The Experts below are selected from a list of 561 Experts worldwide ranked by ideXlab platform
J R Sanudo - One of the best experts on this subject based on the ideXlab platform.
-
External Laryngeal Nerve landmarks revisited
Head and Neck-journal for The Sciences and Specialties of The Head and Neck, 2018Co-Authors: Consuelo Ortega, Eva Maranillo, J R Sanudo, Steve Mchanwell, Teresa VazquezosorioAbstract:Background Because External Laryngeal Nerve (ELN) iatrogenic damage is frequent during neck surgery, its precise localization has been highly recommended. This study analyzes the different surgical landmarks previously proposed and the anatomy of the collateral and terminal branches of the ELN. Methods The necks of 157 (77 men and 80 women) human adult embalmed cadavers were examined. The ELN origin, length, and relationship to different landmarks were recorded and results statistically compared with those previously reported. Results The ELN is located deep to the ascending pharyngeal vein in 100% of patients. In most patients, it crosses the carotid axis at the thyroid artery origin level (47% of patients), passes medial to it (89% of patients), and shows an intramuscular trajectory through the inferior constrictor of the pharynx (80% of patients). Conclusion The ELN position, in relation to classical landmarks, is highly variable. The most reliable relationships are those with the ascending pharyngeal vein or with the superior thyroid artery.
-
is the External Laryngeal Nerve an exclusively motor Nerve the cricothyroid connection branch
Laryngoscope, 2003Co-Authors: Eva Maranillo, Xavie Leo, Miquel Que, Cesa Orus, J R SanudoAbstract:Objectives To obtain an accurate morphological description of the Nerve that provides communication between the External Laryngeal Nerve and the recurrent Laryngeal Nerve in a large sample of human larynges. Study Design Morphological study of human larynges. Methods Microdissection of 103 human larynges obtained from necropsies was performed. Both the External Laryngeal Nerve and the recurrent Laryngeal Nerve were identified and dissected. The existence of a communication between the two Nerves was evaluated. Results A neural communication between the External Laryngeal Nerve and the recurrent Laryngeal Nerve was found in 85% of the larynges studied (bilaterally in 44% and unilaterally in 41%). Two patterns of communication (with single or double branches) were found. The communication between the Nerves can appear at different levels, giving off collateral branches to the cricothyroid muscle (23%), the cricothyroid joint capsule (49%), and the subglottic mucosa (50%). Conclusions The Nerve supply of the human larynx is more complex than classically considered. Our study does not support the classic neuroanatomical belief that the External Laryngeal Nerve is purely a motor Nerve to the cricothyroid muscle. Our results reveal that it carries sensory and motor fibers on to other muscles (thyroarytenoid) or regions (subglottis mucosa and cricothyroid joint), as has been demonstrated in experimental studies in cats and dogs.
Eva Maranillo - One of the best experts on this subject based on the ideXlab platform.
-
External Laryngeal Nerve landmarks revisited
Head and Neck-journal for The Sciences and Specialties of The Head and Neck, 2018Co-Authors: Consuelo Ortega, Eva Maranillo, J R Sanudo, Steve Mchanwell, Teresa VazquezosorioAbstract:Background Because External Laryngeal Nerve (ELN) iatrogenic damage is frequent during neck surgery, its precise localization has been highly recommended. This study analyzes the different surgical landmarks previously proposed and the anatomy of the collateral and terminal branches of the ELN. Methods The necks of 157 (77 men and 80 women) human adult embalmed cadavers were examined. The ELN origin, length, and relationship to different landmarks were recorded and results statistically compared with those previously reported. Results The ELN is located deep to the ascending pharyngeal vein in 100% of patients. In most patients, it crosses the carotid axis at the thyroid artery origin level (47% of patients), passes medial to it (89% of patients), and shows an intramuscular trajectory through the inferior constrictor of the pharynx (80% of patients). Conclusion The ELN position, in relation to classical landmarks, is highly variable. The most reliable relationships are those with the ascending pharyngeal vein or with the superior thyroid artery.
-
is the External Laryngeal Nerve an exclusively motor Nerve the cricothyroid connection branch
Laryngoscope, 2003Co-Authors: Eva Maranillo, Xavie Leo, Miquel Que, Cesa Orus, J R SanudoAbstract:Objectives To obtain an accurate morphological description of the Nerve that provides communication between the External Laryngeal Nerve and the recurrent Laryngeal Nerve in a large sample of human larynges. Study Design Morphological study of human larynges. Methods Microdissection of 103 human larynges obtained from necropsies was performed. Both the External Laryngeal Nerve and the recurrent Laryngeal Nerve were identified and dissected. The existence of a communication between the two Nerves was evaluated. Results A neural communication between the External Laryngeal Nerve and the recurrent Laryngeal Nerve was found in 85% of the larynges studied (bilaterally in 44% and unilaterally in 41%). Two patterns of communication (with single or double branches) were found. The communication between the Nerves can appear at different levels, giving off collateral branches to the cricothyroid muscle (23%), the cricothyroid joint capsule (49%), and the subglottic mucosa (50%). Conclusions The Nerve supply of the human larynx is more complex than classically considered. Our study does not support the classic neuroanatomical belief that the External Laryngeal Nerve is purely a motor Nerve to the cricothyroid muscle. Our results reveal that it carries sensory and motor fibers on to other muscles (thyroarytenoid) or regions (subglottis mucosa and cricothyroid joint), as has been demonstrated in experimental studies in cats and dogs.
