-
ANZ Journal of Surgery Mar 2023Neck dissection is a commonly performed procedure for oncologic control of head and neck malignancy. With contemporary modified radical and selective neck dissections,... (Review)
Review
BACKGROUND
Neck dissection is a commonly performed procedure for oncologic control of head and neck malignancy. With contemporary modified radical and selective neck dissections, haematoma, wound infection, tissue necrosis, chyle leak and injury involving the marginal mandibular, hypoglossal, vagus or accessory nerves are commonly described complications. Although the phrenic nerve courses within the surgical planes explored during a neck dissection and has a vital function in innervating the diaphragm, few studies have been performed to investigate the exact incidence of post-operative phrenic nerve paresis. This study aims to review the literature as to the rate of phrenic nerve injury following neck dissection.
METHODS
A systematic literature review was conducted from 2000 to 2022 including studies reporting on phrenic nerve paresis following neck dissection.
RESULTS
In total, 11 studies were included. The reported rate of immediate post-operative phrenic nerve paresis ranged from 0% to 5.3%, with an average rate of 0.613% (12/1959). The reported rate of phrenic nerve paresis at follow-up (1 month-127 months) ranged from 0% to 4.7%, with an average rate of 1.035% (5/483). There were no cases of bilateral phrenic nerve paresis reported in this period.
CONCLUSIONS
Phrenic nerve paresis is an uncommon complication following neck dissection, often asymptomatic and potentially underreported. Bilateral phrenic nerve paresis is exceedingly rare. Injury can be avoided by staying superficial to the prevertebral fascia when dissecting around the anterior scalene muscle. Routine phrenic nerve integrity monitoring is not commonly utilized but may aid intra-operative phrenic nerve identification or confirmation of function.
Topics: Humans; Phrenic Nerve; Neck Dissection; Head and Neck Neoplasms; Paresis
PubMed: 36792555
DOI: 10.1111/ans.18322 -
Annals of Anatomy = Anatomischer... Jun 2024The aim of this systematic review is to study the subdiaphragmatic anatomy of the phrenic nerve. (Review)
Review
OBJECTIVE
The aim of this systematic review is to study the subdiaphragmatic anatomy of the phrenic nerve.
MATERIALS AND METHODS
A computerised systematic search of the Web of Science database was conducted. The key terms used were phrenic nerve, subdiaphragmat*, esophag*, liver, stomach, pancre*, duoden*, intestin*, bowel, gangli*, biliar*, Oddi, gallbladder, peritone*, spleen, splenic, hepat*, Glisson, falciform, coronary ligament, kidney, suprarenal, and adrenal. The 'cited-by' articles were also reviewed to ensure that all appropriate studies were included.
RESULTS
A total of one thousand three hundred and thirty articles were found, of which eighteen met the inclusion and exclusion criteria. The Quality Appraisal for Cadaveric Studies scale revealed substantial to excellent methodological quality of human studies, while a modified version of the Systematic Review Centre for Laboratory Animal Experimentation Risk of Bias Tool denoted poor methodological quality of animal studies. According to human studies, phrenic supply has been demonstrated for the gastro-esophageal junction, stomach, celiac ganglia, liver and its coronary ligament, inferior vena cava, gallbladder and adrenal glands, with half of the human samples studied presenting phrenic nerve connections with any subdiaphragmatic structure.
CONCLUSIONS
This review provides the first systematic evidence of subdiaphragmatic phrenic nerve supply and connections. This is of interest to professionals who care for people suffering from neck and shoulder pain, as well as patients with peridiaphragmatic disorders or hiccups. However, there are controversies about the autonomic or sensory nature of this supply.
Topics: Phrenic Nerve; Humans; Diaphragm; Animals
PubMed: 38692333
DOI: 10.1016/j.aanat.2024.152269 -
Ultrasound in Medicine & Biology Aug 2022Because of the insidious character and variations in presenting symptoms, Charcot-Marie-Tooth (CMT) disease is challenging to diagnose in children. Diagnosis is based on... (Meta-Analysis)
Meta-Analysis Review
Because of the insidious character and variations in presenting symptoms, Charcot-Marie-Tooth (CMT) disease is challenging to diagnose in children. Diagnosis is based on clinical and nerve conduction studies, as well as genetic examination. Therefore, competent nerve imaging techniques and non-invasive alternatives to nerve conduction studies are a necessity, especially in children. We performed a systematic review and meta-analysis to evaluate the current evidence and effectiveness of ultrasound in investigating nerve cross-sectional area (CSA) in those with CMT compared with healthy controls and to pool the CSA measurements. We included studies published in international peer-reviewed journals that measured nerve CSA by ultrasound in patients with CMT. We implemented double-arm meta-analyses to compare the mean CSA of nerves between patients with CMT and healthy controls by calculating the pooled mean difference in CSA. Moreover, we performed subgroup analyses by stratifying the studies according to the site of CSA measurement and examined the difference in nerve CSA between CMT1A and other CMT types. The included studies provide measurements of 12 nerve roots and nerves (vagus, C3, C4, C5, C6, greater auricular, phrenic, median, ulnar, fibular, tibial and sural nerves) in 628 patients with CMT and 586 healthy controls with a total of 6061 measured nerves. Meta-analyses of sonographic nerve CSA are provided to express nerve ultrasonography in the diagnosis of CMT patient.
