Laryngopharyngeal reflux disease:Updated examination of mechanisms,pathophysiology,treatment,and association with gastroesophageal reflux disease

Laryngopharyngeal reflux disease(LPRD)is an inflammatory condition in the laryngopharynx and upper aerodigestive tract mucosa caused by reflux of stomach contents beyond the esophagus.LPRD commonly presents with symptoms such as hoarseness,cough,sore throat,a feeling of throat obstruction,excessive throat mucus.This complex condition is thought to involve both reflux and reflex mechanisms,but a clear understanding of its molecular mechanisms is still lacking.Currently,there is no standardized diagnosis or treatment protocol.Therapeutic strategies for LPRD mainly include lifestyle modifications,proton pump inhibitors and endoscopic surgery.This paper seeks to provide a comprehensive overview of the existing literature regarding the mechanisms,pathophysiology and treatment of LPRD.We also provide an in-depth exploration of the association between LPRD and gastroesophageal reflux disease.

Electrophysiological neuromonitoring of the laryngeal nerves in thyroid and parathyroid surgery: A review

Recurrent laryngeal nerve(RLN) injury is one of the most common complications of thyroid surgery. Injury to the external branch of the superior laryngeal nerve is less obvious and affects the voice variably; however, it can be of great significance to professional voice users. Recent literature has led to an increase in the use of neuromonitoring as an adjunct to visual nerve identification during thyroid surgery. In our review of the literature, we discuss the application, efficacy and safety of neuromonitoring in thyroid surgery. Although intraoperative neuromonitoring(IONM) contributes to the prevention of laryngeal nerves injury, there was no significant difference in the incidence of RLN injury in thyroid surgery when IONM was used compared with visual identification alone. IONM use is recommended in high risk patients; however, there are no clear identification criteria for what constitutes "high risk". There is no clear evidence that IONM decreases the risk of laryngeal nerve injury in thyroid surgery. However, continuous IONM provides a promising tool that can prevent imminent nerve traction injury by detecting decreased amplitude combined with increased latency.

Nursing Care of the Laryngeal Mask Airway in Pediatric Cataract Surgery

Purpose:.To investigate the important experience of nursing care of the laryngeal mask airway(LMA) in children undergoing cataract surgery.Methods: Fifty-five children undergoing cataract surgery were anesthetized by inhaling sevoflurane through a LMA and received perioperative nursing care. The safety of perioperative nursing for these children was also evaluated.Results: Through perioperative nursing care and psychological counseling for children with LMA,.all patients were anesthetized without complications and underwent successful surgeries..No severe postoperative complications were observed.Conclusion: Nursing care specific for LMA is a vital part of the success of anesthesia and pediatric cataract surgery.

Anatomical Variations of Recurrent Laryngeal Nerve: The Danger in Thyroid Surgery

Objectives: We report two types of anatomical variations of the recurrent laryngeal nerve in two patients. Through these two patients we wanted to highlight our surgical approach of the recurrent nerve in an unusual position and to describe the surgical implication of these almost rare variations. Case report: patient aged 28 and 58 admitted for goiter. They underwent a right lobisthmectomy. Both recurrences were approached retrograde. The anatomical variations of the nerve concerned the non-recurrent laryngeal nerve in the first patient. In the second patient there were three anatomical variations, namely an extra laryngeal bifurcation of the nerve, a pre-vascular position of the nerve and a branch connecting the vagus nerve and the recurrent nerve. No recurrence nerve injury was noted. Conclusion: The anatomical variations of the nerve are numerous. A careful dissection is a guarantee of a good prognosis.

