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Langenbeck's Archives of Surgery Jun 2024The anatomical variations of the recurrent laryngeal nerve (RLN) are common during thyroidectomy. We aimed to evaluate the risk of RLN paralysis in case of its...
PURPOSE
The anatomical variations of the recurrent laryngeal nerve (RLN) are common during thyroidectomy. We aimed to evaluate the risk of RLN paralysis in case of its anatomical variations, retrospectively.
METHODS
The patients with primary thyroidectomy between January 2016 and December 2019 were enrolled. The effect of age, gender, surgical intervention, neuromonitorisation type, central neck dissection, postoperative diagnosis, neck side, extralaryngeal branching, non-RLN, relation of RLN to inferior thyroid artery (ITA), grade of Zuckerkandl tubercle on vocal cord paralysis (VCP) were investigated.
RESULTS
This study enrolled 1070 neck sides. The extralaryngeal branching rate was 35.5%. 45.9% of RLNs were anterior and 44.5% were posterior to the ITA, and 9.6% were crossing between the branches of the ITA. The rate of total VCP was 4.8% (transient:4.5%, permanent: 0.3%). The rates of total and transient VCP were significantly higher in extralaryngeal branching nerves compared to nonbranching nerves (6.8% vs. 3.6%, p = 0.018; 6.8% vs. 3.2%, p = 0.006, respectively). Total VCP rates were 7.2%, 2.5%, and 2.9% in case of the RLN crossing anterior, posterior and between the branches of ITA, respectively (p = 0.003). The difference was also significant regarding the transient VCP rates (p = 0.004). Anterior crossing pattern increased the total and transient VCP rates 2.8 and 2.9 times, respectively.
CONCLUSION
RLN crossing ITA anteriorly and RLN branching are frequent anatomical variations increasing the risk of VCP in thyroidectomy that cannot be predicted preoperatively. This study is the first one reporting that the relationship between RLN and ITA increased the risk of VCP.
Topics: Humans; Thyroidectomy; Female; Male; Vocal Cord Paralysis; Middle Aged; Retrospective Studies; Adult; Recurrent Laryngeal Nerve; Thyroid Gland; Aged; Recurrent Laryngeal Nerve Injuries; Risk Factors; Young Adult; Postoperative Complications; Adolescent
PubMed: 38935142
DOI: 10.1007/s00423-024-03392-y -
Clinical Case Reports Jul 2024Insertion of a nasogastric tube is one of the most common methods of administering nutrition, but can cause vocal cord paralysis.
Insertion of a nasogastric tube is one of the most common methods of administering nutrition, but can cause vocal cord paralysis.
PubMed: 38933707
DOI: 10.1002/ccr3.8960 -
Indian Journal of Pediatrics Jun 2024
PubMed: 38926220
DOI: 10.1007/s12098-024-05194-y -
Biomolecules & Biomedicine Jun 2024A retrospective analysis was conducted on 58 patients with laryngeal and hypopharyngeal tumors and 27 patients with benign vocal cord lesions to explore the role of...
A retrospective analysis was conducted on 58 patients with laryngeal and hypopharyngeal tumors and 27 patients with benign vocal cord lesions to explore the role of serum cytokines in these diseases' characteristics and immunotherapy. The differences in the levels of 12 cytokines were measured. Additionally, the study examined the correlation between T helper cells (Th)1/Th2 cytokine levels and the clinical characteristics and immunotherapy efficacy of laryngeal and hypopharyngeal cancers. The results show that the balance of Th1/Th2 is biased towards Th2 in patients with laryngeal and hypopharyngeal tumors. Among these, interleukin (IL)-6 (P = 0.021) was highly expressed in laryngeal tumors, and the expression levels of IL-1β (P = 0.008), IL-6 (P = 0.005), and IL-8 (P = 0.05) were higher in patients with poorly differentiated laryngeal tumors. The level of IL-4 (P = 0.0048) was significantly correlated with tumor location. The expression levels of IL-2 (P = 0.010), IL-4 (P = 0.028), IL-10 (P = 0.011), IL-12p70 (P = 0.034), IL-17 (P = 0.024), tumor necrosis factor (TNF)-α (P = 0.003), and interferon (IFN)-γ (P = 0.007) were related to lymph node metastasis. The level of IFN-γ (P = 0.016) was correlated with the efficacy of neoadjuvant therapy, while the level of IFN-α (P = 0.013) was significantly correlated with programmed death ligand 1 (PD-L1) expression. The Principal Component Analysis (PCA) results showed that patients with tumors, poor differentiation, and lymph node metastasis had higher levels of Th1 and Th2 cytokine separation. In conclusion, the shift in the balance of Th1 and Th2 cytokine expression indicates higher tumor invasiveness, and IFN has potential as a circulating molecular marker for immunotherapy of head and neck squamous cell carcinoma.
