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Zhong Allen,Sifri Yara,Owen Randall P. 대한내분비외과학회 2023 The Koreran journal of Endocrine Surgery Vol.23 No.3
Coexisting ipsilateral nonrecurrent and recurrent laryngeal nerves have been described previously, but its existence is still debated. We report a case of a concurrent nonrecurrent and recurrent ipsilateral laryngeal nerves that were incidentally found during a total thyroidectomy with intraoperative nerve monitoring signal from both branches. A 57-year-old female was found to have a right thyroid lobe nodule during surveillance whole body positron emission tomography scan and a left 1.7 cm thyroid nodule on ultrasound. The patient underwent a total thyroidectomy and right central cervical lymph node dissection. Exposure of the right recurrent laryngeal nerve revealed a typical recurrent branch as well as a type 2 nonrecurrent laryngeal nerve branch. Intraoperative nerve monitoring demonstrated signal from both the recurrent and nonrecurrent laryngeal nerve branches, implicating innervation of the larynx from both branches. A coexisting ipsilateral nonrecurrent and recurrent laryngeal nerve was identified in this case with novel demonstration of intraoperative nerve monitoring signal from both branches. This case highlights that the identification of either a recurrent or nonrecurrent nerve does not exclude the possibility of a coexisting recurrent or nonrecurrent nerve. While the consequences of damage to either of these nerve branches is currently unknown, both nerve branches may be functionally important and injury to either branch may result in morbidity.
Development of a canine model for recurrent laryngeal injury by harmonic scalpel
Kyu-Eun Lee,Hyeon-Gun Jee,Hoon-Yub Kim,Won-Seo Park,Sung-Hye Park,Yeo-Kyu Youn 한국실험동물학회 2012 Laboratory Animal Research Vol.28 No.4
Various energy devices had been used in thyroid surgery. Aim of study is to develop canine model for recurrent laryngeal nerve injury by harmonic scalpel and to evaluate feasibility of using this model for evaluating the safety use of harmonic scalpel during thyroid surgery. Nine dogs were divided into 3 groups according to distance between harmonic scalpel application and recurrent laryngeal nerve; group 1 (1 mm), 2 (2 mm), and 3 (3 mm). Vocal cord function was assessed pre- and postoperatively using video laryngoscopy. Harmonic scalpel was applied adjacent to left recurrent laryngeal nerve and, two weeks later, right recurrent laryngeal nerve at assigned distances. Recurrent laryngeal nerves were evaluated for subacute and acute morphologic changes. Laryngoscopy demonstrated 3 abnormal vocal cords in group 1, 1 in group 2, and no in group 3 (P=0.020). Subacute histologic changes were observed in nerves with abnormal function. Acute histologic changes were observed 5/8 (62.5%) in group 1, 1/7 (14.3%) in group 2, and not in group 3. We developed canine model for recurrent laryngeal injury. The functional outcomes matched with the histologic changes. These warrant further study to determine the safety margin for energy device in vicinity of recurrent laryngeal nerve.
김정미,최정석 대한갑상선학회 2023 International Journal of Thyroidology Vol.16 No.1
Recurrent laryngeal nerve injury is a common complication of thyroid surgery that can cause communication disorders, aspiration, and swallowing difficulties. Despite extensive knowledge of the pathology and regeneration mechanisms of recurrent laryngeal nerve injury, reliable treatments that guarantee complete functional recovery are insufficient. Currently, nerve auto-grafting is the gold standard for the treatment of recurrent laryngeal nerve damage. However, due to the limitations of nerve auto-grafting, such as donor site morbidity and limited supply, alternative treatment methods are necessary in this field. Nerve guide conduits are being increasingly considered as potential alternatives to nerve auto-grafts in the treatment of recurrent laryngeal nerve damage. In recent years, researchers have attempted to develop structurally stable and biocompatible nerve guide conduits using tissue engineering technology, including internal and external structural changes, the development of biocompatible materials, and drug release. This article reviews research papers on the development of functionally developed nerve-guided conduits for recurrent laryngeal nerve regeneration.
Prediction of Recurrent Laryngeal Nerve Invasion in Thyroid Cancer by Ultrasound
Jung Jin Hyang,Kim Eunji,Kang Byung Ju 대한외과초음파학회 2024 대한외과초음파학회지 Vol.11 No.1
Assessing recurrent laryngeal nerve invasion is crucial for the accurate staging of thyroid cancer. This, in turn, determines the extent of surgery or whether active surveillance is appropriate. Ultrasonography is useful in diagnosing extrathyroidal extension to adjacent structures. However, preoperative ultrasound cannot definitely exclude recurrent laryngeal nerve invasion or identify the entire course of the recurrent laryngeal nerve to the thyroid gland. Therefore, it is important to understand the ultrasound features that are most likely to be associated with the gross involvement of the recurrent laryngeal nerve.