Topics: Charcot-Marie-Tooth Disease; Child; Humans; Peripheral Nerves; Sural Nerve; Ultrasonography
PubMed: 35667977
DOI: 10.1016/j.ultrasmedbio.2022.04.220 -
World Neurosurgery Nov 2022Phrenic nerve dysfunction has been associated with cervical neuroforaminal stenosis in limited case reports and case-controlled studies. It is unclear if magnetic... (Review)
Review
BACKGROUND
Phrenic nerve dysfunction has been associated with cervical neuroforaminal stenosis in limited case reports and case-controlled studies. It is unclear if magnetic resonance imaging of the cervical spine should be included in the workup of patients with pulmonary dysfunction. A systematic review of the current literature was conducted on the topic to provide an outline of the body of knowledge and some guidance for neurosurgeons that receive these patient referrals.
METHODS
A systematic literature review was conducted through the PubMed database to identify articles related to phrenic nerve dysfunction secondary to cervical stenosis.
RESULTS
A total of 12 case reports were found. The median subject age was 64 years, 11 were male. Presenting symptoms included shortness of breath (n = 9), radiculopathy (n = 7), myelopathy (n = 5), reduced pulmonary function (n = 6), weakness (n = 4), and neck pain (n = 5). Ten of these patients underwent surgical intervention, all having improvements in their pulmonary and neurological symptoms at follow-up ranging from 10 days to 2 years.
CONCLUSIONS
Cervical stenosis, resulting in neuroforaminal stenosis, may be related to phrenic nerve dysfunction in select patients with idiopathic diaphragmatic paralysis or pulmonary dysfunction. Surgical decompression improves pulmonary and neurological symptoms.
Topics: Humans; Male; Middle Aged; Female; Constriction, Pathologic; Phrenic Nerve; Spinal Cord Diseases; Cervical Vertebrae; Respiratory Paralysis
PubMed: 36089276
DOI: 10.1016/j.wneu.2022.09.009 -
The American Journal of Cardiology Oct 2022RespiCardia remedē System (Minnetonka, MN 2017), a transvenous phrenic nerve stimulator, is indicated to treat central sleep apnea (CSA) by stimulating the phrenic...
RespiCardia remedē System (Minnetonka, MN 2017), a transvenous phrenic nerve stimulator, is indicated to treat central sleep apnea (CSA) by stimulating the phrenic nerve to cause diaphragmatic contraction to restore normal breathing during sleep. CSA is associated with decreased patient quality of life and worsens cardiovascular outcomes. Systematic review was conducted according to the Preferred Reporting of Systematic Reviews and Meta-Analysis guidelines. PubMed/MEDLINE, Cochrane, EBSCO CINAHL, and Ovid databases were queried by 2 independent reviewers for English-language studies published between 2000 and 2021. The initial search screened for all occurrences of "remedē" then was further refined to include studies evaluating use of the RespiCardia remedē System as a treatment for CSA in multiple patients. A total of 124 articles were identified from the initial search results. A total of 37 articles were identified through screening of title and abstracts from initial results. Full-text review of all the articles was then completed. Of the 13 articles included, a total of 232 patients underwent device implantation. We sought to summarize the available evidence regarding patient selection for implantation, immediate and delayed complications, adherence to therapy, and polysomnographic evidence of efficacy. All 13 articles detailed significant decreases in central apnea index and many patients reported significant mild to marked improvement in quality of life. In conclusion, the remedē System has been demonstrated to improve sleep and respiratory parameters, with few complications. This device demonstrates safe and effective treatment of moderate to severe CSA in adult patients, including those with heart failure.
Topics: Adult; Electric Stimulation Therapy; Humans; Phrenic Nerve; Quality of Life; Sleep Apnea, Central; Systematic Reviews as Topic
PubMed: 35918232
DOI: 10.1016/j.amjcard.2022.06.038 -
Journal of Atrial Fibrillation 2020The Right phrenic nerve (RPN) is vulnerable to injury during the isolation of the right pulmonary veins (RPV). The study aimed to provide a comprehensive meta-analysis...
