Extralaryngeal variants of the location of the recurrent laryngeal nerve. Clinical observation in thyroid surgery

Malyuga, Viktor Y.; Александрович, Куприн Александр

doi:10.14341/serg20173146-156

Cited by 3 publications

(3 citation statements)

References 18 publications

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“…Все авторы, изучающие данную проблему, единогласны в том, что НВГН повреждается в разы чаще нежели ВГН. В исследовании, включавшем 6000 пациентов, парезы гортани при НВГН отмечались в 13-14% случаях, тогда как при обычном расположении нерва -у 1,8% больных [3][4][5][6][7]. К сожалению, в связи с малой изученностью данной аномалии отсутствует и общепринятое анатомическое название, а в классических атласах анатомии подобная структура не упомянута вовсе.…”

Section: обоснованиеunclassified

“…При этом истинный ВГН во время оперативного вмешательства оставался незамеченным, что могло привести к повреждению последнего. Такие структуры названы термином «ложным НВГН» (false non-recurrent laryngeal nerve) [7,9,15]. В сомнительных ситуации незаменимым подспорьем можно считать УЗИ сосудов шеи, выполненное перед операцией.…”

Section: обсуждение основного результата исследованияunclassified

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Possibilities of preoperative ultrasound of neck vessels in the diagnosis of non-recurrent laryngeal nerve

Куприн¹,

Malyuga²

2020

Endo Serg

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Background: According to the anatomical data, the non-recurrent laryngeal nerve is a rather common abnormality and can be found in 4.78% of people. At the same time, the non-recurrent laryngeal nerve is difficult to visualize during surgery, which increases the risk of its damage. Aim: to determine the possibilities of ultrasound of neck vessels in the preoperative diagnosis of the aberrant right subclavian artery (arteria lusoria) and the abnormality of the branches of the vagus nerve. Materials and methods: An observational, single-center, single-stage, randomized, uncontrolled clinical trial was performed, which included patients in whom surgery was performed due to thyroid and parathyroid pathology. In the preoperative period, all patients underwent the ultrasound of the right half of the neck vessels and the mediastinum with visualization of the brachiocephalic trunk and its branches. When the brachiocephalic trunk was detected in the preoperative period, mobilization of the thyroid gland during operation was started with ligation of the upper pole vessels, and followed by a search for the recurrent laryngeal nerve. However, if the brachiocephalic trunk was absent, the right common carotid artery was traced as low as possible to the aortic arch and assessed on its relationship with the right subclavian artery. In such cases, thyroid mobilization was started from the lateral surface of the lobe with the necessary visualization of all structures of this region and followed by a primary search for the inferior laryngeal nerve. When the non-recurrent laryngeal nerve was detected, the computed tomography of the brachiocephalic arteries was performed in the postoperative period. Results: The study has shown that 202 (95.28%) patients out of the total 212 revealed the brachiocephalic trunk on preoperative ultrasound and the recurrent laryngeal nerve was located in a the typical place. Arteria lusoria was detected in 4 (1.89%) cases after the preoperative ultrasound. In this group of patients the non-recurrent laryngeal nerve was identified during operation and the aberrant right subclavian artery was confirmed at computed tomography. In 6 (2.83%) cases the brachiocephalic trunk could not be detected on ultrasound due to the constitutional features of the patient. However, in all these cases, the typical recurrent laryngeal nerve was identified during a surgery. Conclusions: The ultrasound of the neck vessels is the effective method to detect arteria lusoria, which is the predictor of the non-recurrent laryngeal nerve.

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Section: обоснованиеunclassified

Section: обсуждение основного результата исследованияunclassified

Possibilities of preoperative ultrasound of neck vessels in the diagnosis of non-recurrent laryngeal nerve

Куприн¹,

Malyuga²

2020

Endo Serg

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“…Также предположительно симпатическая иннервация играет важную роль в васкуляризации голо-совых складок и секреции желез слизистой оболочки. Однако влияние этих факторов на мобильность голосовых связок гортани остается неизвестным [34].…”

Section: а бunclassified

Anatomical landmarks of the external branch of the superior laryngeal nerve

Malyuga

Malyuga²,

Куприн³

et al. 2019

Endo Serg

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Background. The external branch of the superior laryngeal nerve innervates a cricothyroid muscle, which provides tension in vocal cords and formation of high-frequency sounds. When the nerve is damaged during surgery, patients may notice hoarseness, inability to utter high pitched sounds, “rapid fatigue” of the voice, and dysphagia. According to literature, paresis of an external branch of the superior laryngeal nerve reaches up to 58% after thyroid surgery. Aim: to identify permanent landmarks and topographic variations of the external branch of the superior laryngeal nerve. Materials and methods. The study is based on the autopsy material (21 complexes organs of the neck) and on identification of variations of 40 external branches of the superior laryngeal nerve. We identified two permanent landmarks that are located at the minimum distance from nerve and we made metrical calculations relative to them: oblique line of thyroid cartilage and tendinous arch of the inferior pharyngeal constrictor muscle. Results. The piercing point of the nerve is always located at the inferior pharyngeal constrictor muscle without protruding beyond the oblique line of thyroid cartilage superiorly and tendinous arch of the inferior pharyngeal constrictor muscle anteriorly. The nerve had the parallel direction in 92.8% of cases (angel less than 30 degrees) relative to the oblique line and in 85.7% cases it was in close proximity to this line (at distance up to 4 mm). The proposed topographic classification of the location of the external branch of the superior laryngeal nerve is based on localization of the piercing point of the nerve relative to the length of the oblique line of thyroid cartilage and the risk of nerve damage. In 14.2% of cases, the piercing point was in the front third of the line (type I), and in 50% it was in the middle third of this line (type II). These variations of the external branch of the superior laryngeal nerve was in close proximity to the upper pole of the thyroid gland, which could have lead to its damage during surgery. In type III and IV (35.8%) – the piercing point in the muscle was located as far as possible from the upper pole of the thyroid gland and the greater part of the nerve was covered with the fibers of inferior pharyngeal constrictor muscle. Conclusion. We identified the main orienteers for the search and proposed anatomical classification of the location of the external branch on the superior laryngeal nerve.

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Surgical anatomy of the external branch of the superior laryngeal nerve

Куприн¹,

Malyuga²

2021

Oper. khir.

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Extralaryngeal variants of the location of the recurrent laryngeal nerve. Clinical observation in thyroid surgery

Cited by 3 publications

References 18 publications

Possibilities of preoperative ultrasound of neck vessels in the diagnosis of non-recurrent laryngeal nerve

Possibilities of preoperative ultrasound of neck vessels in the diagnosis of non-recurrent laryngeal nerve

Anatomical landmarks of the external branch of the superior laryngeal nerve

Surgical anatomy of the external branch of the superior laryngeal nerve

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