Neurolysis of peripheral nerves of the extremities

Symptoms of vagus nerve damage

When the nerve is damaged, the tone of the voice changes, difficulty swallowing, and choking occur for several weeks, months, sometimes years. As the disease progresses, difficulty swallowing and speaking increases. Paralysis of the muscles of the pharynx, esophagus, and palatine muscles leads to impaired swallowing (dysphagia), the entry of liquid into the nose during the act of swallowing. On examination, a drooping soft palate (80%) and dysphonia are revealed. The uvula deviates in the healthy direction, there are no pharyngeal and palatal reflexes - 65–80%. With vocal paralysis, a change in the voice appears: it becomes hoarse (50%). When the vagus nerve is damaged on both sides, aphonia develops, impaired breathing and heart function.

Other treatments

For mild forms of damage to the recurrent nerve, reflexology is used, which involves treatment by applying pressure to certain points in the larynx area. This method stimulates the restoration of damaged tissue. Treatment also includes special exercises, the effect of which is aimed at normalizing vocal functions. Such classes are conducted by a phoniatrist.

For bilateral recurrent nerve palsy, laryngoplasty is recommended. The method is not used for malignant tumors and some other pathologies, as well as for elderly patients.

During surgery, access to the problem area is made through the mucous membrane of the mouth or neck and collagen or Teflon is introduced, which increases the volume of nerve fibers.

If necessary, a surgical method is used that involves excision of some tissues in the larynx area, after which individual fibers are transferred to a new area. This approach is used for severe asphyxia, when the airways are completely blocked.

The prognosis after surgery for recurrent nerve paresis is determined on an individual basis. In uncomplicated cases, it is possible to partially or completely restore both respiratory and vocal functions.

Recurrent nerve palsy is a dangerous condition that interferes with the motor activity of the muscles in the throat area. Such violations can cause suffocation, leading to the death of the patient.

Treatment of vagus nerve damage

Treatment is prescribed only after confirmation of the diagnosis by a medical specialist. It is necessary to eliminate the cause of the disease; Prednisolone, vitamins, antihistamines, anticholinesterase drugs are indicated; plasmapheresis. Differential diagnosis:

• Tumors and cerebrovascular disorders in the medulla oblongata.
• Amyotrophic lateral sclerosis.
• Herpes zoster.
• Tumors of the lungs, thyroid gland, esophagus.
• Left atrial hypertrophy.
• Aneurysm of the aortic arch.

Essential drugs

There are contraindications. Specialist consultation is required.

• Prednisolone (systemic GCS). Dosage regimen: the average oral dose for adults is 5-60 mg/day. in 3-4 doses. The maximum daily dose is 200 mg.
• Milgamma (B complex of vitamins). Dosage regimen: therapy begins with 2 ml intramuscularly 1 time per day for 5-10 days. Maintenance therapy - 2 ml IM two or three times a week.
• Prozerin (inhibitor of acetylcholinesterase and pseudocholinesterase). Dosage regimen: orally for adults, 10-15 mg 2-3 times a day; subcutaneously - 1-2 mg 1-2 times a day.
• Diphenhydramine (antihistamine, sedative, hypnotic). Dosage regimen: 1–5 ml of 1% solution intramuscularly; orally 0.025–0.05 g 1-3 times a day. The course of treatment is 10-15 days.

Recurrent and superior laryngeal nerves - Gregory W. Randolph

Book “Recurrent and superior laryngeal nerves”

Author: Gregory W. Randolph

ISBN: 978-5-00030-752-6

The book “Recurrent and superior laryngeal nerves” was written by a large team of specialists in the field of thyroid surgery and reflects new achievements in the seemingly developed “down to the smallest detail” technique of operations on this anatomically complex and physiologically important organ. We are talking about the method of intraoperative neuromonitoring (IONM) of the function of the laryngeal nerves, which not only was a significant improvement in surgical techniques, but also changed the approach to preparing patients for surgery and the method of managing them in the postoperative period; it made it necessary to perform laryngoscopy before surgery, and for some patients, also ultrasound, CT and MRI.

The publication “Recurrent and superior laryngeal nerves” describes the features of research methods in relation to the thyroid gland in terms of upcoming intervention on it. Of significant interest is the clinical anatomy of the thyroid gland considered in a new light and the description of the anatomy of the recurrent nerves, especially the external branch of the superior laryngeal nerve, which until recently has received insufficient attention, is distinguished by its novelty. The description is very detailed, supported by wonderful diagrams and photographs taken during operations. The IONM technique, its types (constant and variable), methods for monitoring the integrity of the laryngeal nerves are thoroughly outlined: visual observation, electromyography, as well as recording laryngeal muscle potentials using electrodes integrated into the endotracheal tube.

The use of IONM takes thyroid surgery to a new level; it makes it possible to secure operations performed on it and, what is especially important, for surgeons who do not yet have sufficient experience or perform these operations relatively rarely, because according to the data provided by the authors, the share of surgeons , performing less than twenty such thyroid surgeries per year, account for approximately 75% of all thyroid surgeries. Knowledge of anatomy at the level presented in the book is also important from a medico-legal point of view, as it will reduce the number of unfortunate cases when the surgeon has to act as a defendant in lawsuits filed by patients who have suffered from damage to the laryngeal nerves.

The book “Recurrent and superior laryngeal nerves” will serve as a source of new knowledge about the thyroid gland for anatomists, surgeons, and doctors of related specialties involved in the treatment of thyroid diseases.

