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Sample records for laryngeal nerve paralysis

  1. Cricothyroid Muscle Botulinum Toxin Injection to Improve Airway for Bilateral Recurrent Laryngeal Nerve Paralysis, A Case Series.

    PubMed

    Benninger, Michael S; Hanick, Andrea; Hicks, Douglas M

    2016-01-01

    Bilateral vocal fold paralysis most commonly results from iatrogenic trauma to the recurrent laryngeal nerve during surgical procedures in the anterior neck. Patients may require tracheostomy because of acute or gradual onset of dyspnea and airway compromise. The intralaryngeal injection of Botox has been considered as a possible therapy for these airway symptoms of bilateral vocal fold paralysis. Chronic unopposed activity of intact cricothyroid muscles could potentially result in gradual medialization of the vocal folds in patients with bilateral recurrent laryngeal nerve paralysis. This case series describes three patients who successfully underwent injections of botulinum toxin into the bilateral cricothyroid muscles to offer sustained relief of dyspnea resulting from bilateral vocal fold paralysis. PMID:25814315

  2. Laryngeal nerve "anastomoses".

    PubMed

    Naidu, L; Lazarus, L; Partab, P; Satyapal, K S

    2014-02-01

    Laryngeal nerves have been observed to communicate with each other and forma variety of patterns. These communications have been studied extensively and have been of particular interest as it may provide an additional form of innervation to the intrinsic laryngeal muscles. Variations noted in incidence may help explain the variable position of the vocal folds after vocal fold paralysis. This study aimed to examine the incidence of various neural communications and to determine their contribution to the innervation of the larynx. Fifty adult cadaveric en-bloc laryngeal specimens were studied. Three different types of communications were observed between internal and recurrent laryngeal nerves viz. (1) Galen's anastomosis (81%):in 13%, it was observed to supply the posterior cricoarytenoid muscle; (2) thyroarytenoid communication (9%): this was observed to supply the thyroarytenoid muscle in 2% of specimens and (3) arytenoid plexus (28%): in 6%, it supplied a branch to the transverse arytenoid muscle. The only communication between the external and recurrent laryngeal nerves was the communicating nerve (25%). In one left hemi-larynx, the internal laryngeal nerve formed a communication with the external laryngeal nerve, via a thyroid foramen. The neural communications that exist in the larynx have been thought to play a role in laryngeal innervation. The results of this study have shown varying incidences in neural communications. Contributions from these communications have also been noted to various intrinsic laryngeal muscles which may be a possible factor responsible for the variable position of the vocal folds in certain cases of vocal fold paralysis. PMID:24590520

  3. Partial Recurrent Laryngeal Nerve Paralysis or Paresis? In Search for the Accurate Diagnosis

    PubMed Central

    Delides, Alexander; Kokotis, Panagiotis; Maragoudakis, Pavlos

    2015-01-01

    Partial paralysis of the larynx is a term often used to describe a hypomobile vocal fold as is the term paresis. We present a case of a dysphonic patient with a mobility disorder of the vocal fold, for whom idiopathic partial paralysis was the diagnosis made after laryngeal electromyography, and discuss a proposition for a different implementation of the term. PMID:26236524

  4. Irregular vocal fold dynamics incited by asymmetric fluid loading in a model of recurrent laryngeal nerve paralysis

    NASA Astrophysics Data System (ADS)

    Sommer, David; Erath, Byron D.; Zanartu, Matias; Peterson, Sean D.

    2011-11-01

    Voiced speech is produced by dynamic fluid-structure interactions in the larynx. Traditionally, reduced order models of speech have relied upon simplified inviscid flow solvers to prescribe the fluid loadings that drive vocal fold motion, neglecting viscous flow effects that occur naturally in voiced speech. Viscous phenomena, such as skewing of the intraglottal jet, have the most pronounced effect on voiced speech in cases of vocal fold paralysis where one vocal fold loses some, or all, muscular control. The impact of asymmetric intraglottal flow in pathological speech is captured in a reduced order two-mass model of speech by coupling a boundary-layer estimation of the asymmetric pressures with asymmetric tissue parameters that are representative of recurrent laryngeal nerve paralysis. Nonlinear analysis identifies the emergence of irregular and chaotic vocal fold dynamics at values representative of pathological speech conditions.

