흰쥐에서 편측 반회후두신경 재지배 후 Phopholipase C-$\gamma$1(PLC-$\gamma$1)의 발현과 후두기능회복과의 관계

정성민,신혜정,김성숙,김문정,윤선옥,박수경,신유리,김진경 대한후두음성언어의학회 2001 대한후두음성언어의학회지 Vol.12 No.2

Background and Objectives : Signal traduction through phospholipase C(PLC) participate in the regulation of cell growth and differentiation. Growth factors bind to their receptors and thereby induce tyrosine phophorylation of the phospholipase C-${\gamma}$1(PLC-${\gamma}$1). PLC-${\gamma}$1 is a substrate for several receptor tyrosine kinases and its catalytic activity is increased by tyrosine phosphorylation. Tyrosine kinase phosphorylation of PLC-${\gamma}$1 stimulates PLC activation and cell proliferation. However the signal transduction pathway and the significance of PLC in injured recurrent laryngeal nerve regeneration is unknown. Therefore after we obtained fuctionally recovered rats using PEMF in this study, we attempt to provide some evidence that PLC plays a role in nerve regeneration itself and regeneration related to PEMF through the analysis of the difference between fucntional recovery group and non-recovery group in the recurrent laryngeal nerve. Materials and Method : Using 32 healthy male Sprague-Dawley rats, transections and primary anastomosis were performed on their left recurrent laryngeal nerves. Rats were then randomly assigned to 2 groups. The experimental group(n=16) received PEMS by placing them in custom cages equipped with Helm-holz coils(3hr/day, 5days/wk, for 12wk). The control group(n=16) were handled the same way as the experimental group, except that they did not receive PEMS. Laryngo-videoendoscopy was performed before and after surgery and followed up weekly. Laryngeal EMG was obtained in both PCA and TA muscles. Immunohistochemisty staining and Western blotting analysis using monoclonal antibody was performed to detect PLC-${\gamma}$1 in recurrent laryngeal nerve and nodose ganglion. Results : 10 rats(71%) in experimental group and 4 rats(38%) in the control group showed recovery of vocal fold motion. Functionally-recoverd rats show PLC-${\gamma}$1 positive cells in neuron and ganglion cells after 12 weeks from nerve injury. Conclusion : This study shows that PLC1-${\gamma}$ involved in singnal trasduction pathway in functinal recovery of injured recurrent laryngeal nerve and PEMF enhance the functional recovery by effect on this molecule.

부갑상선 선종 수술시 관찰된 비회귀성 반회후두신경 (Non-Recurrent Recurrent Laryngeal Nerve) 1례

한수진,임재열,박헌이,최홍식 대한후두음성언어의학회 2000 대한후두음성언어의학회지 Vol.11 No.2

In thyroid and parathyroid surgery, damage to the recurrent laryngeal nerve(RLN) is the most common iatrogenic cause of vocal cord paralysis. Identification and preservation of the BLNs and meticulous technique can siginificantly decrease the incidence of this complication. We experienced one case of NRRLN in a patient with the parathyroid adenoma. During the dissection, there was no branch to be considered as RLN in tracheoesophageal groove. While searching for the RLN, We found a white structure coursing horizontally at the level of cricoid cartilage directly arising from the vagus nerve in the carotid sheath. That structure was nonrecurrent recurrent laryngeal nerve(NRRLN) and NRRLNs are exceedingly rare. Awareness of the possibility of NRRLN will prevent the surgeon from accidentally severing one if it is encountered during surgery.