Bulent Yalcin - One of the best experts on this subject based on the ideXlab platform.
-
blood supply of the terminal part of the External branch of the superior Laryngeal Nerve
Surgery Today, 2015Co-Authors: Bulent Yalcin, Sedat Develi, Shane R Tubbs, Yavuz Poyrazoglu, Fatih YazarAbstract:Purpose The External Laryngeal Nerve (ELN) carries motor fibers to the cricothyroid and inferior pharyngeal muscles. Damage to the Nerve may cause symptoms such as a monotone voice. One reason for these symptoms may be Nerve injury due to inadvertent stretching, ligation or transaction of the Nerve during the dissection of the superior pole of the thyroid gland. We hypothesized a new reason for the symptoms, an insufficient arterial blood supply to the Nerve, and investigated this hypothesis.
-
blood supply of the terminal part of the External branch of the superior Laryngeal Nerve
Surgery Today, 2015Co-Authors: Bulent Yalcin, Sedat Develi, Shane R Tubbs, Yavuz Poyrazoglu, Fatih YazarAbstract:The External Laryngeal Nerve (ELN) carries motor fibers to the cricothyroid and inferior pharyngeal muscles. Damage to the Nerve may cause symptoms such as a monotone voice. One reason for these symptoms may be Nerve injury due to inadvertent stretching, ligation or transaction of the Nerve during the dissection of the superior pole of the thyroid gland. We hypothesized a new reason for the symptoms, an insufficient arterial blood supply to the Nerve, and investigated this hypothesis. From 36 larynges, 52 sides (26 right and 26 left) were dissected under a surgical Zeiss-OpM1 microscope. The arterial branch to the External branch of the superior Laryngeal Nerve originated from the posterior glandular branch of the superior thyroid artery in 26 (50 %) sides, from the anterior glandular branch in 23 (44.23 %) sides, from its trunk on one (1.92 %) side, from the infrahyoid branch on one (1.92 %) side and from the bifurcation of the superior thyroid artery at the level of separation of the anterior and posterior glandular branches on one (1.92 %) side. Devascularization of the ELN may lead to dysfunction, so this Nerve’s varied blood supply should be kept in mind when invasive procedures are performed in this region.
-
a detailed study of the relationship between the External Laryngeal Nerve and superior thyroid artery including its glandular branches
Clinical Anatomy, 2012Co-Authors: Bulent Yalcin, Sedat Develi, Shane R Tubbs, Yavuz PoyrazogluAbstract:The External layrngeal Nerve (ELN) may be at risk during thyroidectomy. Because the relationship between the ELN and superior thyroid artery (STA) can be variable, we aimed to investigate their relationship in detail. In human cadavers, 81 ELN and STA and their branches were carefully dissected. The position of the Nerve was classified as medial (Group I, on 76.5% sides), lateral (Group II, on 20.9% sides), or posterior (Group III, on 2.4% sides) to the origin of the STA. In Group Ia, the Nerve did not cross the artery while it did cross the artery in Group Ib. In Group II, the Nerve was located lateral to the origin of the artery and crossed it. In Group III, the Nerve coursed downward posterior to the artery. In conclusion, the topography of the ELN showed much more variability in its relationship to the STA than is described in the literature. Such variations should be kept in mind during surgery of the anterior neck. It is our hope that such data will decrease surgical morbidity following surgery of the anterior neck.
-
branching pattern of the External branch of the superior Laryngeal Nerve and its clinical importance
Clinical Anatomy, 2012Co-Authors: Bulent Yalcin, Shane R Tubbs, Marios Loukas, Abdullah Durmaz, Ayhan Comert, Mehmet Toygar, Sedat DeveliAbstract:The External branch of the superior Laryngeal Nerve gives off many branches above the upper pole of the thyroid gland. Differentiating the branch innervating the cricothyroid muscle from the others may be important during surgery. Therefore, we aimed to demonstrate the branching pattern of this Nerve in detail. In 34 human cadavers (59 sides), branches of the Nerve were exposed and measurements related to them and neighboring structures were made. A cricothyroidal branch was present on all sides. This branch pierced the inferior pharyngeal constrictor muscle 3.9–17.6 mm above, 3.1–9.9 mm below, or at the level of the upper pole of the thyroid gland. On all sides, the Nerve provided one or two thyroidal branches. The thyroidal branch was generally thinner than the cricothyroidal branch. But they were equal in size on three (5%) sides. The External Laryngeal Nerve provided two or three pharyngeal branches on all sides. These branches arose from the Nerve 3.5–12.7 mm from the upper pole of the thyroid gland. Although the branch was generally thinner than the cricothyroidal branch, both branches were equal on four (6.7%) sides. Two cardiac branches were observed on two (3.3%) left sides. In conclusion, the cricothyroidal branch was generally thicker than the other branches. But on seven (11.8%) sides, thyroidal or pharyngeal branches and the cricothyroidal branch were equal in size. These data may be important during surgery as the surgeon may confuse the cricothyroidal branch with other branches of the External Laryngeal Nerve. Clin. Anat. 25:32–39, 2012. © 2011 Wiley-Liss, Inc.