  5. Tuberculous pericarditis associated with hoarseness of voice due to left recurrent laryngeal nerve paralysis

    PubMed Central

    Fouda, Ragai; Ammar, Hussam; Edward, Ramy; Alnabawy, Waleed M; Fouda, Iman M

    2011-01-01

    A 16-years-old Egyptian girl presented with massive pericardial effusion, fever, weight loss and hoarseness of voice. Laryngoscopy showed left vocal cord paralysis. Chest CT revealed pericardial effusion, amalgamated mediastinal lymph nodes and clear lung fields. Pericardial fluid analysis revealed a lymphocytic exudate with high adenosine deaminase enzyme level, negative stains and cultures for bacteria and fungi. Despite a negative nucleic acid test for tuberculosis; antituberculous and corticosteroids therapies resulted in resolution of pericardial effusion after 3 weeks but hoarseness of voice persisted. Few cases of vocal cord paralysis with tuberculous mediastinal lymphadenopathy were reported in English literature. PMID:22675007

  6. Juvenile laryngeal paralysis in three Siberian husky x Alaskan malamute puppies.

    PubMed

    Polizopoulou, Z S; Koutinas, A F; Papadopoulos, G C; Saridomichelakis, M N

    2003-11-15

    Three three-month-old Siberian husky x Alaskan malamute crossbreds had suffered episodic inspiratory dyspnoea and stridor for four to eight weeks and their endurance had decreased. In two of them bilateral, and in the other unilateral, laryngeal paralysis was diagnosed by laryngoscopy. In the nucleus ambiguus of the dogs there was a depletion of motor neurons, neuronal degeneration and mild gliosis, but there were no lesions in the root and peripheral segments of the recurrent laryngeal nerves. PMID:14653342

  7. Facial nerve paralysis in children

    PubMed Central

    Ciorba, Andrea; Corazzi, Virginia; Conz, Veronica; Bianchini, Chiara; Aimoni, Claudia

    2015-01-01

    Facial nerve palsy is a condition with several implications, particularly when occurring in childhood. It represents a serious clinical problem as it causes significant concerns in doctors because of its etiology, its treatment options and its outcome, as well as in little patients and their parents, because of functional and aesthetic outcomes. There are several described causes of facial nerve paralysis in children, as it can be congenital (due to delivery traumas and genetic or malformative diseases) or acquired (due to infective, inflammatory, neoplastic, traumatic or iatrogenic causes). Nonetheless, in approximately 40%-75% of the cases, the cause of unilateral facial paralysis still remains idiopathic. A careful diagnostic workout and differential diagnosis are particularly recommended in case of pediatric facial nerve palsy, in order to establish the most appropriate treatment, as the therapeutic approach differs in relation to the etiology. PMID:26677445

  8. Facial nerve paralysis in children.

    PubMed

    Ciorba, Andrea; Corazzi, Virginia; Conz, Veronica; Bianchini, Chiara; Aimoni, Claudia

    2015-12-16

    Facial nerve palsy is a condition with several implications, particularly when occurring in childhood. It represents a serious clinical problem as it causes significant concerns in doctors because of its etiology, its treatment options and its outcome, as well as in little patients and their parents, because of functional and aesthetic outcomes. There are several described causes of facial nerve paralysis in children, as it can be congenital (due to delivery traumas and genetic or malformative diseases) or acquired (due to infective, inflammatory, neoplastic, traumatic or iatrogenic causes). Nonetheless, in approximately 40%-75% of the cases, the cause of unilateral facial paralysis still remains idiopathic. A careful diagnostic workout and differential diagnosis are particularly recommended in case of pediatric facial nerve palsy, in order to establish the most appropriate treatment, as the therapeutic approach differs in relation to the etiology. PMID:26677445

  9. Laryngeal paralysis in dogs: an update on recent knowledge.

    PubMed

    Kitshoff, Adriaan M; Van Goethem, Bart; Stegen, Ludo; Vandekerckhov, Peter; de Rooster, Hilde

