PDE-neo)system is an effective and useful method that decreases the operation time and enables faster detection of the parathyroid gland.


Assuntos
Câncer Papilífero da Tireoide , Neoplasias da Glândula Tireoide , Feminino , Fluorescência , Humanos , Pessoa de Meia-Idade , Glândulas Paratireoides , Nervo Laríngeo Recorrente , Câncer Papilífero da Tireoide/diagnóstico , Neoplasias da Glândula Tireoide/diagnóstico
11.
Medicine (Baltimore) ; 99(19): e20138, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32384495

RESUMO

BACKGROUND: More surgeons have known the importance of parathyroid grand and recurrent laryngeal nerve protection in the surgery, but there is still plenty of scope to improve the surgical techniques. This study aims at investigating whether the improved method of finding recurrent laryngeal nerve (RLN) can protect parathyroid grand and RLN. METHODS: One hundred fifty-eight patients were enrolled and divided randomly into the test and control group according to different methods of finding RLN in the surgery. In the experimental group the author could quickly find the laryngeal recurrent nerve in the lower part of the neck and separate along the surface of the recurrent laryngeal nerve to the point where the recurrent laryngeal nerve gets into the larynx close to the thyroid gland named lateral approach, while in the control group the author severed the middle and lower thyroid vein and raised the lower thyroid pole to look for the RLN near the trachea by the blunt separation. RESULTS: The author identified 152 and 159 parathyroid glands in the test and control group, respectively and there were a lower ratio of auto-transplantation and less operative time in the test group compared with that in the control group. The author also found that the parathyroid hormone level (1 day and 2 months) in the test group was higher than that in the control group. There were no differences in metastatic LN and recurrent laryngeal nerve palsy in the 2 groups. CONCLUSION: The improved method of finding RLN is a simple, efficient and safe way, and easy to implement.


Assuntos
Nervo Laríngeo Recorrente/anatomia & histologia , Câncer Papilífero da Tireoide/cirurgia , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia/métodos , Adulto , China , Feminino , Humanos , Hipoparatireoidismo/tratamento farmacológico , Hipoparatireoidismo/etiologia , Metástase Linfática/patologia , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Glândulas Paratireoides/anatomia & histologia , Complicações Pós-Operatórias/epidemiologia , Câncer Papilífero da Tireoide/patologia , Neoplasias da Glândula Tireoide/patologia
12.
Sci Rep ; 10(1): 7609, 2020 05 06.
Artigo em Inglês | MEDLINE | ID: mdl-32376878

RESUMO

Intraoperative neuromonitoring (IONM) facilitates recurrent laryngeal nerve (RLN) protection in thyroid and parathyroid surgeries. This study aimed to investigate a novel transcutaneous electromyography (EMG) recording method for IONM of the RLN during minimally invasive parathyroidectomy (MIP). Twenty patients with primary hyperparathyroidism undergoing MIP were enrolled. Two paired needle electrodes were percutaneously inserted into the bilateral laminas of thyroid cartilage for monitoring the vagus nerve and RLN. A standardized IONM procedure (V1-R1-R2-V2 signals) was strictly followed, and the RLN was routinely located and mapped. Pre- and postoperative laryngofiberoscopy was performed to confirm vocal cord function. The proposed technique was successfully used in all patients, and typical EMG signals were effectively detected. No significant change in EMG signals before and after tumor resection was noted, and a normal vocal cord movement was ensured in all patients with postoperative laryngofiberoscopy. IONM helped localize the position of the RLN and facilitated the safe resection of the parathyroid tumor during MIP. The novel transcutaneous EMG recording method proposed in this study was feasible, convenient, reliable, and inexpensive.