Orlo H Clark - One of the best experts on this subject based on the ideXlab platform.
-
computer assisted evoked electromyography with stimulating surgical instruments for recurrent External Laryngeal Nerve identification and preservation in thyroid and parathyroid operation
Surgery, 2002Co-Authors: Alan P B Dackiw, Lorne E Rotstein, Orlo H ClarkAbstract:Abstract Background. The reported incidence of recurrent Laryngeal Nerve (RLN) palsy/paralysis in thyroid and parathyroid operation ranges from 2% to 13%. Injury to the External branch of the superior Laryngeal Nerve (EBSLN) is less clearly documented. We hypothesized that a novel evoked electromyography system using an audio warning alarm might be beneficial for detection and preservation of the RLN and EBSLN. Methods. A total of 117 thyroid/parathyroid operations were performed using a Nerve locator/monitor (Neurovision SE, RLN Systems Inc, Jefferson City, Mo). Dissection was performed using a stimulating hemostat with conduction to an endotracheal surface electrode. Results. A total of 97 thyroidectomies (50 total, 47 lobectomies) and 20 parathyroidectomies (16 directed, 4 bilateral) were performed representing 176 RLN and 152 EBSLN at risk. Of 176 RLN, 161 were correctly identified by the Nerve stimulator alarm including 2 nonrecurrent Nerves. The cricothyroid space and the superior pole vessels were scanned to identify the EBSLN by observing for cricothyroideus contraction or an alarm. Fourteen of 152 (8.9%) cases of type 2 anatomy were suggested where meticulous dissection of superior pole vessels prevented EBSLN injury. Conclusions. Computer-assisted evoked electromyography with stimulating surgical instruments is a useful surgical tool. This technology may be especially useful in reoperation in dense scar tissue and preserving the EBSLN in thyroid operation. (Surgery 2002;132:1100-8.)
Aravindan Nair - One of the best experts on this subject based on the ideXlab platform.
-
Mapping the compound muscle action potentials of cricothyroid muscle using electromyography in thyroid operations: a novel method to clinically type the External branch of the superior Laryngeal Nerve.
Annals of surgery, 2009Co-Authors: Ben Selvan, Srinivasa Babu, M. J. Paul, Deepak Thomas Abraham, Prasanna Samuel, Aravindan NairAbstract:Objective: Variations of the External branch of the superior Laryngeal Nerve (EBSLN) are well represented in literature but with conflicting reports about the types and variations. Using EMG, the cricothyroid compound muscle action potential (CMAP) was recorded, to identify the EBSLN and classified them according to clinical variation during routine thyroid operations. Summary Background Data: There is increasing awareness among patients and physicians of the consequences of injury to the External Laryngeal Nerve in thyroid surgeries. There are at least 4 types, which are described in the literature. 1 The gold standard of Nerve identification is EMG, which we used during operations in this study to identify all the EBSLN by demonstrating CMAP and reclassify them. Based on this principle, to avoid injury during thyroidectomy, we propose a new classification. Methods: This study was a prospective, descriptive study of the EBSLN done during elective thyroidectomy operations. CMAP was demonstrated and EMG was plotted to identify and type them according to clinical variations. The distance between the entry of superior thyroid vessels (STVs) to the lobe and the EBSLN, relationship with the cricothyroid muscle and inferior constrictor muscle were taken into consideration. Based on the possible risk to this during thyroidectomy, we divided them into 4 types. Results: A total of 70 External Laryngeal Nerves were dissected and confirmed by the CMAPs in 35 total thyroidectomy patients. Using CMAPs, all the Nerves were identified. Ia. The Nerve can be found within 1 cm from the entry of the vessels into the gland either anterior or intertwined to the STVs or within 3 cm from the cricoid cartilage. Ib. The Nerve can be found posterior to the vessels but within 1 cm from the entry of the STV into the gland. This entry point was close to the anterior insertion line of the CT muscle onto cricoid cartilage. II. Nerve can be found within 1 to 3 cm from the entry of the vessels into the gland or within 3 to 5 cm from the cricoid cartilage. III. Nerve can be found between 3 and 5 cm from the entry of the vessels into the gland or more than 5 cm from the cricoid cartilage. Conclusion: New clinical typing of the EBSLN will give a better understanding of the EBSLN in the intraoperative period. EBSLN need not be identified in routine thyroidectomy operations. Even in large goiters, the incidence of Nerve at risk does not increase significantly. Injury to EBSLN can be avoided if the principle of ligating the STVs individually away from the CT muscle and close to the capsule of the gland is followed.
