The Experts below are selected from a list of 93 Experts worldwide ranked by ideXlab platform
Gregory W Randolph - One of the best experts on this subject based on the ideXlab platform.
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surgical approach and monitoring of the external branch of the superior laryngeal nerve ebsln
2016Co-Authors: Marcin Barczynski, Gregory W RandolphAbstract:In this chapter, methods of intraoperative preservation and monitoring of the external branch of the superior laryngeal nerve (EBSLN) are described in detail. Contrary to routine dissection of the recurrent laryngeal nerve (RLN), most surgeons tend to avoid rather than routinely expose and identify the EBSLN during thyroidectomy. The EBSLN is believed to be the most commonly underestimated morbidity following thyroid surgery and is at a high risk of injury during dissection of the superior thyroid pole in the course of thyroidectomy in approximately one-third of patients (Cernea type 2A and 2B nerves). The laryngeal head of the Sternothyroid Muscle is a robust landmark for the course of the EBSLN as it descends along the inferior constrictor to the cricothyroid Muscle (CTM). In up to 20 % of cases the nerve may not be able to be visualized due to a subfascial course along the inferior constrictor Muscle, and hence use of intraoperative neural monitoring (IONM) can significantly improve the identification rate of the EBSLN during thyroidectomy. CTM twitch and glottic EMG recordings are both methods of IONM which are recommended in all cases of thyroid surgery, especially those which might jeopardize the EBSLN. A technique of togging the stimulator probe between the tissue of the superior thyroid pole vessels (with negative stimulation) and the region of the laryngeal head of the Sternothyroid Muscle (with positive stimulation) is recommended to assure preservation of the EBSLN. Transverse division of the superior edge of Sternothyroid Muscle and gentle traction of the superior thyroid pole into lateral and caudal direction followed by blunt dissection within the avascular plane of Sternothyroid-laryngeal triangle allow for improving exposure of the EBSLN which is usually descending parallel to superior thyroid artery and is lying on the fascia or between the fibers of the inferior constrictor Muscle before its termination within CTM. Nerve stimulation can objectively identify the EBSLN, leading to a visible CTM twitch in all cases. EMG activity can currently be quantified in nearly 80 % of cases using standard EMG tubes, but in all patients using novel EMG tubes with anterior surface electrodes. The role of measuring the waveform amplitude in prognostication of EBSLN function is yet to be determined.
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normative intra operative electrophysiologic waveform analysis of superior laryngeal nerve external branch and recurrent laryngeal nerve in patients undergoing thyroid surgery
World Journal of Surgery, 2013Co-Authors: Andre S Potenza, Gregory W Randolph, Eimear Phelan, Claudio Roberto Cernea, Cristian M Slough, Dipti Kamani, Ashlie Darr, David ZurakowskiAbstract:Injury to the external branch of the superior laryngeal nerve (EBSLN) can occur during superior pole dissection in thyroid surgery; the EBSLN injury rate is reported as high as 28 % (Cernea et al., Head Neck 14:380–383, 1992). Injury to the EBSLN leads to variable symptoms that may be overlooked, but that can be significant, especially to professional speakers and singers. Intraoperative nerve monitoring (IONM) is employed widely to aid in nerve identification. We report on normative electroneuromyography (EMG) data on EBSLN-IONM and cricothyroid Muscle (CTM) twitch response during stimulation as an aid to EBSLN identification. A prospective study of the SLN and the recurrent laryngeal nerve (RLN) IONM data in 72 consecutive thyroid surgeries was carried out. All patients underwent preoperative and postoperative laryngeal exams, and patients with abnormal preoperative laryngeal function were excluded. Normative EMG data and CTM twitch response during EBSLN stimulation were recorded and analyzed. Stimulation of the EBSLN resulted in a positive CTM twitch response in 100 %, whereas EMG response was recordable in 80 %. Electromyographic amplitude was ~1/3 of ipsilateral RLN amplitude and did not change through the case with multiple stimulations. Stimulation of the EBSLN was similar for men and women and at 1 and 2 mA stimulation levels. Intraoperative nerve monitoring of the EBSLN aids in EBSLN identification and provides electroneuromyographic information in 80 % of cases. The laryngeal head of the Sternothyroid Muscle is a useful landmark to locate EBSLN.