Surgical Reports of the Inferior Laryngeal Nerve and the Inferior Thyroid Artery in General Surgery and in ENT

Aim: The purpose of this study was to determine the frequency of the hurts of the inferior laryngeal nerve, according to its anatomical reports with the inferior thyroid artery during the thyroid surgery. Methodology: We realized a forward-looking and retrospective study from January, 1979 till December, 2017 in the service of surgery “B” to the University hospital of the Point G of Bamako and in the service of ENT and cervico-facial surgery of the Teaching Hospital “Mother-Child”, the Luxembourg of Bamako (Mali). All the patients operated in both services for mild goiters were retained. Cancers and other thyroid pathologies were not included. The diagnosis of mild goiter was paused by the histological examination realized on all the surgical specimens. Results: On 2109 dissections of the inferior laryngeal nerve realized during the surgical operations on the thyroid, the frequency of lesion of the inferior laryngeal nerve was 1.09% (20 cases) when it passed dorsally with regard to the inferior thyroid artery (1837 cases) and when 4.04%, it was transvascular or prevascular (272 cases). Conclusion: The prevascular route or transvascular of the inferior laryngeal nerve favors its lesion per operating.

Clinical Observation of Double Tube Laryngeal Mask in Fast-Track Anesthesia for Limb Orthopedic Surgery in Children with Cerebral Palsy

Objective: To compare and analyze the effect and safety of double tube laryngeal mask and endotracheal intubation general anesthesia in fast track anesthesia for limb orthopaedic surgery in children with cerebral palsy. Methods: 78 children with cerebral palsy undergoing limb orthopedic surgery were randomly divided into laryngeal mask group and intubation group, with 39 cases in each group. The perioperative hemodynamic indexes, anesthesia effect related indexes, anesthesia related complications or adverse reaction rates of the two groups were observed and compared between the two groups. Results: When the two groups of children entered the room, there was no significant difference in MAP and HR (P > 0.05);MAP and HR of children in the intubation group were higher than those in the laryngeal mask anesthesia group (P Conclusion: Laryngeal mask is used to establish the airway of intravenous general anesthesia in limb orthopaedic surgery of children with cerebral palsy, which is conducive to the stability of children’s circulatory and respiratory system, to reduce the impact of narcotic drugs on children, to reduce the incidence of postoperative anesthesia related complications, and to improve the anesthetic effect. It meets the requirements of fast track anesthesia, and can be widely used in clinical practice.

Study on Effect of Laryngeal Mask Anesthesia and Endotracheal Intubation Anesthesia on Elderly Patients Undergoing Laparoscopic Gallbladder Surgery

Objective:To analyze the effect of laryngeal mask anesthesia and endotracheal intubation anesthesia in elderly laparoscopic gallbladder surgery.Methods:100 subjects of the experiment came from elderly patients with gallbladder stones admitted from September 2016 to September 2019 in our hospital.There were group A and group B of 50 cases each,and were used tube anesthesia and laryngeal mask anesthesia,then comparing the anesthesia effect.Results:Statistical significance(P<0.05):Air pressure and end-respiratory carbon dioxide partial pressure index changes when immediately after insertion,immediately after removal,3 minutes after removal;heart rate,mean arterial pressure,airway pressure,and end-expiratory carbon dioxide index changes when 3 minutes after insertion and immediately before removal;blood glucose and cortisol changes when after insertion,immediately before removal and min after removal.No statistical significance(P>0.05):Changes in heart rate,mean arterial pressure,airway pressure,and endexpiratory carbon dioxide indexes before insertion;changes in blood glucose and cortisol indexes before insertion.Conclusion:It is more ideal for elderly patients with abdominal cavity and gallbladder surgery to have laryngeal mask anesthesia,which can effectively keep blood circulation stable and have promotion value.

Premature Division of the Inferior Laryngeal Nerve in Surgery and in ENT and Cervico-Facial Surgery in Mali

The purpose of this study was to study the frequency of premature division of the inferior laryngeal nerve and its consequences in thyroid surgery. Methodology: We realized a forward-looking and retrospective study from January, 1979 till December, 2017 in the service of surgery B to the University hospital of the Point G of Bamako and in the service of ENT and cervico-facial surgery of the CHU “mother-child”, the Luxembourg of Bamako (Mali). All the patients operated in both services for mild goiters were included. Cancers and other thyroid pathologies were not included. The diagnosis of mild goiter was paused by the histological examination realized on all the surgical specimens. Results: On 2109 dissections of the lower laryngeal nerve realized during the surgical operations on the thyroid 95.1% of the cases, the nerve had a single branch;in 4.1% of the cases, the nerve had two branches;and in 0.8% of the cases, the nerve had more than 2 branches. Conclusion: The complications of the thyroid surgery in touch with the hurts of the lower laryngeal nerve are known. However, our study shows that these do not seem to be influenced by the premature division of the lower laryngeal nerve.

