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BACKGROUND: the main reason for postoperative vocal folds paresis is the variable anatomy of the recurrent laryngeal nerve. An example of such an “extreme form of embryonal development» is the non-recurrent laryngeal nerve. However, many surgeons consider this structure to be a rare anomaly with prevalence less than 0.5%. This opinion is associated with a six to seven-fold increase in the number of vocal folds paresis when a surgeon encounters with a non-recurrent laryngeal nerve. Meanwhile, in cadaveric studies a significantly higher prevalence of non-recurrent laryngeal nerve was demonstrated — 2.2%. The right aberrant subclavian artery was diagnosed during CT in 3.1% patients.AIM: the aim of the study is to determine the effectiveness of preoperative ultrasound in detecting the right aberrant subclavian artery and non-recurrent laryngeal nerve.MATERIALS AND METHODS: patients underwent thyroid and parathyroid surgery with identification of a right inferior laryngeal nerve. The preoperative neck ultrasound was performed on all patients with visualization of a brachiocephalic trunk (Y-sign) or a right aberrant subclavian artery (AL-sign). CT-angiography was performed in the postoperative period on patients who had a non-recurrent laryngeal nerve.RESULTS: the study included 1476 patients. The Y-sign was determined among 1338 (90.7%) patients. In these cases a typical anatomy of the recurrent laryngeal nerve was observed. In 138 (9.3%) cases, the Y-sign was not detected. In this subgroup of patients, in 20 (1.4%) cases, a non-recurrent laryngeal nerve and a right aberrant subclavian artery were noted. Thus, the sensitivity of the Y-sign in confirming the normal anatomy of the recurrent laryngeal nerve was 100%, specificity — 91.9%, positive prognostic value — 14.5%, negative prognostic value — 100%. On the contrary, AL-sign was notedall 20 (1.4%) patients with non-recurrent laryngeal nerve and right aberrant subclavian artery. False positive and false negative results were not observed. Three variants of the non-recurrent laryngeal nerve were identified: type I (superior type) — located behind the upper third of the thyroid lobe, has a direct descending way and forms an angle to the larynx of 30–50°; type III (inferior type) — has a direct ascending way (simulates the course of the recurrent laryngeal nerve) and forms an angle to trachea in 30–50°; type II (middle type) — all variants of the non-recurrent laryngeal nerve located between types I and III.CONCLUSION: the preoperative ultrasound detection of brachiocephalic trunk (Y-sign) confirms the presence of a recurrent laryngeal nerve (sensitivity 100%), and visualization of the right aberrant subclavian artery (AL-sign) determines a non-recurrent laryngeal nerve (sensitivity and specificity 100%).
BACKGROUND: the main reason for postoperative vocal folds paresis is the variable anatomy of the recurrent laryngeal nerve. An example of such an “extreme form of embryonal development» is the non-recurrent laryngeal nerve. However, many surgeons consider this structure to be a rare anomaly with prevalence less than 0.5%. This opinion is associated with a six to seven-fold increase in the number of vocal folds paresis when a surgeon encounters with a non-recurrent laryngeal nerve. Meanwhile, in cadaveric studies a significantly higher prevalence of non-recurrent laryngeal nerve was demonstrated — 2.2%. The right aberrant subclavian artery was diagnosed during CT in 3.1% patients.AIM: the aim of the study is to determine the effectiveness of preoperative ultrasound in detecting the right aberrant subclavian artery and non-recurrent laryngeal nerve.MATERIALS AND METHODS: patients underwent thyroid and parathyroid surgery with identification of a right inferior laryngeal nerve. The preoperative neck ultrasound was performed on all patients with visualization of a brachiocephalic trunk (Y-sign) or a right aberrant subclavian artery (AL-sign). CT-angiography was performed in the postoperative period on patients who had a non-recurrent laryngeal nerve.RESULTS: the study included 1476 patients. The Y-sign was determined among 1338 (90.7%) patients. In these cases a typical anatomy of the recurrent laryngeal nerve was observed. In 138 (9.3%) cases, the Y-sign was not detected. In this subgroup of patients, in 20 (1.4%) cases, a non-recurrent laryngeal nerve and a right aberrant subclavian artery were noted. Thus, the sensitivity of the Y-sign in confirming the normal anatomy of the recurrent laryngeal nerve was 100%, specificity — 91.9%, positive prognostic value — 14.5%, negative prognostic value — 100%. On the contrary, AL-sign was notedall 20 (1.4%) patients with non-recurrent laryngeal nerve and right aberrant subclavian artery. False positive and false negative results were not observed. Three variants of the non-recurrent laryngeal nerve were identified: type I (superior type) — located behind the upper third of the thyroid lobe, has a direct descending way and forms an angle to the larynx of 30–50°; type III (inferior type) — has a direct ascending way (simulates the course of the recurrent laryngeal nerve) and forms an angle to trachea in 30–50°; type II (middle type) — all variants of the non-recurrent laryngeal nerve located between types I and III.CONCLUSION: the preoperative ultrasound detection of brachiocephalic trunk (Y-sign) confirms the presence of a recurrent laryngeal nerve (sensitivity 100%), and visualization of the right aberrant subclavian artery (AL-sign) determines a non-recurrent laryngeal nerve (sensitivity and specificity 100%).
Aim to evaluate the correlation between the course of vertebral arteries and veins and the results of calculations of hemodynamic parameters during ultrasound with functional tests. Material and methods. In the observation, 252 volunteers were examined using Samsung SonoAce R7 and GE Logiq F6 equipment. The hemodynamics was studied at the level of the second segment of the vertebral arteries and veins at rest, when turning, tilting and lifting the head. The results were processed using Microsoft Excel 2007 with subsequent statistical analysis. Results. 504 vascular complexes were analyzed without taking into account the visualization side. When assessing the arteries, the highest maximum blood flow velocity was registered when lifting the head in women with a rectilinear course of the vessels. In the group of men with non-rectilinear course of vessels, the lowest average blood flow velocity was registered when tilting the head. The highest volume flow was recorded in case of non-rectilinear vascular course in women when lifting the head. For vertebral veins, the highest indicators of maximum and minimum venous blood flow rates were observed in men with a rectilinear course of vessels when lifting the head. The highest values of the average flow velocity and volume flow were noted in men who had a rectilinear course of the vessels. The maximum values of the calculated venous volume flow were registered in groups with rectilinear vascular course: in men up to 19.4214.85 ml/min. (Me 12.45 ml/min.), in women 18.52 15.30 ml/min. (Me 10.50 ml/min.). Conclusion. The data obtained by the study contributes to improving the software and analysis of individual changes during patient examination, helps to evaluate the effectiveness of treatment and rehabilitation, as well as to analyze multifactorial models.
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