Superior laryngeal nerve block for treatment of throat pain and cough following laryngeal herpes zoster:A case report

BACKGROUND Herpes zoster is caused by reactivation of latent varicella-zoster virus infection within the sensory nerve ganglion of the spinal or cranial nerves.Laryngeal herpes zoster is rare and involves superior laryngeal nerve,which leads to several complications such as throat pain,and cough.CASE SUMMARY Patient concerns:A 52-year old woman presented with a 70 d history of throat pain and a 67 d history of non-productive cough.Three days after onset of pain,she was diagnosed with laryngeal herpes zoster.Flexible nasolaryngoscopy revealed multiple white ulcerated lesions on the left hemi epiglottis and the left supraglottic area.She was prescribed with 750 mg famciclovir a day for 7 d,and 150 mg pregabalin,100 mg tramadol and 10 mg nortriptyline a day for 67 d.However,despite of these medications,she complained of pain and persistent cough.Therefore,superior laryngeal nerve block under ultrasound guidance was performed.Three days after the intervention,the throat pain and cough disappeared.The patient remained symptom-free at 3 mo follow-up.CONCLUSION A superior laryngeal nerve block can be an effective option for treatment of pain and cough following laryngeal herpes zoster.

Adipose-derived mesenchymal stem cells accelerate nerve regeneration and functional recovery in a rat model of recurrent laryngeal nerve injury

Medialization thyroplasty or injection laryngoplasty for unilateral vocal fold paralysis cannot restore mobility of the vocal fold. Recent studies have shown that transplantation of mesenchymal stem cells is effective in the repair of nerve injuries. This study investigated wheth- er adipose-derived stem celt transplantation could repair recurrent laryngeal nerve injury. Rat models of recurrent laryngeal nerve injury were established by crushing with micro forceps. Adipose-derived mesenchymal stem cells （ADSCs; 8 ×105） or differentiated Schwann-like adipose-derived mesenchymal stem cells （dADSCs; 8×105） or extracellular matrix were injected at the site of injury. At 2, 4 and 6 weeks post-surgery, a higher density of myelinated nerve fiber, thicker myelin sheath, improved vocal fold movement, better recovery of nerve conduction capacity and reduced thyroarytenoid muscle atrophy were found in ADSCs and dADSCs groups compared with the extracellu- lar matrix group. The effects were more pronounced in the ADSCs group than in the dADSCs group. These experimental results indicated that ADSCs transplantation could be an early interventional strategy to promote regeneration after recurrent laryngeal nerve injury.

Applied anatomy of the cervical region of the recurrent laryngeal nerve

BACKGROUND AND OBJECTIVE： To avoid recurrent laryngeal nerve （RLN） injury during thyroid surgery, it is important to identify the nerve and to follow its projection carefully to discriminate it from the inferior thyroid artery. DESIGN, TIME AND SETTING： All studies were performed at the Anatomy Division of Shaoyang Medical College from May 2003 to May 2004 with repeated measurement design. MATERIALS： Fifty embalmed adult corpses, comprising 20 females and 30 males, were obtained by donation. METHODS AND MAIN OUTCOME MEASURES： The projection, branches, and the relationship of the RLN to the inferior thyroid artery were observed. RESULTS： The RLN in all cases ascended through the tracheoesophageal groove at the isthmus superior levels of the thyroid gland. However, the RLN in 14 cases were situated inferior to the isthmus of the thyroid gland; 11 cases were to the right side and 2 cases to the left side, projected in the tracheoesophageal groove, and ascended away from the groove after 4.5-6.5 mm. The RLN typically ramified at the thyroid isthmus plane （44 cases, 44% of all cases）. The RLN branches were variable. Type 2 rami were most common in the RLN, accounting for 55%; the second most common was RLN branches with no rami. RLN braches with type 3 rami, 4 rami, and 5 rami were less common. Approximately 54% of nerves were situated behind the main branch artery. The nerves located adjacent to the arteries, and between the arterial branches, were similar; the former applied to 19 cases, accounting for 19%, whereas the latter applied to 18 cases, accounting for 18%. Left nerves behind the artery, and right nerves before the artery, were more common. There were significant differences between the left and right nerves （P 〈 0.01）. CONCLUSION： There was not a significant difference in the projection of the RLN, while a significant difference in the number of RLN branches existed. In addition, the anatomical relationship of the RLN and the inferior thyroid artery exhibited side differences.

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.

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.

Clinical significance and characteristics of recurrent laryngeal nerve lymph node metastasis of thoracic esophageal cancer

Objective To investigate the clinical significance and characteristics of recurrent laryngeal nerve lymph node metastasis of thoracic esophageal cancer. Methods One hundred and twenty-four patients who had undergone thoracic esophageal resection with recurrent laryngealnerve lymph node dissection in our hospital from March 2007 to February 2010. All clinical data were retrospectively analysed. Results Recurrent laryngeal

Three Cases of Idiopathic Superior Laryngeal Neuralgia Treated by Superior Laryngeal Nerve Block under Ultrasound Guidance

In treating superior laryngeal neuralgia （SLN）, superior laryngeal nerve blocks （SLNBs） can provide immediate relief of persistent pain. Although SLNB was effective, the procedure can increase the risks due to the proximity to the carotid artery, external vein, and other vessels. To avoid complications such as advertent intravascular injection, local anesthetic toxicity from intravascular absorption, and intratracheal injection, we successfully blocked the superior laryngeal nerve under ultrasound guidance in three patients suffering from SLN. The written informed consent before treatment was obtained for each patient participating in this study.