    2013-01-01

    Laryngeal paralysis is the effect of an inability to abduct the arytenoid cartilages during inspiration, resulting in respiratory signs consistent with partial airway obstruction. The aetiology of the disease can be congenital (hereditary laryngeal paralysis or congenital polyneuropathy), or acquired (trauma, neoplasia, polyneuropathy, endocrinopathy). The most common form of acquired laryngeal paralysis (LP) is typically seen in old, large breed dogs and is a clinical manifestation of a generalised peripheral polyneuropathy recently referred to as geriatric onset laryngeal paralysis polyneuropathy. Diagnosing LP based on clinical signs, breed and history has a very high sensitivity (90%) and can be confirmed bylaryngeal inspection. Prognosis after surgical correction depends on the aetiology: traumatic cases have a good prognosis, whereas tumour-induced or polyneuropathy-induced LP has a guarded prognosis. Acquired idiopathic LP is a slow progressive disease, with dogs reaching median survival times of 3-5 years after surgical correction. PMID:23718178

  10. A Case of Associated Laryngeal Paralysis Caused by Varicella Zoster Virus without Eruption

    PubMed Central

    Fujiwara, Keishi; Furuta, Yasushi; Fukuda, Satoshi

    2014-01-01

    We report a patient with significant weakness of the left soft palate, paralysis of the left vocal cord, and left facial nerve palsy. Although the patient showed no herpetic eruption in the pharyngolaryngeal mucosa and auricle skin, reactivation of varicella zoster virus (VZV) was confirmed by serological examination. She was diagnosed with zoster sine herpete. After treatment with antiviral drugs and corticosteroids, her neurological disorder improved completely. When we encounter a patient with associated laryngeal paralysis, we should consider the possibility of reactivation of VZV even when no typical herpetic eruption is observed. PMID:24715925

  11. A Case of Associated Laryngeal Paralysis Caused by Varicella Zoster Virus without Eruption.

    PubMed

    Fujiwara, Keishi; Furuta, Yasushi; Fukuda, Satoshi

    2014-01-01

    We report a patient with significant weakness of the left soft palate, paralysis of the left vocal cord, and left facial nerve palsy. Although the patient showed no herpetic eruption in the pharyngolaryngeal mucosa and auricle skin, reactivation of varicella zoster virus (VZV) was confirmed by serological examination. She was diagnosed with zoster sine herpete. After treatment with antiviral drugs and corticosteroids, her neurological disorder improved completely. When we encounter a patient with associated laryngeal paralysis, we should consider the possibility of reactivation of VZV even when no typical herpetic eruption is observed. PMID:24715925

  12. Recurrent largngeal nerve paralysis: a laryngographic and computed tomographic study

    SciTech Connect

    Agha, F.P.

    1983-07-01

    Vocal cord paralysis is a relatively common entity, usually resulting from a pathologic process of the vagus nerve or its recurrent larynegeal branch. It is rarely caused by intralargngeal lesions. Four teen patients with recurrent laryngeal nerve paralysis (RLNP) were evaluated by laryngography, computed tomography (CT), or both. In the evaluation of the paramedian cord, CT was limited in its ability to differentiate between tumor or RLNP as the cause of the fixed cord, but it yielded more information than laryngography on the structural abnormalities of the larynx and pre-epiglottic and paralaryngeal spaces. Laryngography revealed distinct features of RLNP and is the procedure of choice for evaluation of functional abnormalities of the larynx until further experience with faster CT scanners and dynamic scanning of the larynx is gained.

  13. A systematic review of variations of the recurrent laryngeal nerve.

    PubMed

    Ling, Xing Yao; Smoll, Nicolas Roydon

    2016-01-01

    With thyroid cancer fast becoming one of the most common endocrine cancers, the frequency of thyroid surgery has increased. A common and debilitating concern with thyroid surgery is recurrent laryngeal nerve (RLN) paralysis leading to glottal obstruction and airway compromise. A systematic review regarding the anatomical variation of the recurrent laryngeal nerve was performed to determine the position of anatomical variants of the RLN in relation to the inferior thyroid artery (ITA) as well as the prevalence of nonrecurrent laryngeal nerve (NRLN). MEDLINE, Web of Science, MEDITEXT, AMED, CINAHL, Cochrane, ProQuest, Pubmed, and ScienceDirect. Databases were searched using the search terms "inferior thyroid artery," "recurrent laryngeal nerve," "nonrecurrent laryngeal nerve," and "anatomical variation." The reference sections of the articles found were searched for additional reports. The references of all articles were searched to find articles missed in the database search. A total of 8,655 RLN sides were included in this study. One thousand eight hundred and thirteen (20.95%; 95% confidence interval (CI) 20.09, 2,182) showed a Type A configuration of RLN in relation to the ITA, 2,432 (28.10%; 95% CI 27.15, 29.06) showed a Type B configuration and 4,410 (50.95%; 95% CI 49.89, 52.01) showed a Type C configuration between the RLN and the ITA. The second search returned with 38,568 recurrent laryngeal sides and only 221 (0.57%; 95%CI 0.5, 0.65) NRLN documented. The RLN is most commonly found in the posterior position, relative to the ITA. The incidence of the NRLN is low, only occurring in 0.57% of people. Clin. Anat. 29:104-110, 2016. 2015 Wiley Periodicals, Inc. PMID:26297484