BACKGROUND
The Right phrenic nerve (RPN) is vulnerable to injury during the isolation of the right pulmonary veins (RPV). The study aimed to provide a comprehensive meta-analysis of the overall prevalence of right phrenic nerve injury (RPNI), its course and its association with the superior and inferior pulmonary veins.
METHODS
Through December 2017, a database search was performed on PubMed, Science Direct, EMBASE, SciELO, and Web of Science. The references were also extensively searched in the included articles.
RESULTS
Detection of the RPN may vary according to the identification method. It ranges from 100% in postmortem studies, 93% in intraoperative, to 57.88% in computer tomography (CT) imaging. Based on the included studies (n-507), the distance from the right superior pulmonary vein (RSPV) ostium to the RPN was 12.48mm (±6.21). In postmortem studies, the distance was 6.92mm (±3.94); in pre or intraoperative techniques, 13.32mm (±5.96) if noninvasive, 13.97mm (±7.8) if invasive. Distances ranged from 0DC342.6 mm. For the right inferior pulmonary vein (RIPV) (n-125) the mean distance was 16.53mm (±8.92) with distances from 0.4 68mm. The risk of RPNI with distance-included studies was 12.46% (47 RPNI in 377 cases). In the meta-analysis, the distance from the RSPV to the RPN that was associated with an increased risk of RPNI was 7.36mm.
CONCLUSIONS
RPNI is a relatively rare complication. A firm understanding of its course, relation to the PV ostium, and detection are vital for preventing future injuries and complications.
PubMed: 34950302
DOI: 10.4022/jafib.2305 -
Medicina (Kaunas, Lithuania) Jan 2023: Ipsilateral shoulder pain (ISP) is a common complication after thoracic surgery. Severe ISP can cause ineffective breathing and impair shoulder mobilization. Both... (Meta-Analysis)
Meta-Analysis Review
Efficacy of Phrenic Nerve Block and Suprascapular Nerve Block in Amelioration of Ipsilateral Shoulder Pain after Thoracic Surgery: A Systematic Review and Network Meta-Analysis.
: Ipsilateral shoulder pain (ISP) is a common complication after thoracic surgery. Severe ISP can cause ineffective breathing and impair shoulder mobilization. Both phrenic nerve block (PNB) and suprascapular nerve block (SNB) are anesthetic interventions; however, it remains unclear which intervention is most effective. The purpose of this study was to compare the efficacy and safety of PNB and SNB for the prevention and reduction of the severity of ISP following thoracotomy or video-assisted thoracoscopic surgery. Studies published in PubMed, Embase, Scopus, Web of Science, Ovid Medline, Google Scholar and the Cochrane Library without language restriction were reviewed from the publication's inception through 30 September 2022. Randomized controlled trials evaluating the comparative efficacy of PNB and SNB on ISP management were selected. A network meta-analysis was applied to estimate pooled risk ratios (RRs) and weighted mean difference (WMD) with 95% confidence intervals (CIs). : Of 381 records screened, eight studies were eligible. PNB was shown to significantly lower the risk of ISP during the 24 h period after surgery compared to placebo (RR 0.44, 95% CI 0.34 to 0.58) and SNB (RR 0.43, 95% CI 0.29 to 0.64). PNB significantly reduced the severity of ISP during the 24 h period after thoracic surgery (WMD -1.75, 95% CI -3.47 to -0.04), but these effects of PNB were not statistically significantly different from SNB. When compared to placebo, SNB did not significantly reduce the incidence or severity of ISP during the 24 h period after surgery. This study suggests that PNB ranks first for prevention and reduction of ISP severity during the first 24 h after thoracic surgery. SNB was considered the worst intervention for ISP management. No evidence indicated that PNB was associated with a significant impairment of postoperative ventilatory status.
Topics: Humans; Phrenic Nerve; Shoulder Pain; Nerve Block; Thoracic Surgery; Pain, Postoperative; Network Meta-Analysis; Injections, Intra-Articular
PubMed: 36837476
DOI: 10.3390/medicina59020275 -
Journal of Cardiothoracic and Vascular... Aug 2022This meta-analysis was aimed at investigating the effectiveness and safety of phrenic nerve infiltration (PNI) against ipsilateral shoulder pain (ISP) after thoracic... (Meta-Analysis)
Meta-Analysis Review
Effect of Intraoperative Phrenic Nerve Infiltration on Postoperative Ipsilateral Shoulder Pain After Thoracic Surgeries: A Systematic Review and Meta-Analysis of Randomized Controlled Studies.
OBJECTIVES
This meta-analysis was aimed at investigating the effectiveness and safety of phrenic nerve infiltration (PNI) against ipsilateral shoulder pain (ISP) after thoracic surgery.
DESIGN
A systematic review and meta-analysis of randomized controlled trials (RCTs).
SETTING
Operating room.
PARTICIPANTS
Patients undergoing thoracic surgery.