Contents of the book “Recurrent and superior laryngeal nerves”

1. Prevalence of iatrogenic damage to the recurrent and superior laryngeal nerves: data from national quality of care registries and literature

2. Examination of the larynx: indications and methods

3. Neurological control of laryngeal function

4. Microscopic neuroanatomy of the vagus nerve, superior and recurrent laryngeal nerves

5. Intralaryngeal anatomy of the recurrent laryngeal nerve

6. Visualization of the recurrent laryngeal nerve

Part III. Surgical anatomy of the recurrent laryngeal nerve

7. Recurrent laryngeal nerve and its decussation with the inferior thyroid vessels

8. Branching of the recurrent laryngeal nerve

9. Recurrent laryngeal nerve and tubercle of Zuckerkandl

10. Berry bunch

11. Irreversible inferior laryngeal nerve

12. International anatomical classification of the recurrent laryngeal nerve

13. Surgical approaches to the laryngeal nerve

Part IV. Intraoperative monitoring of recurrent laryngeal nerve function

14. Intraoperative monitoring of recurrent laryngeal nerve function

15. Continuous intraoperative monitoring of recurrent laryngeal nerve function

Part V. Surgical anatomy and monitoring of superior laryngeal nerve function

16. External branch of the superior laryngeal nerve: anatomical classification

17 Surgical access to the external branch of the superior laryngeal nerve and monitoring of its function

Part VI. Nerve damage

18. Loss of electrophysiological signal during intraoperative neuromonitoring and staged operations on the thyroid gland

19. Mechanism of damage

20. Surgeon’s tactics in case of nerve damage during surgery: neurapraxia - damage to the nerve without violating its anatomical integrity

21. Intraoperative tactics for nerve damage: intersection and segmental defect

22. Surgical tactics for tumor invasion of the recurrent laryngeal nerve

23. Postoperative management of patients with unilateral dysfunction of the recurrent laryngeal nerve

24. Tactics of postoperative management of patients with bilateral vocal cord paralysis

25. Recurrent laryngeal nerve and medical error in thyroid surgery

26. Postoperative management of patients with dysfunction of the superior laryngeal nerve

Examples of pages from the book “Recurrent and Superior Laryngeal Nerves”

From the author of the book “Recurrent and superior laryngeal nerves”

The book you are holding in your hands is a comprehensive overview of the current knowledge of the recurrent laryngeal and superior laryngeal nerves, their relationship to the surgical anatomy of the thyroid and parathyroid glands, surgical techniques, and the latest technological advances, including neuromonitoring techniques designed to preserve integrity. these nerves, and to identify and treat nerve damage that may occur during thyroid surgery.

The emphasis of the book is on the electrophysiological aspect of thyroid and parathyroid surgery. Nerve function plays an extremely important role in the daily life, work life, and sometimes even the spiritual life of our patients. The chapters in this book contain information regarding neurolaryngology, the basics of laryngeal function, indications for laryngoscopy, and surgical techniques for the recurrent laryngeal and superior laryngeal nerves based on their anatomy. Particular attention is paid to recent advances in the field of intraoperative neuromonitoring, including new promising methods for monitoring the condition of the superior laryngeal nerve and continuous monitoring of vagus nerve function.

In general, we tried to present the material in the most easy-to-understand manner, using both tables and visual presentation methods. The value of this book lies in the high level of each part. Each co-author of this book was selected from leading researchers and practitioners, including surgeons, around the world. The selection of co-authors was carried out very carefully. The main goal was to ensure that their clinical or research contributions to the published literature were consistent with the topics of the book chapters. As a result, all authors have brought unique contributions and insights to their respective topics, going beyond anecdotal evidence. In an attempt to achieve a complete combination of disparate elements, many of the chapters of this book were written by specialists with experience in various fields of medicine from around the world. We believe that this is the first book that pays such close attention to the innervation of the larynx in the context of surgical interventions on the larynx. thyroid gland. We hope that the book will be useful for both beginners and experienced surgeons involved in the treatment of diseases and the study of the thyroid and parathyroid glands.

I want to acknowledge all the people without whom this work would not have seen the light of day. First, I am grateful to the editorial board, namely Henning Dralle, Gianlorenzo Dionigi, Marcin Barczynski and Feng-Yu Chiang. Additionally, I thank my friend and colleague Dr. Dipti Kamani for her tireless research assistance. I also thank John and Claire Bertucci and Mike and Liz Ruane for their friendship and constant support over the years. Finally, I would like to acknowledge the significant contributions of several doctors to this book, especially Dr. Brad Welling, my supervisor, friend, and mentor, for his continued support in the evolution of my thyroid surgery practice in Boston and for helping me grow in my career. I would also like to thank Dr. Keith Lillemoe and Dr. Ken Tanabe for their belief in true professional relationships and dedication to the principles of modern endocrine surgery.

Recommendations

A consultation with a neurologist and magnetic resonance imaging of the brain are recommended.

Diagnostic methods

Recurrent neuropathy is diagnosed based on the results of collecting information about the patient's condition. In addition to the medical history, pathologies help in determining the disease:

• external examination of the larynx;
• CT;
• X-ray in various projections;
• phonetography;
• laryngoscopy;
• electromyography of the laryngeal muscles.

In order to identify the causative factor, ultrasound, CT and other methods of examining the thyroid gland, brain, heart, lungs, and respiratory system are used. Additionally, a biochemical blood test is prescribed to identify the pathogenic agent.

In the case of bilateral laryngeal paralysis, a tracheotomy is first performed, and then the patient is examined. This is explained by the fact that paralysis of this type poses a direct threat to the patient’s life.

Incidence (per 100,000 people)

Symptoms