Schwannoma originating from the recurrent laryngeal nerve in a thyroid cancer patient: A case report and review of the literature

BACKGROUND Schwannoma rarely originates from the recurrent laryngeal nerve, and there are few reports on schwannoma originating from the recurrent nerve in the mediastinum. Herein, we present an extremely rare case of schwannoma originating from the recurrent laryngeal nerve in the neck.CASE SUMMARY This is a case report of one patient diagnosed with thyroid cancer with schwannoma originating from the recurrent laryngeal nerve in the neck, which was incidentally found during a thyroidectomy, and a review of the literature.CONCLUSION Preoperative diagnostic examinations are of less use for detecting schwannoma originating from a recurrent laryngeal nerve in the neck in such small size, which may only incidentally be found during a thyroidectomy. Surgical excision with opening the capsule and shelling out the tumor is the treatment of choice. If the nerve is unable to be preserved, end-to-end recurrent laryngeal nerve anastomosis may be a simple and minimally invasive reconstruction procedure to improve phonation.

External Branch of the Superior Laryngeal Nerve: Anatomy and Operating Hurts

Purpose: Our purpose was to describe the anatomy of the external branch of the upper laryngeal nerve and to estimate the frequency of nerves at risk during the total thyroidectomies sub. Methodology: We realized in the CHU Point G in Bamako a forward-looking study over a period going from September 1st, 2016 till December 31st, 2017. All the patients operated by thyroidectomies subtotals for mild goiters were included to whom a systematic location of the external branch of the superior laryngeal nerve in the space avascular of Reeve was realized. Cancers and other thyroid pathologies were not included. Results: We counted and operated 120 cases of mild goiters. The external branch of the superior laryngeal nerve was seen and dissected in 80.8%;it was not seen in 19.2%. According to the classification of Cernea: the type 2 was found in 80.8% of the cases with him under typical 2b in 47.5% and under type 2a in 40 (33.3%). The global frequency of lesion of the external branch of the upper laryngeal nerve was 10.8% at 9 patients among whom 6 who presented a BENLS of Type Ni. Conclusion: The external branch of the upper laryngeal nerve of type 2 presents a risk of wound because the surgeon treats the upper pedicle at the level of the critical centimeter place over the upper pole of the thyroid. The identification of the nerve during the thyroid surgery is the solution of choice.

Coblation: An Alternative to CO2 Laser and Microdebrider for Laryngeal Papillomatosis

Objective: To assess the efficacy of coblation in treating laryngeal papillomatosis and its effect on post operative voice outcome. Study Design: This is a retrospective study. Setting: Tertiary referral centre. Subjects and Methods: All the patients diagnosed with laryngeal papillomatosis between January 2013 to December 2016 were included in this study. Preoperative assessment was done with rigid and flexible laryngoscopy. PRAAT software was used for voice analysis. All patients underwent coblation assisted microlaryngeal surgery. Post operatively patients were followed up at 1 week, 15 days, 1 month, 3 months and 6 months with rigid laryngoscopy. Voice analysis was repeated after 3 months to assess the improvement in voice. Results: Coblation was found to be effective in treating laryngeal papillomatosis. In our series of seven patients, three patients underwent repeat procedure with coblation for recurrence. But longterm follow up these patients did not reveal any recurrence of laryngeal papillomatosis. Voice analysis revealed a significant improvement in measures of perturbation and maximum phonation time. Conclusion: Coblation is a promising alternative to the conventional methods for the treatment of laryngeal papillomas as it can achieve satisfactory disease clearance with good voice quality.