PubMed: 38920620
DOI: 10.17305/bb.2024.10783 -
Journal of Anaesthesiology, Clinical... 2024Though permanent vocal cord palsy consequent to recurrent laryngeal nerve (RLN) injury is rare following thyroidectomies, its consequences are grave enough for it to be... (Review)
Review
Though permanent vocal cord palsy consequent to recurrent laryngeal nerve (RLN) injury is rare following thyroidectomies, its consequences are grave enough for it to be the most feared complication postoperatively. Anesthesiologists and surgeons take various precautions to prevent its occurrence and employ various methods for its early detection. They include direct visualization of the nerve intraoperatively, use of intraoperative nerve monitoring, and post-extubation visualization of vocal cord mobility by use of direct or indirect methods. In the present narrative review, we aim to discuss the clinical evidence pertaining to the various methods adopted for the prevention and early detection of RLN palsy during thyroidectomy.
PubMed: 38919442
DOI: 10.4103/joacp.joacp_346_22 -
Cureus May 2024Background Thyroidectomy is a routinely performed surgical procedure used to treat benign, malignant, and some hormonal disorders of the thyroid that are not responsive...
Background Thyroidectomy is a routinely performed surgical procedure used to treat benign, malignant, and some hormonal disorders of the thyroid that are not responsive to medical therapy. Voice alterations following thyroid surgery are well-documented and often attributed to recurrent laryngeal nerve dysfunction. However, subtle changes in voice quality can persist despite anatomically intact laryngeal nerves. This study aimed to quantify post-thyroidectomy voice changes in patients with intact laryngeal nerves, focusing on fundamental frequency, first formant frequency, shimmer intensity, and maximum phonation duration. Methodology This cross-sectional study was conducted at a tertiary referral center in central India and focused on post-thyroidectomy patients with normal vocal cord function. Preoperative assessments included laryngeal endoscopy and voice recording using a computer program, with evaluations repeated at one and three months post-surgery. Patients with normal laryngeal endoscopic findings underwent voice analysis and provided feedback on subjective voice changes. The PRAAT version 6.2 software was utilized for voice analysis. Results The study included 41 patients with normal laryngoscopic findings after thyroid surgery, with the majority being female (85.4%) and the average age being 42.4 years. Hemithyroidectomy was performed in 41.4% of patients and total thyroidectomy in 58.6%, with eight patients undergoing central compartment neck dissection. Except for one patient, the majority reported no subjective change in voice following surgery. Objective voice analysis showed statistically significant changes in the one-month postoperative period compared to preoperative values, including a 5.87% decrease in fundamental frequency, a 1.37% decrease in shimmer intensity, and a 6.24% decrease in first formant frequency, along with a 4.35% decrease in maximum phonatory duration. These trends persisted at the three-month postoperative period, although values approached close to preoperative levels. Results revealed statistically significant alterations in voice parameters, particularly fundamental frequency and first formant frequency, with greater values observed in total thyroidectomy patients. Shimmer intensity also exhibited slight changes. Comparison between hemithyroidectomy and total thyroidectomy groups revealed no significant differences in fundamental frequency, first formant frequency, and shimmer. However, maximum phonation duration showed a significantly greater change in the hemithyroidectomy group at both one-month and three-month postoperative intervals. Conclusions This study on post-thyroidectomy patients with normal vocal cord movement revealed significant changes in voice parameters postoperatively, with most patients reporting no subjective voice changes. The findings highlight the importance of objective voice analysis in assessing post-thyroidectomy voice outcomes.