성대주입술 후 음향학적 분석결과 비교: 암의 신경 침윤으로 인한 일측성 성대마비 환자와 수술 후 발생한 일측성 성대마비 환자

조용민,최현석,오경호,백승국,우정수,권순영,정광윤,조재구 대한후두음성언어의학회 2022 대한후두음성언어의학회지 Vol.33 No.3

Background and Objectives Injection laryngoplasty is a common method for treatment of unilateral vocal fold paralysis. Unilateral vocal fold paralysis has various causes, including idiopathic, infection, stroke, neurologic condition, surgery and nerve invasion by cancer. To the knowledge of the authors, there was no study on the relationship between the causes of vocal cord paralysis and the outcome of injection laryngoplasty. Therefore, we tried to investigate the difference in the outcomes of injection laryngoplasty between vocal cord paralysis after surgery group and nerve invasion by cancer group.Materials and Method A retrospective analysis was performed for 24 patients who underwent vocal cord injection due to unilateral vocal cord paralysis caused by surgery or nerve invasion by cancer. The objective quality of the voice was assessed by acoustic voice analysis with the Multi-Dimensional Voice Program.Results Both group showed an improvement of fundamental frequemcy (F0), jitter percent, shimmer (percent), and noise to hearmonic ratio (NHR) after injection laryngoplasty. The vocal cord paralysis due to nerve invasion group showed more improvement in both the mean and median value of F0, shimmer percent and NHR than the vocal cord paralysis due to surgery group, but there was not statistically significant.Conclusion Our study did not show a statistically significant difference in outcome between vocal cord paralysis due to cancer invasion group and surgery group, but statistically tendency was suggested. The vocal cord paralysis due to nerve invasion group showed more improvement in both the mean and median value of acoustic voice analysis than surgery group.

흰쥐에서 편측 반회후두신경 재지배 후 neuronal Nitric Oxide Synthase(nNOS)의 발현과 후두기능회복과의 관계

정성민,김성숙,조윤희,구태완,박수경,신유리 대한후두음성언어의학회 2001 대한후두음성언어의학회지 Vol.12 No.1

Background and Objectives : Nitric oxide(NO) is a short-lived molecule with messenger and cytotoxic functions in nervous, cardiovascular, and immune systems. Among the three distinct NOS isoforms, the neuronal isoform is expressed in small, discrete neuronal populations of CNS and PNS. Axonal injury in adult animals results in a dramatic NOS up-regulation in many types of central and peripheral neurons which normally lack the enzyme or express it only at very low levels. In previous study, we confirmed the efficacy of PEMS on the early functional recovery in rats with surgically transected and reanastomosed recurrent laryngeal nerve. Therefore, after we obtained functionally recovered rats using PEMS in this study, we studied to evaluate the expression of nNOS through the analysis of the difference between functional recovery group and non-recovery group in the recurrent laryngeal nerve. Materials and Method : Using 84 healthy male Sprague-Dawley rats, transections and primary anastomosis were performed on their left recurrent laryngeal nerves. Rats were then randomly assigned to 2 groups. The rats in group A(n=42) received PEMS by placing them in custom cages equipped with Helm-holz coils(3 hr/day, 5 days/wk, for 12 wk). The rats in group B(n=42) were handled the same way as the group A, except that they did not receive PEMS. Laryngovideoendoscopy was performed before and after surgery and followed up weekly. Laryngeal EMG was obtained in both PCA and TA muscles. Immunohistochemisty staining using monoclonal anti-neuronal nitric oxide synthase(nNOS) antibody was performed to detect nNOS in recurrent laryngeal nerve and nodose ganglion. Results : 20 rats(63%) in group A and 5 rats(17%) in the group B showed recovery of vocal fo1d motion. The number of NOS-positive cells was increased in functionally-recovered rats. NOS-staining intensity was reduced 12 weeks after nerve injury. The difference between PEMS group and non-stimulated group was not found. Conclusion : This study shows that nNOS may exert a beneficial effect on nerve regeneration and functional repair.

갑상선 수술 후 발생하는 음성장애의 치료

정은재,Chung, Eun-Jae 대한후두음성언어의학회 2016 대한후두음성언어의학회지 Vol.27 No.1

Hoarseness is a postoperative complication of thyroidectomy, mostly due to damage to the recurrent laryngeal nerve (RLN). Hoarseness may also be brought about via vocal cord dysfunction (VCD) due to injury of the vocal cords from manipulations during anesthesia, as well as from psychogenic disorders and respiratory and upper-GI related infections. The clinician or surgeon should 1) document assessment of the patient's voice once a decision has been made to proceed with thyroid surgery ; 2) examine vocal fold mobility, or refer the patient to a clinician who can examine vocal fold mobility 3) examine vocal fold mobility, or refer the patient to a clinician who can examine vocal fold mobility, once a decision has been made to proceed with thyroid surgery 4) educate the patient about the potential impact of thyroid surgery on voice once a decision has been made to proceed with thyroid surgery ; 5) inform the anesthesiologist of the results of abnormal preoperative laryngeal assessment in patients who have had laryngoscopy prior to thyroid surgery ; 6) take steps to preserve the external branch of the surperior laryngeal nerve(s) when performing thyroid surgery ; 7) document whether there has been a change in voice between 2 weeks and 2 months following thyroid surgery ; 8) examine vocal fold mobility or refer the patient for examination of vocal fold mobility in patients with a change in voice following thyroid surgery ; 9) refer a patient to an otolaryngologist when abnormal vocal fold mobility is identified after thyroid surgery ; 10) counsel patients with voice change or abnormal vocal fold mobility after thyroid surgery on options for voice rehabilitation.

