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Recurrent Laryngeal Nerve Injury (recurrent + laryngeal_nerve_injury)
Selected AbstractsQuantitative Assessment of Laryngeal Muscle Morphology After Recurrent Laryngeal Nerve Injury: Right vs.THE LARYNGOSCOPE, Issue 10 2008Left Differences Abstract Objectives/Hypothesis: Reports of laryngeal response to denervation are inconsistent. Some document atrophy and fibrosis in denervated laryngeal muscles, whereas others indicate resistance to atrophy. Spontaneous reinnervation has also been documented. The goal of this study was to clarify the effects of nerve injury and reinnervation on thyroarytenoid (TA) and posterior cricoarytenoid (PCA) muscles. Study Design: Laboratory experiment. Methods: TA and PCA muscles of cats were harvested 5 to 6 months after transecting right or left recurrent laryngeal nerve (RLN). Images of muscle cross-sections were acquired and studied using an image analysis workstation. Cross-sectional areas as well as total cross-sectional area of randomly selected muscle fibers were recorded. Results: TA reinnervation was robust on both sides, but there was less reinnervation of the PCA muscle after left-sided RLN lesion than after right-sided injury. Conclusions: Differences in reinnervation after RLN injury could contribute to the higher clinical incidence of left- vs. right-sided laryngeal paralysis. [source] Expression of Fibroblast Growth Factor-2 in the Nucleus Ambiguus Following Recurrent Laryngeal Nerve Injury in the RatTHE LARYNGOSCOPE, Issue 12 2000Tetsuji Sanuki MD Abstract Objectives To examine fibroblast growth factor-2 (FGF-2) immunoreactivity in the nucleus ambiguus (NA) after three different recurrent laryngeal nerve (RLN) injuries. Study Design Immunohistochemical analysis of FGF-2. Methods Thirty adult rats underwent left-sided RLN crush (group A). The left RLN was transected in groups B (n = 30) and C (n = 30); in group C, both nerve stumps were covered with silicone caps. FGF-2 in the NA was assessed as the ratio of the positive areas on the left (operated [O]) and right (unoperated [U]) sides. The ratio (O/U) was measured 1, 3, 7, 14, and 28 days after the procedure. Three rats underwent left-sided RLN exposure and were killed 7 days later (control). Results Left-sided RLN paralysis occurred until day 28 in group A. In the control group, O/U was approximately 1. In group A, O/U was significantly elevated on day 7; in group B, on days 3, 7, and 14; and in group C, on day 3. O/U in group B was significantly greater than that in group A on days 14 and 28. Maximal FGF-2 immunoreactivity was significantly lower in group C than in groups A and B. Conclusions We demonstrated elevated production of FGF-2 in the NA after RLN injury. This endogenous FGF-2 might contribute to preventing lesion-induced neuronal death. Blockage of axonal regeneration might suppress FGF-2 production in the NA. Further understanding of the roles of FGF-2 after RLN in-jury may contribute to the prevention of neuronal death and facilitation of axonal regeneration. [source] Medical malpractice and the thyroid glandHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 6 2003Daniel D. Lydiatt DDS Abstract Background. A medical malpractice litigation "crisis" exists in this country. Analyzing litigation trends through verdict summaries may help understand causes. Methods. Jury verdict reviews from 1987,2000 were obtained from a computerized database. Reviews compile data on defendants, plaintiffs, allegations of wrongdoing, and verdict summaries. Results. Thirty suits from nine states occurred. Plaintiffs were women in 80% of the cases, with a median age of 41. Fifty percent of patients (15 of 30) had a bad outcome, (9 of 30 dead, 4 of 30 with neurologic deficits, 1 blind, and 1 alive with cancer). Thirty percent alleged surgical complications, mostly recurrent laryngeal nerve injury, and 75% of cancer patients alleged a delay, either through falsely negative biopsies or no biopsy taken. Respiratory events occurred in 43% and frequently resulted in large awards. Conclusions. The liberal use of fine-needle aspiration and documentation of surgical risks may help reduce litigation. Complications and bad outcomes do not indicate negligence. Analysis may contribute to risk management strategies or litigation reform. © 2003 Wiley Periodicals, Inc. Head Neck 25: 429,431, 2003 [source] Delivery of an Adenoviral Vector to the Crushed Recurrent Laryngeal Nerve,THE LARYNGOSCOPE, Issue 6 2003Adam Rubin MD Abstract Objectives Objectives were to create a model of recurrent laryngeal nerve injury for testing the efficacy of potential therapeutic viral gene therapy vectors and to demonstrate that remote injection of a viral vector does not cause significant additional neuronal injury. Study Design Animal model. Methods Rats were randomly assigned to three groups of 10 animals each. In group I, the recurrent laryngeal nerve was crushed. In group II, the nerve was crushed and then injected with an adenoviral vector containing no transgene. In group III, the nerve was identified but was not crushed. Rats were killed at 1 week, and their larynges and brainstems were cryosectioned in 15-,m sections. Laryngeal cryosections were processed for acetylcholine histochemical analysis (motor endplates) followed by neurofilament immunoperoxidase (nerve fibers). Percentage of nerve,endplate contact was determined and compared between groups. Fluorescent in situ hybridization was performed on brainstem sections from rats in group II to confirm the presence of virus. Results No significant difference in percentage of nerve,endplate contact exists between the two crushed-nerve groups (groups I and II) (P = .88). The difference between both crushed-nerve groups and the group with noncrushed nerves (group III) was highly significant (P <.0001). The presence of virus was confirmed in group II rats. Conclusions Crush provides a significant measurable injury to the recurrent laryngeal nerve and may be used as a model to explore therapeutic interventions for nerve injury. The remote injection of viral vector did not cause significant additional neuronal injury. Remote delivery of viral vectors to the central nervous system holds promise in the treatment of recurrent laryngeal nerve injury and central nervous system diseases. [source] Vocal Fold Paralysis After Anterior Cervical Spine Surgery: Incidence, Mechanism, and Prevention of Injury,THE LARYNGOSCOPE, Issue 9 2000Mark D. Kriskovich MD Abstract Objective Vocal fold paralysis is the most common otolaryngological complication after anterior cervical spine surgery (ACSS). However, the frequency and etiology of this injury are not clearly defined. This study was performed to establish the incidence and mechanism of vocal fold paralysis in ACSS and to determine whether controlling for endotracheal tube/laryngeal wall interactions induced by the cervical retraction system could decrease the rate of paralysis. Study Design Retrospective review and complementary cadaver dissection. Methods Data gathered on 900 consecutive patients undergoing ACSS were reviewed for complications and procedural risk factors. After the first 250 cases an intervention consisting of monitoring of endotracheal tube cuff pressure and release of pressure after retractor placement or repositioning was employed. This allowed the endotracheal tube to re-center within the larynx. In addition, anterior approaches to the cervical spine were performed on fresh, intubated cadavers and studied with videofluoroscopy following retractor placement. Results Thirty cases of vocal fold paralysis consistent with recurrent laryngeal nerve injury were identified with three patients having permanent paralysis. With this technique temporary paralysis rates decreased from 6.4% to 1.69% (P = .0002). The cadaver studies confirmed that the retractor displaced the larynx against the shaft of the endotracheal tube with impingement on the vulnerable intralaryngeal segment of the recurrent laryngeal nerve. Conclusion The study results suggest that the most common cause of vocal fold paralysis after anterior cervical spine surgery is compression of the recurrent laryngeal nerve within the endolarynx. Endotracheal tube cuff pressure monitoring and release after retractor placement may prevent injury to the recurrent laryngeal nerve during anterior cervical spine surgery. [source] | ||||||||||