PubMed: 38916010
DOI: 10.7759/cureus.60873 -
European Archives of... Jun 2024To evaluate whether trans-thyroid cartilage nerve monitoring for thyroid surgeries is as effective and safe as endotracheal tube monitoring.
PURPOSE
To evaluate whether trans-thyroid cartilage nerve monitoring for thyroid surgeries is as effective and safe as endotracheal tube monitoring.
METHODS
Fifty-one thyroidectomies (38 hemithyroidectomies and 13 total thyroidectomies, analyzed as two separate hemi-thyroidectomies) were included. Patients undergoing surgery from 6/2020 to 8/2021 were monitored simultaneously with the NIM® Nerve Monitoring System TriVantage™ Electromyography (EMG) endotracheal tube and EMG trans-thyroid cartilage. Electrophysiological responses of 64 vagus and recurrent laryngeal nerves were obtained. Peri-operative evaluation and 12-month post-operative follow-up were conducted to examine nerve function. Wilcoxon signed-rank and Spearman coefficient tests were used to determine whether there were differences between the methods.
RESULTS
The average initial amplitude measured with the trans-thyroid cartilage method was higher in the recurrent laryngeal and vagus nerves (p = 0.002, p = 0.003, respectively). The mean difference in EMG amplitude from start to end of surgery for 10 damaged nerves (7 temporary and 3 permanent) differed from intact nerves in both methods and nerves (p < 0.05 for all). Among intact recurrent laryngeal nerves, 20.4% had 20-80% decrease in amplitude in endotracheal tube electrodes and 16.7% in trans-thyroid cartilage electrodes (p = 0.92). All cases with stable EMG signals or with increased EMG amplitude (with both types of electrodes and with both nerves) had normal post-operative vocal function. No significant difference was found between the two methods when measuring the vagus and recurrent laryngeal nerves. No complications occurred when using trans-thyroid cartilage electrodes.
CONCLUSIONS
Trans-thyroid cartilage nerve monitoring for thyroid surgeries is as effective and safe as the current standard monitoring using an endotracheal tube. During thyroid surgery, patients are monitored to avoid damaging nerves near the vocal cords. This study compared monitoring through a throat tube with the easier method of monitoring outside of the throat to see if it is as effective and safe. No major difference was found between the two methods and there were no problems.
PubMed: 38914816
DOI: 10.1007/s00405-024-08760-4 -
International Journal of Biological... Jun 2024In this report, we present a dual crosslinking hydrogel fiber made from polyamine saccharides chitosan (CS), synthesized through UV polymerization. This process utilizes...
On the dual crosslinking for functionality enhancement of poly (acrylamide-co-acrylic acid)/chitosan-aluminum (III) ions and its characterization and sensory hydrogel fibers.
In this report, we present a dual crosslinking hydrogel fiber made from polyamine saccharides chitosan (CS), synthesized through UV polymerization. This process utilizes Irgacure 2959 and N,N'-Methylenebisacrylamide (MBAA) as initiators, followed by immersion in an aluminum chloride (AlCl) solution. The resulting hydrogel incorporates a dual crosslinking mechanism, quantitatively studied via Nuclear Magnetic Resonance (NMR) spectroscopy. This mechanism involves chemical crosslinking through radical graft polymerization of acrylamide and acrylic acid onto CS in the presence of MBAA, and physical crosslinking through hydrogen bonding interactions between P(AAm-co-AA) and a metal coordination bond. The mechanical properties of the hydrogel fiber enable it to withstand stresses up to 656 kPa and strains exceeding 300 %. Additionally, the hydrogel fiber exhibits conductivity at 1.96 Scm. Serving as a multifunctional material, it acts as a strain sensor and finds utility in optics. Remarkably, it demonstrates the capability to detect human motions such as finger bending and minor deformations like vibrations of the vocal cords. Furthermore, its ability to guide dynamic light makes it promising for optical applications. Consequently, this multifunctional hydrogel fiber emerges as a highly promising candidate for diverse applications in fields such as bioengineering and electronics.