Yuuki Takamura - One of the best experts on this subject based on the ideXlab platform.
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clinical significance of extrathyroid extension to the parathyroid gland of papillary thyroid carcinoma
Endocrine Journal, 2009Co-Authors: Yasuhiro Ito, Kennichi Kakudo, Mitsuyoshi Hirokawa, Mitsuhiro Fukushima, Chisato Tomoda, Hiroyuki Inoue, Minoru Kihara, Takuya Higashiyama, Takashi Uruno, Yuuki TakamuraAbstract:Extrathyroid extension is a prominent prognostic factor of papillary thyroid carcinoma (PTC). In the UICC TNM classification, minimal extension to the Sternothyroid Muscle and perithyroid soft tissue is classified as T3 and further massive extension is classified as T4, the highest T grade. However, there have been few studies on the clinical significance of extension to the parathyroid gland in a large case series. In this study, we investigated the prognosis of PTC with extension to the parathyroid gland in a series of 3208 patients who underwent initial surgery between 1997 and 2004. Of these patients, 51 (1.6%) showed extension to the parathyroid gland on pathological examination. Twenty-one of these patients had massive extrathyroid extension to other adjacent organs corresponding to pT4. The remaining 30 were enrolled in this study. The disease-free survival (DFS) of these 30 patients was significantly better (p<0.0001) than that of pT4 patients and did not differ from that of patients showing minimal extrathyroid extension without extension to the parathyroid gland (p = 0.6264). Furthermore, none of these 30 patients died of carcinoma. Taken together, it is appropriate that extension to the parathyroid gland of PTC is graded as minimal extrathyroid extension (pT3), but not massive extension (pT4). Since minimal extension did not affect patient prognosis in our series, it is suggested that extension to the parathyroid gland has little clinical significance in PTC.
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prognostic significance of extrathyroid extension of papillary thyroid carcinoma massive but not minimal extension affects the relapse free survival
World Journal of Surgery, 2006Co-Authors: Yasuhiro Ito, Chisato Tomoda, Takashi Uruno, Yuuki Takamura, Akihiro Miya, Kaoru Kobayashi, Fumio Matsuzuka, Kanji Kuma, Akira MiyauchiAbstract:Objectives Extrathyroid extension has been recognized as a prognostic factor in papillary thyroid carcinoma. In the most recent version of the UICC TNM classification system, extrathyroid extension has been classified into two grades, minimal extension (extension to Sternothyroid Muscle or perithyroid soft tissues) and massive extension (extension to subcutaneous soft tissue, larynx, trachea, esophagus, or recurrent laryngeal nerve). In this study, we investigated the prognostic significance of each of the two types of extension.
Yasuhiro Ito - One of the best experts on this subject based on the ideXlab platform.
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clinical significance of extrathyroid extension to the parathyroid gland of papillary thyroid carcinoma
Endocrine Journal, 2009Co-Authors: Yasuhiro Ito, Kennichi Kakudo, Mitsuyoshi Hirokawa, Mitsuhiro Fukushima, Chisato Tomoda, Hiroyuki Inoue, Minoru Kihara, Takuya Higashiyama, Takashi Uruno, Yuuki TakamuraAbstract:Extrathyroid extension is a prominent prognostic factor of papillary thyroid carcinoma (PTC). In the UICC TNM classification, minimal extension to the Sternothyroid Muscle and perithyroid soft tissue is classified as T3 and further massive extension is classified as T4, the highest T grade. However, there have been few studies on the clinical significance of extension to the parathyroid gland in a large case series. In this study, we investigated the prognosis of PTC with extension to the parathyroid gland in a series of 3208 patients who underwent initial surgery between 1997 and 2004. Of these patients, 51 (1.6%) showed extension to the parathyroid gland on pathological examination. Twenty-one of these patients had massive extrathyroid extension to other adjacent organs corresponding to pT4. The remaining 30 were enrolled in this study. The disease-free survival (DFS) of these 30 patients was significantly better (p<0.0001) than that of pT4 patients and did not differ from that of patients showing minimal extrathyroid extension without extension to the parathyroid gland (p = 0.6264). Furthermore, none of these 30 patients died of carcinoma. Taken together, it is appropriate that extension to the parathyroid gland of PTC is graded as minimal extrathyroid extension (pT3), but not massive extension (pT4). Since minimal extension did not affect patient prognosis in our series, it is suggested that extension to the parathyroid gland has little clinical significance in PTC.