  14. Electrophysiological neural monitoring of the laryngeal nerves in thyroid surgery: review of the current literature

    PubMed Central

    Deniwar, Ahmed; Randolph, Gregory

    2015-01-01

    Recurrent laryngeal nerve (RLN) injury is one of the most common complications of thyroid surgery. RLN injury can cause vocal cord paralysis, affecting the patients voice and the quality of life. Injury of the external branch of the superior laryngeal nerve (EBSLN) can cause cricothyroid muscle denervation affecting high vocal tones. Thus, securing the laryngeal nerves in these surgeries is of utmost importance. Visual identification of the nerves has long been the standard method for this precaution. Intraoperative neuromonitoring (IONM) has been introduced as a novel technology to improve the protection of the laryngeal nerves and reduce the rate of RLN injury. The aim of this article is to provide a brief description of the technique and review the literature to illustrate the value of IONM. IONM can provide early identification of anatomical variations and unusual nerve routes, which carry a higher risk of injury if not detected. IONM helps in prognosticating postoperative nerve function. Moreover, by detecting nerve injury intraoperatively, it aids in staging bilateral surgeries to avoid bilateral vocal cord paralysis and tracheostomy. The article will discuss the value of continuous IONM (C-IOMN) that may prevent nerve injury by detecting EMG waveform changes indicating impending nerve injury. Herein, we are also discussing anatomy of laryngeal nerves and aspects of its injury. PMID:26425449

  15. Ramsay Hunt syndrome and zoster laryngitis with multiple cranial nerve involvement

    PubMed Central

    Shinha, Takashi; Krishna, Pasala

    2015-01-01

    Ramsay Hunt syndrome is characterized by varicella zoster virus infection affecting the geniculate ganglion of the facial nerve. It typically presents with vesicles in the external auditory canal associated with auricular pain and peripheral facial nerve paralysis. Although vestibulocochlear nerve is frequently co-involved during the course of Ramsay Hunt syndrome, multiple lower cranial nerve involvement has rarely been described in the literature. In addition, laryngitis due to varicella zoster virus is a diagnostic challenge due to its unfamiliarity among clinicians. We report a case of Ramsay Hunt syndrome with laryngitis involving multiple lower cranial nerves.

  16. Ortner's Syndrome: Secondary Laryngeal Paralysis Caused by a Great Thoracic Aorta Aneurysm.

    PubMed

    Zangirolami, Ana Claudia Alves; Oliveira, Frederico Vieira de; Tepedino, Miguel Soares

    2015-04-01

    Introduction?Recurrent laryngeal nerve injury caused by cardiovascular disease is a rare condition, and often it is the only prominent sign of an imminent break of an aortic artery aneurysm. Objective?To report left laryngeal paralysis caused by a great aortic arch aneurysm and to highlight the importance of an otorhinolaryngologic evaluation along with a thoracic radiologic study. Resumed Report?A 42-year-old man complained of thickness of his voice and dysphagia for 3 months, but no thoracic pain or other relevant complaints. Video laryngoscopy revealed immobility of his left vocal fold in the paramedian position. Imaging was obtained for investigation, including magnetic resonance imaging of his thorax, which showed a fusiform aneurysm in the aortic arch, leading to recurrent compression of the left laryngeal nerve. The patient was successfully treated with endovascular repair of the aneurysm. At 2-month follow-up, there was still no recovery of the laryngeal mobility. Conclusion?An aortic artery aneurysm can suddenly break, requiring emergency heart surgery, and the results can be fatal in many cases. We suggest routine exam of the vocal folds in all patients with a heart condition, and we review the literature and suggest the use of imaging to reduce the number of emergency procedures. PMID:25992177