Intraoperative monitoring of the recurrent laryngeal nerve in surgeries for thyroid cancer: a review

Intraoperative nerve monitoring(IONM)has evolved into an objective tool not only for the identification but also for the preservation and prognostication of function of the recurrent laryngeal nerve in thyroid surgeries.Technical improvements have resulted in the increasing incorporation of IONM into operating rooms around the world.The importance of adherence to recommended standards is also recognized as being vital in optimizing the efficacy of IONM.The advent of continuous IONM has made real-time nerve monitoring possible,thus providing the surgeon with an ally in difficult surgeries.Additionally,as thyroid surgeries are evolving into remote access and minimally invasive procedures,so also is the applicability of IONM.This review focuses on the use of IONM for nerve monitoring in thyroidectomies for neoplastic conditions while discussing the rationale,technique,and interpretation of findings and their implications.

Current landscape in motoneuron regeneration and reconstruction for motor cranial nerve injuries

The intricate anatomy and physiology of cranial nerves have inspired clinicians and scientists to study their roles in the nervous system. Damage to motor cranial nerves may result from a variety of organic or iatrogenic insults and causes devastating functional impairment and disfigurement. Surgical innovations directed towards restoring function to injured motor cranial nerves and their associated organs have evolved to include nerve repair, grafting, substitution, and muscle transposition. In parallel with this progress, research on tissue-engineered constructs, development of bioelectrical interfaces, and modulation of the regenerative milieu through cellular, immunomodulatory, or neurotrophic mechanisms has proliferated to enhance the available repertoire of clinically applicable reconstructive options. Despite these advances, patients continue to suffer from functional limitations relating to inadequate cranial nerve regeneration, aberrant reinnervation, or incomplete recovery of neuromuscular function. These shortfalls have profound quality of life ramifications and provide an impetus to further elucidate mechanisms underlying cranial nerve denervation and to improve repair. In this review, we summarize the literature on reconstruction and regeneration of motor cranial nerves following various injury patterns. We focus on seven cranial nerves with predominantly efferent functions and highlight shared patterns of injuries and clinical manifestations. We also present an overview of the existing reconstructive approaches, from facial reanimation, laryngeal reinnervation, to variations of interposition nerve grafts for reconstruction. We discuss ongoing endeavors to promote nerve regeneration and to suppress aberrant reinnervation and the development of synkinesis. Insights from these studies will shed light on recent progress and new horizons in understanding the biomechanics of peripheral nerve neurobiology, with emphasis on promising strategies for optimizing neural regeneration and identifying future directions in the field of motor cranial neuron research.

A three-dimensional digital visualization model of cervical nerves in a healthy person

Three-dimensional reconstruction nerve models are classically obtained from two-dimensional images of ＂visible human＂ frozen sections. However, because of the flexibility of nerve tissues and small color differences compared with surrounding tissues, the integrity and validity of nerve tissues can be impaired during milling. Thus, in the present study, we obtained two-dimensional data from a healthy volunteer based on continuous CT angiography and magnetic resonance myelography. Semi-automatic segmentation and reconstruction were then conducted at different thresholds in different tissues using Mimics software. Small anatomical structures such as muscles and cervical nerves were reconstructed using the medical computer aided design module. Three-dimensional digital models of the cervical nerves and their surrounding structures were successfully developed, which allowed visualization of the spatial relation of anatomical structures with a strong three-dimensional effect, distinct appearance, clear distribution, and good continuity, precision, and integrality. These results indicate the validity of a three-dimensional digital visualization model of healthy human cervical nerves, which overcomes the disadvantages of milling, avoids data loss, and exhibits a realistic appearance and three-dimensional image.

Ⅰ型神经纤维瘤病累及喉返神经1例

1 临床资料患者,女,16岁,发现颈前肿物2个月。专科查体:颈部正中偏右侧肿大,表面皮肤无红肿破溃,触诊可及一直径约4 cm×2 cm大小肿物,质软,无压痛,边界清楚,活动度良好。彩超检查示:甲状腺右叶后方实性肿物,大小约4.7 cm×2.7 cm×2.5 cm,与甲状腺关系不清(图1A)。CT示:甲状腺后方低密度灶,考虑良性病变,对应部位气管轻度受压变形。

Identifying a Safe Range of Stimulation Current for Intraoperative Neuromonitoring of the Recurrent Laryngeal Nerve： Results from a Canine Model

Background： lntraoperative neuromonitoring （IONM） of the recunent laryngeal nerve （RLN） has been widely applied during thyroid surgery. However, the sale range of stimulation intensity for IONM remains undetermined, Methods： Total thyroidectomies were performed on twenty dogs, and their RLNs were stimulated with a current of 5 20 mA （step-wise in 5 mA increments） for 1 min. The evoked electromyography （EMG） of vocal muscles before and after supramaximal stimulation were recorded and compared. Acute microstructural morphological changes in the RLNs were observed immediately postoperatively under an electron microscope. Results： The average stimulating threshold for RLNs stimulated with 15 mA and 20 mA showed no significant changes compared to the unstimulated RLNs （15 mA group： 0.320 ± 0.123 mA vs. 0.315 ±0.097 mA, P =0.847; 20 mA group： 0.305 ± 0.101 mA vs. 0.300 ＋ 0.103 mA, P = 0.758）. Similar outcomes were shown in average evoked EMG amplitude （15 mA group： 1,026 ± 268 p.V xs. 1,021 ± 273 p.V, P = 0.834; 20 mA group： 1,162 ± 275 μV vs. 1,200 ± 258μV, P = 0.148）. However, obvious acute microstructural morphological changes were observed in the nerves that were stimulated with 20 mA. Conclusions： A stimulation intensity less than 15 mA might be safe for IONM of the RLN.