PubMed: 38914395
DOI: 10.1016/j.ijbiomac.2024.133383 -
Scientific Reports Jun 2024In the healthcare domain, the essential task is to understand and classify diseases affecting the vocal folds (VFs). The accurate identification of VF disease is the key...
In the healthcare domain, the essential task is to understand and classify diseases affecting the vocal folds (VFs). The accurate identification of VF disease is the key issue in this domain. Integrating VF segmentation and disease classification into a single system is challenging but important for precise diagnostics. Our study addresses this challenge by combining VF illness categorization and VF segmentation into a single integrated system. We utilized two effective ensemble machine learning methods: ensemble EfficientNetV2L-LGBM and ensemble UNet-BiGRU. We utilized the EfficientNetV2L-LGBM model for classification, achieving a training accuracy of 98.88%, validation accuracy of 97.73%, and test accuracy of 97.88%. These exceptional outcomes highlight the system's ability to classify different VF illnesses precisely. In addition, we utilized the UNet-BiGRU model for segmentation, which attained a training accuracy of 92.55%, a validation accuracy of 89.87%, and a significant test accuracy of 91.47%. In the segmentation task, we examined some methods to improve our ability to divide data into segments, resulting in a testing accuracy score of 91.99% and an Intersection over Union (IOU) of 87.46%. These measures demonstrate skill of the model in accurately defining and separating VF. Our system's classification and segmentation results confirm its capacity to effectively identify and segment VF disorders, representing a significant advancement in enhancing diagnostic accuracy and healthcare in this specialized field. This study emphasizes the potential of machine learning to transform the medical field's capacity to categorize VF and segment VF, providing clinicians with a vital instrument to mitigate the profound impact of the condition. Implementing this innovative approach is expected to enhance medical procedures and provide a sense of optimism to those globally affected by VF disease.
Topics: Humans; Vocal Cords; Machine Learning
PubMed: 38910146
DOI: 10.1038/s41598-024-64987-5 -
Journal of Voice : Official Journal of... Jun 2024To assess the long-term outcomes and efficacy of respiratory retraining therapy in patients with exercise-induced laryngeal obstruction (EILO).
OBJECTIVE
To assess the long-term outcomes and efficacy of respiratory retraining therapy in patients with exercise-induced laryngeal obstruction (EILO).
METHODS
A retrospective chart review and prospective questionnaire-based survey were conducted on 88 patients who received respiratory retraining therapy for EILO at our institution over the past 5 years RESULTS: Thirty-four patients were included in the final analysis, with a mean age at symptom onset and age at initial evaluation of 13.67 ± 2.96 and 15.12 ± 3.48, respectively. We found a statistically significant difference in the pretreatment and post-treatment Dyspnea indices following respiratory retraining therapy, with a mean difference of 12.03 ± 7.18 (P < 0.001). When asked about the effectiveness of respiratory retraining therapy, the majority of patients (n = 28) reported improvement (13.3% "a little," 13.3% "somewhat better," 53.3% ("a lot better," and 13.3% complete resolution of symptoms. Only two patients (6.7%) responded that their breathing "did not get better." The most effective therapy techniques cited by patients were abdominal breathing (n = 10), ratio breathing (n = 5), and pursed lips or "straw" breathing (n = 5).
CONCLUSIONS
Respiratory retraining therapy represents an effective technique in both the short-term and long-term management of EILO. This therapy remains the first line in the management of EILO due to its ease of administration, non-invasive nature, and durable effect on breathing function.
PubMed: 38910062
DOI: 10.1016/j.jvoice.2024.06.005