Anatomical Dissection of the External Branch of the Superior Laryngeal Nerve to the Laboratory of Anatomy of the Faculty of Medicine of Bamako(Mali)

Aim: This study aimed at describing the anatomical variations of the external branch of the superior laryngeal nerve and at estimating the frequency of nerves at risk during the thyroid surgery. Methodology: We realized a forward-looking study from September, 2016 in May 31st, 2018 in the laboratory of anatomy of the Faculty of Medicine and Odontostomatology of Bamako in Mali. All the fresh anatomical subjects not carrying trauma and or a scar at the level of the previous region of the neck were held. The anatomical subjects were not included presenting a traumatic lesion and\or a scar of the previous region of the neck. Results: We realized 34 dissections of the external branch of the superior laryngeal nerve to 17 deathly subjects (11 men and 6 women with a sex-ratio of 1.8). The average age of the subjects was of 42 years (extremes: 18 and 70 years). Our study allowed highlighting in 100% of the cases, the external branch of the superior laryngeal nerve and the superior thyroid artery so to the right as to the left. On 34 dissected external branch of the superior laryngeal nerve, none had a previous route. However we found 28 nerves (82.4%) having a later route, stuck to the external face of the lower constrictor of the pharynx. These were not mixed with the superior thyroid artery and its branch of division and were situated outside the thyroid capsule. In 17.6% of the cases (6 cases), the nerve had a route mixed in the branch of the superior thyroid artery. These were found inside of the capsule (11.8% adhered to the artery and 5.8% crossed its branch of division). Conclusion: The risk of injury of the external laryngeal nerve during thyroid surgery procedure is never zero. It is more important on the left side.

Larynx Organ Preservation in Patients with Hypopharyngeal-Laryngeal Cancer

Object: The therapeutic options for advanced laryngeal-hypopharyngeal cancer have broadened in the last decades, in the attempt to cure the cancer sparing laryngeal functions and to improve quality of life (functional surgery, chemo- radiotherapy, combined therapy). Methods: We propose a single-centre based retrospective study on the results of the treatment of larynx-hypopharynx cancer on the basis of the different therapies offered, focusing on advanced-stage cancers. Among 146 patients with laryngeal-hypopharyngeal cancer treated in the period 1999-2006, we focused on 64 patients with advanced stage resectable cancer. In the larynx cancer group ?n = 40-, 32 patients had surgery and 8 patients had CT-RT (refusal of laryngectomy or relative contraindications to surgery). In the hypopharynx cancer group ?n = 24-, 16 patients underwent surgery and 8 patients had CT-RT. The outcome measure considered has been overall survival. Results: Larynx cancer group. Overall survival: after surgery we observed a 3-year survival of 62%, and a 5-year survival of 44%, while after CT-RT we had a 3-year survival of 25% and a 5-year survival of 12%. Hypopharynx cancer group. Overall survival: surgery: 3-year survival: 40%, 5-year survival 32%;CT-RT: 3-year survival: 50%, 5-year survival: 34%. Conclusion: The results emphasize the use of larynx-preserving approaches for appropriately selected patients without a compromise in survival;in our case series, surgery had better outcome than CT-RT in advanced-stage larynx cancer;whilst no significant differences were observed in the treatment of hypopharynx cancer.

T4a期甲状腺癌外科治疗的临床经验报告

目的分析T4a期甲状腺癌的临床特点及外科治疗策略。方法回顾性纳入2004年1月至2021年5月间在四川省肿瘤医院头颈外科住院手术的甲状腺恶性肿瘤患者,共计纳入T4a的甲状腺癌病例303例,分析患者的病理分型、受侵器官、手术方式、生存时间等。分析患者的总生存率,使用Kaplan Meier法分析患者术后生存曲线。结果在入组的303例患者中,共计53例患者失访,1年总生存率为98.4%(246/250),3年总生存率为97.0%(224/231),5年总生存率为90.2%(92/102)。其中喉返神经单独受侵94例,失访13例,1年总生存率为100%(81/81),3年总生存率为98.7%(77/78),5年总生存率为97.4%(38/39)。喉返神经合并气管/喉/食道受侵151例,失访31例,1年总生存率为96.7%(116/120),3年总生存率为95.3%(101/106),5年总生存率为82.2%(37/45)。在生存曲线分析中,喉返神经单独受侵组较喉返神经合并气管、喉或食道等器官受侵组在总生存时间上存在优势。结论T4a期甲状腺癌如果有手术机会,应该首选手术切除,通过合理的手术策略,根治性手术的同时重视重要组织器官的一期修复重建,患者可获得较好的生活质量和预后。