반회후두신경을 침윤한 갑상선 유두상암에 대한 처치

김충영,노혜원,조진성,박민호,윤정한,제갈영종,Choong Young Kim,Hye Won Ro,Jin Seong Cho,Min Ho Park,Jung Han Yoon and Young Jong Jegal 대한갑상선-내분비외과학회 2008 The Koreran journal of Endocrine Surgery Vol.8 No.2

갑상선절제술시 손상된 반회후두신경에 대한 문합술 후의 음성 및 화상분석

한경열,홍석준,홍석중,이석우,남순열 대한이비인후과학회 2001 대한이비인후과학회지 두경부외과학 Vol.44 No.7

흰쥐에서 편측 반회후두신경 재지배 후 의핵내 운동신경원의 재분포와 후두기능회복과의 관계

정성민,홍현정,윤선옥,신혜정,박수경,신유리,김진경 대한이비인후과학회 2001 대한이비인후과학회지 두경부외과학 Vol.44 No.8

비반회 후두 신경을 동반한 갑상선 미세 수질성-유두상 동시 암종 1예

심윤상,이지웅,홍수원,이가희 대한이비인후과학회 2007 대한이비인후과학회지 두경부외과학 Vol.50 No.12

We report a case of concurent medullary and papilary microcarcinoma of the thyroid gland. We also found a nonrecurrent la-ryngeal nerve in the right side. The nonrecurrent laryngeal nerve is an unusual and potentialy serious postoperative complication. A 36-year-old female underwent right hemithyroidectomy for folicular neoplasm, diagnosed by fine needle aspiration biopsy. The micocarcinoma in other two lesions. Incidentally, we also found an aberrant right subclavian artery by computed tomography and confirmed nonrecurent laryngeal nerve in surgery. We performed completion thyroidectomy with central and lateral neck lymph nodes disection. We could not find any more carcinoma on the pathologic examination. The patient was given radioactive iodine therapy for remnant thyroid ablation. The patient is scheduled to check serum calcitonin and CEA level every 3 months. J Otorhinolaryngol-Head Neck Surg 2007 ;50 :1175-8)

최소 침습적 개방 갑상선 엽절제술에서 피부 전극을 이용한 반회후두신경의 수술 중 신경감시술

천용일,신성찬,서명구,권하늬,조영진,이병주 대한갑상선학회 2022 International Journal of Thyroidology Vol.15 No.2

Background: Intraoperative neuromonitoring (IONM) using adhesive skin electrodes has been reported to be useful method for preserving recurrent laryngeal nerve (RLN) in thyroid surgery. The aim of this study is to investigate the usefulness of IONM using adhesive skin electrodes in minimally invasive open hemithyroidectomy. Materials and Methods: A retrospective study was conducted on 23 patients diagnosed with micropapillary thyroid carcinoma from May 2020 to August 2022 who underwent minimally invasive open hemithyroidectomy. Adhesive skin electrodes were attached to the skin in the area of the lateral border of the thyroid cartilage lamina. Hemithyroidectomy was performed by approaching between sternocleidomastoid and strap muscles, after a 3-4 cm horizontal skin incision. We collected the data regarding age, sex, mean amplitude and latency of evoked electromyogram (EMG) (V1, R1, R2, V2). Results: The amplitude of EMG from vagus and RLN was successfully measured. The mean amplitude was measured as 239.2 μV for V1, 278.0 μV for R1, 362.1 μV for R2, and 307.0 μV for V2, respectively. Conclusion: The monitoring using adhesive skin electrodes is good alternative method of IONM using EMG endotracheal tube for preserving RLN during minimally invasive open hemithyroidectomy.