Assuntos
Eletromiografia , Procedimentos Cirúrgicos Minimamente Invasivos , Paratireoidectomia , Nervo Laríngeo Recorrente/fisiologia , Adulto , Idoso , Feminino , Humanos , Período Intraoperatório , Masculino , Pessoa de Meia-Idade
13.
Sci Rep ; 10(1): 8437, 2020 05 21.
Artigo em Inglês | MEDLINE | ID: mdl-32439970

RESUMO

We adopted a vision-based tracking system for augmented reality (AR), and evaluated whether it helped surgeons to localize the recurrent laryngeal nerve (RLN) during robotic thyroid surgery. We constructed an AR image of the trachea, common carotid artery, and RLN using CT images. During surgery, an AR image of the trachea and common carotid artery were overlaid on the physical structures after they were exposed. The vision-based tracking system was activated so that the AR image of the RLN followed the camera movement. After identifying the RLN, the distance between the AR image of the RLN and the actual RLN was measured. Eleven RLNs (9 right, 4 left) were tested. The mean distance between the RLN AR image and the actual RLN was 1.9 ± 1.5 mm (range 0.5 to 3.7). RLN localization using AR and vision-based tracking system was successfully applied during robotic thyroidectomy. There were no cases of RLN palsy. This technique may allow surgeons to identify hidden anatomical structures during robotic surgery.


Assuntos
Realidade Aumentada , Traumatismos do Nervo Laríngeo Recorrente/prevenção & controle , Nervo Laríngeo Recorrente/anatomia & histologia , Procedimentos Cirúrgicos Robóticos/métodos , Cirurgia Assistida por Computador/métodos , Câncer Papilífero da Tireoide/cirurgia , Neoplasias da Glândula Tireoide/cirurgia , Adulto , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Nervo Laríngeo Recorrente/cirurgia , Câncer Papilífero da Tireoide/patologia , Neoplasias da Glândula Tireoide/patologia , Tireoidectomia
14.
J Vis Exp ; (158)2020 04 21.
Artigo em Inglês | MEDLINE | ID: mdl-32391811

RESUMO

Electromyography (EMG) measures the muscle response to electrical stimulation or spontaneous activity of motor units and plays an important role in assessing neuromuscular function. Chronic recording of EMG activity reflecting a muscle's reinnervation status after nerve injury has been limited, due to the invasive nature of traditional EMG recording techniques. In this regard, an implantable system is designed for long-term, in vivo EMG recording and nerve stimulation. It has been applied and tested in a study on reinnervation of laryngeal muscles. This system consists of 1) two bipolar electrode nerve cuffs and leads for stimulating each of two nerves: the recurrent laryngeal nerve (RLN) and internal branch of the superior laryngeal nerve (SLN); 2) two EMG recording electrodes and leads for each of the two laryngeal muscles: posterior cricoarytenoid (PCA) muscle and thyroarytenoid-lateral cricoarytenoid (TA-LCA) muscle complex; and 3) a skin receptacle interfacing all implanted lead terminals to an external recording preamplifier and stimulator using a connection cable. The wire leads are Teflon-coated, multi-filament, type 316 stainless steel. They are coiled and can stretch during body movement of the awake animal to prevent lead breakage and electrode migration. This system is implanted during an aseptic surgery. Afterwards, baseline EMG recordings are performed before the RLN is transected in the second surgery to study muscle reinnervation. Throughout the study, multiple physiological sessions are conducted in the anesthetized animal to obtain evoked and spontaneous EMG activity that reflects the reinnervation status of laryngeal muscles. The system is compact, free of infection over the course of the study, and highly durable. This implantable system can provide a reliable platform for research in which long-term recording or nerve stimulation is required in an anesthetized or freely moving animal.


Assuntos
Eletromiografia/métodos , Monitoração Neuromuscular/métodos , Próteses e Implantes , Animais , Estimulação Elétrica , Eletrodos Implantados , Eletromiografia/instrumentação , Músculos Laríngeos/inervação , Músculos Laríngeos/fisiologia , Monitoração Neuromuscular/instrumentação , Nervo Laríngeo Recorrente/fisiologia
15.
J Laparoendosc Adv Surg Tech A ; 30(5): 488-494, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32182158

