The identification and dissection of the recurrent laryngeal nerve is essential to guarantee its anatomical and functional integrity. The superior approach of the recurrent nerve is a reliable surgical alternative. Various indications are recognized with a reliable landmark. This is the entry point into the larynx under the inferior horn of the thyroid cartilage. The limits of this technique, namely, the extralaryngeal divisions and the hemorrhages encountered at the point of entry of the larynx are a source of morbidity of the recurrent laryngeal nerve. A careful dissection, respect for the surgical steps, and the surgeon's experience are guarantees of a good result. We wanted through a review of the literature and our experience in the superior approach to discuss surgical indications, to identify landmarks at the point of entry of the larynx, to determine the limits of this approach, and to take precautions to mitigate the risk of recurrent laryngeal nerve injury.
Background: This study aims to study the epidemiological and therapeutic aspects of tympanic retraction pockets in the ENT-CCF department of the CHU GT. Method: This was a descriptive prospective study. Results: A total of 9400 patients consulted during the study period. A retraction pocket was diagnosed in 70 patients, i.e., 0.74% of all consultations. The most represented age group was that of [25-39 years]. The average age was 45.71 years. The extremes of ages were 10 years and 81 years. The female gender was the most represented, i.e., 60% with a sex ratio꞊0.67. CT of the petrous bone was performed in two patients. Medical treatment based on systemic corticosteroids and nasal decongestant was initiated in all our patients associated with quarterly monitoring for stage I charachon. The placement of a tympanostomy tube was performed in 8 patients classified (stage II of charachon). Cartilaginous tympanoplasty was performed in one patient, antroatticotomy associated with reinforcement tympanoplasty was performed in one patient (1.43%). Conclusions: The pockets of tympanic retraction constitute a particular nosological entity which deserves rigorous monitoring. The ENT surgeon will be faced with two major challenges: the erosion of the ossicular chain and their potential risk of progression towards cholesteatoma. The diversity of therapeutic options represents an issue that makes this entity a hot topic.
Objectives: We report two cases of a non-recurrent right inferior laryngeal nerve; per operative discovery during a thyroidectomy. Through these cases, we highlight the clinical and surgical implications by first analyzing the most appropriate technique. Results: The frequency of the recurrent non recurrent nerve was 1.3% with confidence interval between 0.2 and 4.6% in our center. We identified two patients who underwent a thyroidectomy, during which the discovery of the recurrent non-recurrent right nerve was made intraoperatively. The nerve approach was performed by the superior approach in front of a bulky and plunging goiter. The outcome was simple. Conclusion:The thyroid surgeon must keep in mind the probability of finding this nerve variation. For indirect signs, the superior approach would be the most suitable technique to avoid recurrent morbidity.
Objectives: We report two types of anatomical variations of the recurrent laryngeal nerve in two patients. Through these two patients we wanted to highlight our surgical approach of the recurrent nerve in an unusual position and to describe the surgical implication of these almost rare variations. Case report: patient aged 28 and 58 admitted for goiter. They underwent a right lobisthmectomy. Both recurrences were approached retrograde. The anatomical variations of the nerve concerned the non-recurrent laryngeal nerve in the first patient. In the second patient there were three anatomical variations, namely an extra laryngeal bifurcation of the nerve, a pre-vascular position of the nerve and a branch connecting the vagus nerve and the recurrent nerve. No recurrence nerve injury was noted. Conclusion: The anatomical variations of the nerve are numerous. A careful dissection is a guarantee of a good prognosis.
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