Bilateral recurrent laryngeal nerve (RLN) palsies result in dyspnea and often require further surgery to secure an adequate airway for safe respiration. The present study was devised to determine a predictive value of laryngeal electromyography (LEMG) and if it has therapeutic consequences. In a retrospective study of 63 patients with bilateral recurrent laryngeal nerve palsies after thyroid gland surgery we compared the results of LEMG from the thyroarytenoid muscles with the spontaneous recovery rate of vocal cord mobility. A tracheostomy had to be performed in 18 patients because of unsafe dyspnea, while a unilateral lateral cord fixation had to be carried out in 20 patients. Primary thyroidectomies as treatment for benign goiters showed spontaneous normalization of unilateral or bilateral vocal cord mobility in 75% of cases versus 36% after revision thyroidectomies. Single LEMG correctly predicted prognosis in 78% of patients. In all, LEMG was found to be of value in the assessment of bilateral recurrent laryngeal nerve palsies. Findings also showed that a lateral cord fixation should be planned after a 9-month waiting period. When a patient refuses a tracheostomy lateral cord fixation can be performed at an earlier time, with the use of repeated LEMGs to predict whether or not a corrective surgery.
Study Design Systematic review. Objective The aim of this study was to conduct a systematic overview of the pathogenesis and the treatment options of combined odontoid and atlas fractures in geriatric patients. Methods This review is based on articles retrieved by a systematic search in the PubMed and Web of Science databases for articles published until February 2021 dealing with combination fractures of C1 and C2 in geriatric patients. Results Altogether, 438 articles were retrieved from the literature search. A total of 430 articles were excluded. The remaining eight original articles were included in this systematic review depicting the topics pathogenesis, non-operative treatment, posterior approach, and anterior approach. The overall level of evidence of the studies is low. Conclusion Combined odontoid and atlas fractures in the geriatric population are commonly caused by simple falls and seem to be associated with atlanto-odontoid osteoarthritis. Non-operative treatment with a cervical orthosis is a feasible treatment option in the majority of patients with stable C2 fractures. In case of surgery posterior C1 and C 2 stabilization and anterior triple or quadruple screw fixation are possible techniques. Some patients may also deserve an occipito-cervical fusion. A possible treatment algorithm is proposed.
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