RESUMO

Background: To compare the endoscopic thyroidectomy (ET) with the open thyroidectomy (OT) for patients with papillary thyroid carcinomas and share our experience of central lymph nodes dissection and recurrent laryngeal nerve exposure. Materials and Methods: From January 2015 to July 2017, 197 patients were enrolled in our hospital. Among them, 85 underwent ET and 112 underwent OT. The mean age of the patients was 38.15 ± 11.72 years in ET group and 47.79 ± 10.51 years in OT group. Unilateral thyroidectomy was performed in 47 patients of ET group and 63 patients of OT group. Bilateral thyroidectomy was performed in 38 patients of ET group and 49 patients of OT group. Intraoperative information, including operation time, hemorrhage, tumor size, capsular invasion, central LN metastasis, number of retrieved lymph nodes, hospital stay, cost, postoperative complication, and cosmetic satisfaction, was compared between the two groups. Results: The operation time of ET group was significantly longer (P < .05). There were no significant differences between the two groups in postoperative complications (P > .05). The patients in ET group were more satisfied with the cosmetic effects (P < .05). Conclusion: ET was a safe and effective alternative operation method for selected patients with papillary thyroid carcinomas.


Assuntos
Endoscopia/métodos , Câncer Papilífero da Tireoide/cirurgia , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia/métodos , Adolescente , Adulto , Idoso , Endoscopia/efeitos adversos , Endoscopia/economia , Feminino , Humanos , Tempo de Internação , Linfonodos/patologia , Linfonodos/cirurgia , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Esvaziamento Cervical/métodos , Invasividade Neoplásica , Duração da Cirurgia , Satisfação do Paciente , Complicações Pós-Operatórias/etiologia , Nervo Laríngeo Recorrente/cirurgia , Estudos Retrospectivos , Tórax , Câncer Papilífero da Tireoide/secundário , Neoplasias da Glândula Tireoide/patologia , Tireoidectomia/efeitos adversos , Tireoidectomia/economia , Carga Tumoral , Adulto Jovem
16.
Int J Pediatr Otorhinolaryngol ; 131: 109846, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31935629

RESUMO

OBJECTIVE: Injury of the recurrent laryngeal nerve (RLN) is the most frequent complication of thyroid and parathyroid (TP) surgery. Monitoring of the RLN in children is not widely studied as this is not a common disease in the pediatric population. The aim of our study was to evaluate the reliability, feasibility and benefits of RLN monitoring during TP surgery in children. METHODS: We analyzed all children who underwent TP surgery in our department between January 2009 and March 2018. Patients were classified into three groups: without monitoring (group 1), monitoring with an endotracheal tube (group 2) and monitoring with a double-needle electrode placed through the cricothyroid ligament (group 3). RESULTS: We performed 53 surgeries (77 RLNs at risk) on 47 patients aged between 6 months and 18 years. Fourteen RLNs were in group 1, 47 in group 2 and 16 in group 3. We found one transient lesion of the RLN in group 1, three in group 2 and two in group 3. Seven patients in group 3 could not undergo monitoring with the tube because they need an orotracheal tube smaller than the smallest monitoring tube size available. The sensitivity and specificity values of the monitoring methods were 33% and 97% in group 2 and 67% and 100% in group 3, respectively. The positive and negative predictive values were 50% and 95% in group 2 and 100% and 92% in group 3, respectively. No complications arose during insertion of the electrode through the cricothyroid ligament. CONCLUSION: Monitoring of the RLN with a double-needle electrode inserted through the cricothyroid ligament is a reliable method with no associated complication, which is achievable at any age.


Assuntos
Monitorização Intraoperatória , Paratireoidectomia/efeitos adversos , Traumatismos do Nervo Laríngeo Recorrente/fisiopatologia , Nervo Laríngeo Recorrente/fisiologia , Tireoidectomia/efeitos adversos , Adolescente , Criança , Pré-Escolar , Eletrodos , Eletromiografia/métodos , Estudos de Viabilidade , Feminino , Humanos , Lactente , Intubação Intratraqueal/efeitos adversos , Masculino , Monitorização Intraoperatória/métodos , Valor Preditivo dos Testes , Traumatismos do Nervo Laríngeo Recorrente/diagnóstico , Traumatismos do Nervo Laríngeo Recorrente/etiologia , Reprodutibilidade dos Testes
17.
Laryngoscope ; 130(7): 1770-1774, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-31782801