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prognostic significance of extrathyroid extension of papillary thyroid carcinoma massive but not minimal extension affects the relapse free survival
World Journal of Surgery, 2006Co-Authors: Yasuhiro Ito, Chisato Tomoda, Takashi Uruno, Yuuki Takamura, Akihiro Miya, Kaoru Kobayashi, Fumio Matsuzuka, Kanji Kuma, Akira MiyauchiAbstract:Objectives Extrathyroid extension has been recognized as a prognostic factor in papillary thyroid carcinoma. In the most recent version of the UICC TNM classification system, extrathyroid extension has been classified into two grades, minimal extension (extension to Sternothyroid Muscle or perithyroid soft tissues) and massive extension (extension to subcutaneous soft tissue, larynx, trachea, esophagus, or recurrent laryngeal nerve). In this study, we investigated the prognostic significance of each of the two types of extension.
Dipti Kamani - One of the best experts on this subject based on the ideXlab platform.
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superior laryngeal nerve signal attenuation influences voice outcomes in thyroid surgery
Laryngoscope, 2021Co-Authors: Ayaka J Iwata, Marcin Barczynski, Claudio Roberto Cernea, Whitney Liddy, Tzuyen Huang, Sam Van Slycke, Rick Schneider, Gianlorenzo Dionigi, H Dralle, Dipti KamaniAbstract:OBJECTIVES/HYPOTHESIS The objective was to identify whether injury of the external branch of the superior laryngeal nerve (EBSLN) or changes in EBSLN parameters after dissection during thyroidectomies correlate with changes in voice quality postoperatively. STUDY DESIGN Prospective multicenter case series. METHODS A prospective multicenter study was conducted on patients undergoing thyroidectomies with intraoperative nerve monitoring. Electromyography waveforms of EBSLN stimulation before (S1) and after superior pole dissection (S2) were evaluated using endotracheal tube (ETT) and cricothyroid intramuscular (CTM) electrodes. Voice outcomes were assessed using Voice-Related Quality of Life Surveys and Voice Handicap Index. RESULTS A total of 131 at-risk EBSLNs were evaluated in 80 patients. Two nerves showed loss of CTM twitch coupled with an absent S2 signal response. Complete EBSLN loss of signal was more likely with: 1) Cernea EBSLN anatomic classification Type 2B; 2) with a longer distance from the Sternothyroid Muscle insertion site; and 3) with larger lobar volumes (P < .05). Patients who experienced a more than 50% decrement in CTM amplitudes of S2 (n = 7) by CTM electrodes had a statistically significant decline in their voice outcomes compared to those who did not (n = 69) (P < .05). CONCLUSIONS Patients experienced worse voice outcomes when at least one EBSLN response amplitude decreased by more than 50% after dissection when measured by CTM needle electrodes. CTM needle electrodes have an ability to measure finer amplitude changes compared to ETT electrodes, may represent a safe method to deduce subtle EBSLN injuries, and may serve to optimize voice outcomes during thyroidectomy. CTM needle electrodes are safe and tolerated well. LEVEL OF EVIDENCE 4 Laryngoscope, 2021.