快速康复外科干预在喉癌手术患者中的应用效果

目的探讨快速康复外科干预在喉癌手术患者中的应用效果。方法根据干预方式的不同将72例喉癌手术患者分为常规组(n=35)和快速康复外科干预组(n=37),常规组患者围手术期接受常规干预,快速康复外科干预组患者在常规组的基础上接受快速康复外科干预。比较两组患者的术后恢复指标、营养指标、心理状态[抑郁自评量表(SDS)、焦虑自评量表(SAS)]及并发症发生情况。结果快速康复外科干预组患者胃管拔除时间、进食恢复时间及术后住院时间均短于常规组,并发症总发生率低于常规组,差异均有统计学意义(P﹤0.05)。干预第5天,两组患者血红蛋白、白蛋白水平均低于本组干预前,快速康复外科干预组患者血红蛋白、白蛋白水平均高于常规组,差异均有统计学意义(P﹤0.05)。干预后,两组患者SDS、SAS评分均低于本组干预前,快速康复外科干预组患者SDS、SAS评分均低于常规组,差异均有统计学意义(P﹤0.05)。结论快速康复外科干预可以缩短喉癌手术患者的住院时间,促进患者术后恢复,改善患者的营养状态和心理状态,并且降低并发症的发生率。

喉癌患者围手术期快速康复查检单的设计与应用

目的 设计喉癌患者围手术期快速康复查检单并探讨其应用效果,以便更好地指引和规范护士在喉癌患者围手术期快速康复的行为。方法 采用前-后对照研究法,将本科室2020年4月至9月收治的35例喉癌患者设为对照组,2020年10月至2021年4月收治的37例喉癌患者设为试验组。对照组采用常规喉癌围手术期快速康复方案,试验组在对照组基础上成立喉癌快速康复持续治疗改进小组,通过文献回顾、专家咨询等方法设计喉癌患者围手术期快速康复查检单并在临床应用。比较两组患者喉癌围手术期快速康复措施的执行规范率,医护人员对快速康复方案执行的满意度,患者平均住院日和满意度。结果 试验组患者围手术期快速康复措施规范执行率为93.28%,患者满意度为(95.57±2.25)分,医生对快速康复方案执行满意度为(35.75±0.89)分,护士对快速康复方案执行满意度为(35.45±1.10)分,高于对照组84.08%、(92.60±2.49)分、(32.88±1.50)分、(33.00±1.30)分;试验组患者平均住院日为(9.89±3.32)d,低于对照组(12.60±4.33)d,两组比较,差异具有统计学意义(均P<0.05)。结论 喉癌患者围手术期快速康复查检单可提高患者快速康复措施的执行规范率,并提高医护人员及患者满意度,促进患者康复。

经皮针状电极在甲状腺术中喉返神经监测的研究

目的比较经皮针状电极和经口插管表面电极用于甲状腺术中神经监测的异同,并探讨在不适合经口插管或表面电极故障时,如何识别和保护喉返神经和迷走神经。方法收集并分析32例因甲状腺疾病接受手术治疗患者的临床资料,共计监测喉返神经和迷走神经各40侧,分别使用经口插管表面电极及经皮针状电极对神经进行监测,记录所获取的振幅及潜伏期。采用SPSS 26.0软件进行统计分析,采用配对t检验对潜伏期进行分析比较,采用秩和检验分析经皮针状电极与经口插管表面电极刺激所得振幅是否有差异。结果经皮针状电极用于甲状腺术中神经监测时,所有神经均被识别并获得与经口插管表面电极潜伏期和振幅相似的双相肌电信号,并可通过潜伏期有效鉴别喉返神经和迷走神经[(3.22±0.50)ms vs.(3.85±1.00)ms,P<0.05],与经口插管表面电极的监测效果[(3.04±0.58)ms vs.(3.89±1.07)ms,P<0.05]无明显差异;同时,经皮针状电极可视化操作度及安全性都更高,具有很大优势。结论经皮针状电极可有效辅助识别并保护喉返神经和迷走神经,是经口插管表面电极的重要补充。