RESUMO

OBJECTIVES/HYPOTHESIS: We evaluated the efficacy of a vocal fold reconstruction technique using a vascularized autologous pedicled fat (PEFA) flap in a rabbit model of vocal fold paralysis. STUDY DESIGN: Animal model. METHODS: The study included 30 male New Zealand White rabbits; 20 received vocal fold reconstructions (PEFA group) and 10 served as normal controls (control group). The right recurrent laryngeal nerve was resected, and simultaneous PEFA flap reconstruction was performed. The PEFA flap, including a pre-epiglottic fat and thyroid perichondrium, was elevated and implanted through a window at the inferior border of the thyroid cartilage. Histological and high-speed video analyses of vocal fold vibration were performed 1 month after PEFA reconstruction. The maximum amplitude of vocal fold vibration and the dynamic glottal gap were used to assess vocal fold vibration. RESULTS: The histological findings showed that the lamina propria ratio (lamina propria pixels/total vocal fold pixels) and the total number of vocal fold pixels were similar between the PEFA and control groups. Vocal fold vibration analyses indicated that the maximum amplitude differences in the vibration were slightly lower in the PEFA group. However, the dynamic glottal gap of the vocal fold was not significantly different between the PEFA group and the control group. CONCLUSIONS: The PEFA flap vocal fold reconstruction technique maintained the vocal fold area without a significant reduction in vocal fold vibration in a rabbit model. LEVEL OF EVIDENCE: NA Laryngoscope, 130:1770-1774, 2020.


Assuntos
Procedimentos Neurocirúrgicos/métodos , Fonação/fisiologia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Nervo Laríngeo Recorrente/cirurgia , Retalhos Cirúrgicos , Paralisia das Pregas Vocais/cirurgia , Prega Vocal/cirurgia , Animais , Modelos Animais de Doenças , Masculino , Coelhos , Nervo Laríngeo Recorrente/fisiopatologia , Paralisia das Pregas Vocais/fisiopatologia , Prega Vocal/fisiopatologia
19.
Ann Otol Rhinol Laryngol ; 129(4): 355-360, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31735062

RESUMO

OBJECTIVES: Recurrent laryngeal nerve (RLN) injury may be a consequence of surgical procedures of the skull base, neck, and chest, with adverse consequences to function and quality of life. Laryngeal reinnervation offers a potentially stable improvement in vocal fold position and tone. The classic donor nerve is the ansa cervicalis, but is not always available due to damage or sacrifice during previous neck surgeries. Our objective was to introduce the nerve to the thyrohyoid (TH) muscle as an alternate donor nerve for reinnervation, which has not previously been described. METHODS: Case series of two patients using the TH nerve for laryngeal reinnervation after RLN injury, with description of surgical harvest. RESULTS: Follow-up results are available for 10 months (one patient) and 3 years (one patient) demonstrating both subjective and objective improvement in function. GRBAS scores were reduced. Maximal phonation time was improved. Patient rating of voice was stable or improved postoperatively. One patient described significant preoperative dyspnea which was significantly improved postoperatively, from a score of 24 to 10 out of 40 on the dyspnea handicap index. VHI was improved in one patient, but scores elevated in the other, despite a change from "moderately severe impairment" to "normal voice" subjectively. Neither patient experienced significant complications from the procedure. CONCLUSION: Laryngeal reinnervation procedures provide good outcomes in pediatric patients. When ansa cervicalis is not available as a donor nerve, the nerve to TH provides a reasonable alternative.


Assuntos
Complicações Intraoperatórias , Músculos Laríngeos , Transferência de Nervo/métodos , Qualidade de Vida , Traumatismos do Nervo Laríngeo Recorrente , Câncer Papilífero da Tireoide/cirurgia , Glândula Tireoide/inervação , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia/efeitos adversos , Adolescente , Feminino , Humanos , Complicações Intraoperatórias/fisiopatologia , Complicações Intraoperatórias/psicologia , Músculos Laríngeos/inervação , Músculos Laríngeos/fisiopatologia , Laringoscopia/métodos , Regeneração Nervosa , Nervo Laríngeo Recorrente , Traumatismos do Nervo Laríngeo Recorrente/fisiopatologia , Traumatismos do Nervo Laríngeo Recorrente/psicologia , Câncer Papilífero da Tireoide/patologia , Neoplasias da Glândula Tireoide/patologia , Tireoidectomia/métodos , Resultado do Tratamento , Qualidade da Voz
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