갑상선 수술 중 신경 손상을 피하기 위한 수술 중 신경 모니터링의 활용
지용배(Yong Bae Ji) 대한신경모니터링학회 2021 Journal of Neuromonitoring & Neurophysiology Vol.1 No.1
Traditionally, visual identification of the nerve is the gold standard to avoid injury. Intraoperative neural monitoring (IONM) has been world-widely popularized in thyroid and parathyroid surgery because it helps identify the nerve. Despite the increasing use of IONM, there is a controversy that IONM can reduce recurrent laryngeal nerve (RLN) injury. It may be derived from the lack of uniformity in the application of and results from nerve monitoring between surgeons. IONM can not only be used to check the nerves, but it can also provide a lot of information to the surgeon. By using this information properly, the function of nerves can be monitored sensitively during surgery, and through this, a surgeon can be relatively freed from nerve damage. Proper use of IONM can improve the quality of neural monitoring and drive surgeons to best practices. In this paper, consistent and useful use of IONM has been described.
Sang Yull Kang,Seon Kwang Kim,Hyun Jo Youn,Sung Hoo Jung 대한갑상선-내분비외과학회 2016 The Koreran journal of Endocrine Surgery Vol.16 No.1
A non-recurrent laryngeal nerve is a rare anatomical variant that entails considerable riskfor iatrogenic injury during thyroid surgery. We encountered a patient with a non-recurrentlaryngeal nerve that went unnoticed on preoperative imaging but was discoveredincidentally during robotic thyroidectomy. A 44 year old woman presented at ourdepartment with papillary thyroid microcarcinoma, diagnosed by ultrasonography-guidedfine needle aspiration cytology. During robotic right thyroidectomy and central lymphnode dissection, we could not detect any structure resembling the recurrent laryngeal nervearound the inferior thyroid artery. Thus, we suspected the existence of a non-recurrentlaryngeal nerve, and successfully identified a nerve entering the larynx directly from thevagus nerve without recurring. A three-dimensional high magnification view via a roboticendoscope can aid thyroid surgeons to safely identify and preserve a non-recurrentlaryngeal nerve.
갑상선유두암 수술 중 확인된 비회귀성 반회후두 신경 1예
신혜승 ( Hye-seung Shin ),윤성필 ( Seong-pil Yoon ),고준완 ( Jun-wan Ko ),김준식 ( Jun-sik Kim ) 대한갑상선학회 2010 International Journal of Thyroidology Vol.3 No.2
A nonrecurrent laryngeal nerve has a reported incidence of 0.3 to 1.6%, and they mostly identified on the right side of neck during thyroid or parathyroid surgery. We experienced a case of nonrecurrent laryngeal nerve during surgery for papillary thyroid cancer. Total thyroidectomy with central node dissection was performed in a 67-year-old female patient. After total thyroidectomy the nerve was found at the level of the 4th tracheal ring, direct branching from the vagus nerve. A surgeon must beware that not to damage a nonrecurrent laryngeal nerve which found during thyroid or parathyroid surgery.
정상 성대 기능을 가진 갑상선유두암종 환자에서 암 침윤이 있는 반회후두신경 보존의 기능적, 종양학적 결과
김영록 ( Young Rok Kim ),김주연 ( Joo Yeun Kim ),김성원 ( Sung Won Kim ),이봉주 ( Bong Ju Lee ),차용우 ( Yong Woo Cha ),이강대 ( Kang Dae Lee ) 대한갑상선학회 2008 International Journal of Thyroidology Vol.1 No.2
Background and Objectives: Complete excision with resection of the recurrent laryngeal nerve (RLN) in differentiated papillary thyroid carcinoma (PTC) with invasion of RLN, reportedly did not improve the survival over incomplete excision. However some investigators have provided definitive oncologic and functional outcomes concerning the preservation of recurrent laryngeal nerve involved in thyroid cancer. Materials and Methods: The RLN involved by locally invasive papillary thyroid carcinoma was preserved in 15 patients with functioning vocal cord, between April 1998 and April 2004. Retrospective study was performed with medical records of 11 patients who were followed-up more than 48 months. All patients were treated by the shaving technique for RLN preservation. Postoperative radioiodine and thyroid stimulating hormone suppression therapy were combined for ablation of microscopic residual PTC. Results: Postoperative survival rate of the patients with RLN preservation was 100%, and local recurrence was not observed. There were 13 nerves showing infiltration by PTC during the operation. Permanent vocal cord paralysis was not observed and transient vocal cord paralysis occurred in 1 nerve (7.7%) of 1 patient. Conclusion: Although the number of patients and follow-up duration of the study may be limited, preservation of RLN infiltrated by PTC maintained the functioning vocal cord without any clinical recurrence.