INTERVENTIONS
PNI.
MEASUREMENTS AND MAIN RESULTS
MEDLINE, Cochrane Library, and EMBASE databases were searched from inception through December 2021. The primary outcome was the overall incidence of ISP, with secondary outcomes including incidence and severity of ISP at postoperative 6, 24, and 48 hours. Six RCTs involving 482 patients undergoing thoracic surgery were included. Pooled results found a significantly lower incidence of overall ISP in patients with PNI (ie, 23.6%) compared to those without (ie, 53.2%; risk ratio: 0.46, 95% confidence interval: 0.34-0.61; I = 19%; 6 RCTs; n = 474; certainty of evidence = high). At postoperative 6, 24, and 48 hours, there was also a significantly lower incidence of ISP in the PNI group than in the control group (certainty of evidence for all outcomes = high). Besides, the severity of ISP was lower in the PNI group at 6 (certainty of evidence = moderate) and 24 hours (certainty of evidence = high), with insufficient data for analysis at 48 hours because of only 1 trial.
CONCLUSION
This meta-analysis showed that PNI not only reduced the incidence but also improved the severity of ipsilateral shoulder pain after thoracic surgery with a prophylactic effect lasting up to 48 hours. The limited number of included studies warrants further research to support these findings.
Topics: Humans; Pain, Postoperative; Phrenic Nerve; Postoperative Period; Shoulder Pain; Thoracic Surgical Procedures
PubMed: 35570082
DOI: 10.1053/j.jvca.2022.04.016 -
Journal of Personalized Medicine Feb 2022The superiority of second-generation cryoballoon (2G-CB) ablation versus contact force-sensing radiofrequency (CF-RF) ablation in patients with paroxysmal atrial... (Review)
Review
A Systematic Review and Meta-Analysis of the Direct Comparison of Second-Generation Cryoballoon Ablation and Contact Force-Sensing Radiofrequency Ablation in Patients with Paroxysmal Atrial Fibrillation.
The superiority of second-generation cryoballoon (2G-CB) ablation versus contact force-sensing radiofrequency (CF-RF) ablation in patients with paroxysmal atrial fibrillation (AF) was assessed in this systematic review and meta-analysis. Freedom from atrial tachyarrhythmias (ATAs) (OR = 0.89; 95% confidence interval [CI] = 0.68 to 1.17; = 0.41), freedom from AF (OR = 0.93; 95% CI = 0.65 to 1.35; = 0.72), and acute pulmonary vein isolation (PVI) (OR = 1.17; 95% CI = 0.54 to 2.53; = 0.70) between 2G-CB ablation and CF-RF ablation were not different. The procedure time for the 2G-CB ablation was shorter (MD = -18.78 min; 95% CI = -27.72 to -9.85 min; < 0.01), while the fluoroscopy time was similar (MD = 2.66 min; 95% CI = -0.52 to 5.83 min; = 0.10). In the 2G-CB ablation group, phrenic nerve paralysis was more common (OR = 5.74; 95% CI = 1.80 to 18.31; = < 0.01). Regarding freedom from ATAs, freedom from AF, and acute PVI, these findings imply that 2G-CB ablation is not superior to CF-RF ablation in paroxysmal AF. Although faster than CF-RF ablation, 2G-CB ablation has a greater risk of phrenic nerve paralysis.
PubMed: 35207786
DOI: 10.3390/jpm12020298 -
Respiratory Physiology & Neurobiology May 2023The perception of breathlessness is mechanistically linked to the awareness of increased inspiratory neural drive (IND). Stimulation of upper airway cold receptors on... (Review)
Review
The perception of breathlessness is mechanistically linked to the awareness of increased inspiratory neural drive (IND). Stimulation of upper airway cold receptors on the trigeminal nerve (TGN) with TGN agonists such as menthol or cool air to the face/nose has been hypothesized to reduce breathlessness by decreasing IND. The aim of this systematic scoping review was to identify and summarize the results of studies in animals and humans reporting on the impact of TGN stimulation or blockade on measures of IND. Thirty-one studies were identified, including 19 in laboratory animals and 12 in human participants. Studies in laboratory animals consistently reported that as TGN activity increased, measures of IND decreased (e.g., phrenic nerve activity). In humans, stimulation of the TGN with a stream of cool air to the face/nose decreased the sensitivity of the ventilatory chemoreflex response to hypercapnia. Otherwise, TGN stimulation with menthol or cool air to the face/note had no effect on measures of IND in humans. This review provides new insight into a potential neural mechanism of breathlessness relief with selected TGN agonists.
Topics: Animals; Humans; Menthol; Olfactory Nerve; Dyspnea; Nose; Trigeminal Nerve
PubMed: 36792044
DOI: 10.1016/j.resp.2023.104035