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normative intra operative electrophysiologic waveform analysis of superior laryngeal nerve external branch and recurrent laryngeal nerve in patients undergoing thyroid surgery
World Journal of Surgery, 2013Co-Authors: Andre S Potenza, Gregory W Randolph, Eimear Phelan, Claudio Roberto Cernea, Cristian M Slough, Dipti Kamani, Ashlie Darr, David ZurakowskiAbstract:Injury to the external branch of the superior laryngeal nerve (EBSLN) can occur during superior pole dissection in thyroid surgery; the EBSLN injury rate is reported as high as 28 % (Cernea et al., Head Neck 14:380–383, 1992). Injury to the EBSLN leads to variable symptoms that may be overlooked, but that can be significant, especially to professional speakers and singers. Intraoperative nerve monitoring (IONM) is employed widely to aid in nerve identification. We report on normative electroneuromyography (EMG) data on EBSLN-IONM and cricothyroid Muscle (CTM) twitch response during stimulation as an aid to EBSLN identification. A prospective study of the SLN and the recurrent laryngeal nerve (RLN) IONM data in 72 consecutive thyroid surgeries was carried out. All patients underwent preoperative and postoperative laryngeal exams, and patients with abnormal preoperative laryngeal function were excluded. Normative EMG data and CTM twitch response during EBSLN stimulation were recorded and analyzed. Stimulation of the EBSLN resulted in a positive CTM twitch response in 100 %, whereas EMG response was recordable in 80 %. Electromyographic amplitude was ~1/3 of ipsilateral RLN amplitude and did not change through the case with multiple stimulations. Stimulation of the EBSLN was similar for men and women and at 1 and 2 mA stimulation levels. Intraoperative nerve monitoring of the EBSLN aids in EBSLN identification and provides electroneuromyographic information in 80 % of cases. The laryngeal head of the Sternothyroid Muscle is a useful landmark to locate EBSLN.
Takashi Uruno - One of the best experts on this subject based on the ideXlab platform.
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clinical significance of extrathyroid extension to the parathyroid gland of papillary thyroid carcinoma
Endocrine Journal, 2009Co-Authors: Yasuhiro Ito, Kennichi Kakudo, Mitsuyoshi Hirokawa, Mitsuhiro Fukushima, Chisato Tomoda, Hiroyuki Inoue, Minoru Kihara, Takuya Higashiyama, Takashi Uruno, Yuuki TakamuraAbstract:Extrathyroid extension is a prominent prognostic factor of papillary thyroid carcinoma (PTC). In the UICC TNM classification, minimal extension to the Sternothyroid Muscle and perithyroid soft tissue is classified as T3 and further massive extension is classified as T4, the highest T grade. However, there have been few studies on the clinical significance of extension to the parathyroid gland in a large case series. In this study, we investigated the prognosis of PTC with extension to the parathyroid gland in a series of 3208 patients who underwent initial surgery between 1997 and 2004. Of these patients, 51 (1.6%) showed extension to the parathyroid gland on pathological examination. Twenty-one of these patients had massive extrathyroid extension to other adjacent organs corresponding to pT4. The remaining 30 were enrolled in this study. The disease-free survival (DFS) of these 30 patients was significantly better (p<0.0001) than that of pT4 patients and did not differ from that of patients showing minimal extrathyroid extension without extension to the parathyroid gland (p = 0.6264). Furthermore, none of these 30 patients died of carcinoma. Taken together, it is appropriate that extension to the parathyroid gland of PTC is graded as minimal extrathyroid extension (pT3), but not massive extension (pT4). Since minimal extension did not affect patient prognosis in our series, it is suggested that extension to the parathyroid gland has little clinical significance in PTC.
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prognostic significance of extrathyroid extension of papillary thyroid carcinoma massive but not minimal extension affects the relapse free survival
World Journal of Surgery, 2006Co-Authors: Yasuhiro Ito, Chisato Tomoda, Takashi Uruno, Yuuki Takamura, Akihiro Miya, Kaoru Kobayashi, Fumio Matsuzuka, Kanji Kuma, Akira MiyauchiAbstract:Objectives Extrathyroid extension has been recognized as a prognostic factor in papillary thyroid carcinoma. In the most recent version of the UICC TNM classification system, extrathyroid extension has been classified into two grades, minimal extension (extension to Sternothyroid Muscle or perithyroid soft tissues) and massive extension (extension to subcutaneous soft tissue, larynx, trachea, esophagus, or recurrent laryngeal nerve). In this study, we investigated the prognostic significance of each of the two types of extension.