低温等离子手术治疗早期喉鳞状细胞癌整体预后及复发的相关因素研究

目的探讨低温等离子手术治疗早期喉鳞状细胞癌(简称喉癌)的整体预后情况,并评估相关风险因素对患者无病生存期(DFS)的影响,从而分析影响手术疗效的因素,总结临床经验。方法回顾性分析2013年4月—2020年12月接受经口内镜下低温等离子手术治疗、有完整随访资料的患者369例早期喉癌患者的临床资料。随访时间为32~124个月,中位随访时间72个月。并统计分析获得患者各项肿瘤学结果,包括DFS、总生存期(OS)、局部控制率(LC)、保喉率(LP)。结果术后共计70例患者出现复发,40例死亡。所有患者总的1、2、5年DFS分别为89%(95%CI:86%~92%)、85%(95%CI:82%~89%)、80%(95%CI:76%~84%),中位DFS未到达。1、2、5年OS分别为97%(95%CI:96%~99%)、92%(95%CI:89%~95%)、89%(95%CI:85%~92%),中位OS未到达。且累及前连合显著影响患者DFS,但对OS没有影响。而ACI患者1、2、5年DFS分别为87%(95%CI:82%~92%)、82%(95%CI:77%~88%)、76%(95%CI:70%~82%)。而未侵犯患者1、2、5年DFS分别为92%(95%CI:87%~96%),89%(95%CI:84%~93%),85%(95%CI:79%~91%)。结论等离子手术与CO_(2)激光手术或是单纯放疗的疗效较为接近。累及前连合与术后肿瘤切缘也是影响患者术后DFS的重要因素,并且术后复发患者的二次等离子手术并非禁忌。术前做好相应评估,在确认前连合区域外侧甲状软骨没有明显侵犯并且术前判断可以获得阴性切缘的情况下再考虑行等离子手术治疗,才能使患者获得最佳疗效。

喉癌术后并发咽瘘的危险因素分析

目的探讨喉癌术后并发咽瘘的危险因素。方法回顾性选取2019年1月—2023年9月钦州市第二人民医院行喉癌手术的157例患者的临床资料。根据患者术后咽瘘分为咽瘘组(n=27)和非咽瘘组(n=130),采用多因素Logistic回归分析确定喉癌术后并发咽瘘的风险因素。结果病理分级>T3、肿瘤分期>Ⅲ期、术前血红蛋白(Hemoglobin,Hb)<118.5 g/L、术中出血量>184.5 mL、鼻胃管置留时长>15.5 d是喉癌患者术后并发咽瘘的独立风险因素(OR=2.271、4.109、0.929、1.026、1.573,P均<0.05)。结论患者的病理分级较高、肿瘤分期较高、术前Hb较低、术中出血量较高、鼻胃管置留时长较长会增加喉癌患者术后并发咽瘘的风险。

Construction of a novel six-gene signature to predict tumour response to induction chemotherapy and overall survival in locoregionally advanced laryngeal and hypopharyngeal carcinoma

Locoregionally advanced laryngeal and hypopharyngeal cancers(LA-LHCs)are traditionally treated with surgery followed by postoperative radiotherapy,which impairs speech and swallowing functions and reduces the quality of life.^(1,2)The use of induction chemotherapy(IC)as a larynxpreserving approach for LA-LHCs has been verified and refined.^(3)However,the short-term tumor response to IC varies,non-responders usually show poor survival and little benefit.