Background: The superior laryngeal nerve divides into two branches, external and internal at the level of the hyoid bone. The relationship of the external branch with the superior thyroid artery and the upper pole of the thyroid gland is variable. Due to this it is at risk of injury while ligating the superior pedicle during thyroidectomy.Methods: The position of the external laryngeal nerve in 110 patients undergoing thyroidectomy in a tertiary care center in south India over a period of one year was assessed. The nerves were identified by opening up the Reeve’s avascular plane near the superior pole of the thyroid gland. The positions were identified and classified based on Cernea’s classification. Data was analyzed using SPSS 16.0 version.Results: The nerve could be identified on the left side in 109 cases (99.1%) and 106 cases (96.4%) on the right side. Cernea’s IIa was the most common position on the left side (46.4%), followed by IIb (35.5%) and I (17.3%). On the right side IIb was the most common position (40%), followed by IIa (36.4%) and I (20%). Overall the most common position was IIa (41.36%).Conclusions: It is possible to identify the external laryngeal branch of the superior laryngeal nerve with careful dissection. Large proportion of the position of the external laryngeal nerve is IIB, which would be at very high risk of injury if the superior pedicle is ligated without identifying it.
CONTEXTThe corneal endothelial cells are incapable of regeneration. When the endothelial cell density falls below 500 cells/mm 2 , corneal decompensation occurs resulting in corneal oedema. Manual Small Incision Cataract Surgery (SICS) and phacoemulsification are two common techniques of cataract surgery followed.
AIMTo study the relationship between change in corneal endothelial cell density and the change in central corneal thickness before and after surgery in manual small incision cataract surgery versus phacoemulsification cataract surgery.
SETTINGS AND DESIGNDepartment of Ophthalmology, Govt. Medical College, Kottayam. Longitudinal study.
MATERIALS AND METHODSSubjects selected were patients admitted for cataract surgery (Manual small incision cataract surgery and phacoemulsification cataract surgery). The basic details of the patients and type of surgery going to be done were obtained. The endothelial cell count and central corneal thickness was measured (Using SP3000 P, TOPCON specular microscope with pachymeter on 3 occasions -1 day prior to surgery, one day after surgery and 4 weeks after surgery. The collected data was entered in excel and analysed using SPSS 16.0. The percentage decrease in endothelial cell count and increase in corneal thickness was calculated and compared among the two groups. Statistical analysis used, t test.
RESULTSAverage CCT of SICS and phaco group was comparable on postoperative day 1 (SICS -555.1 µ phaco -564.71 µ), day 7 (SICS 535.08 µ, phaco -539.43 µ), day 28 (SICS-520.04 µ, phaco -523.49 µ). Percentage loss of endothelial cells -6.78% in SICS and 5.49% in phacoemulsification on postoperative day 28.
CONCLUSIONSThere is no statistical significance in the decrease in endothelial cell count or increase in CCT between SICS and phacoemulsification.
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