  17. Ortner's Syndrome: Secondary Laryngeal Paralysis Caused by a Great Thoracic Aorta Aneurysm

    PubMed Central

    Zangirolami, Ana Claudia Alves; Oliveira, Frederico Vieira de; Tepedino, Miguel Soares

    2015-01-01

    Introduction?Recurrent laryngeal nerve injury caused by cardiovascular disease is a rare condition, and often it is the only prominent sign of an imminent break of an aortic artery aneurysm. Objective?To report left laryngeal paralysis caused by a great aortic arch aneurysm and to highlight the importance of an otorhinolaryngologic evaluation along with a thoracic radiologic study. Resumed Report?A 42-year-old man complained of thickness of his voice and dysphagia for 3 months, but no thoracic pain or other relevant complaints. Video laryngoscopy revealed immobility of his left vocal fold in the paramedian position. Imaging was obtained for investigation, including magnetic resonance imaging of his thorax, which showed a fusiform aneurysm in the aortic arch, leading to recurrent compression of the left laryngeal nerve. The patient was successfully treated with endovascular repair of the aneurysm. At 2-month follow-up, there was still no recovery of the laryngeal mobility. Conclusion?An aortic artery aneurysm can suddenly break, requiring emergency heart surgery, and the results can be fatal in many cases. We suggest routine exam of the vocal folds in all patients with a heart condition, and we review the literature and suggest the use of imaging to reduce the number of emergency procedures. PMID:25992177

  18. The superior laryngeal nerve injury of a famous soprano, Amelita Galli-Curci.

    PubMed

    Marchese-Ragona, R; Restivo, D A; Mylonakis, I; Ottaviano, G; Martini, A; Sataloff, R T; Staffieri, A

    2013-02-01

    The superior laryngeal nerve (SLN) has been attributed much less clinical significance than the recurrent laryngeal nerve. It has sometimes been described as the 'neglected' nerve in thyroid surgery, although injury to this nerve can cause significant disability. The external branch of the SLN is the only motor supply to the cricothyroid muscle, which increases the tension of the ipsilateral vocal fold during highfrequency phonation, particularly in women and voice professionals. Damage to this nerve can manifest as ipsilateral cricothyroid muscle paralysis, and clinical symptoms may include a hoarse, breathy voice, frequent throat clearing, vocal fatigue or diminished vocal frequency range, especially when rising pitch. SLN paralysis can be a significant issue for those whose careers depend largely on a full range of voice. The famous opera soprano, Amelita Galli-Curci, suffered SLN injury during thyroid surgery with distressing consequences. PMID:23620644

  19. Biomechanical properties of recurrent laryngeal nerve in the piglet.

    PubMed

    Alexander, Megan J; Barkmeier-Kraemer, Julie M; Vande Geest, Jonathan P

    2010-08-01

    Unilateral vocal fold paralysis (UVP) results from damage to the recurrent laryngeal nerve (RLN). The most common causes of UVP are associated with compromised RLN tissue. The purpose of this research was to investigate the biomechanical properties of piglet RLN and identify differences in these properties along its length and in between the left and right side. Quasi-static uniaxial tensile testing and isotropic constitutive modeling was performed on seven piglet RLNs. Stiffness and other biomechanical parameters were derived from these tests and compared from conducting two different statistical analysis for the between and within nerve comparisons. Results showed higher stiffness values in the left RLN segment than for the right. Descriptive data demonstrated a higher stiffness in RLN segments surrounding the aortic arch, indicating a more protective role of the extracellular matrix in these nerves. This research offers insight regarding the protective function of the RLN connective tissues and structural compromise due to its environment. PMID:20369296

  20. Laryngeal Adductor Function in Experimental Models of Recurrent Laryngeal Nerve Injury

    PubMed Central

    Paniello, Randal C.; Rich, Jason T.; Debnath, Nick L.

    2014-01-01

    Objectives/Hypothesis Most patients with unilateral vocal fold paralysis experience some degree of spontaneous reinnervation, which depends upon the type and severity of recurrent laryngeal nerve (RLN) injury. After partial recovery, the paretic vocal fold may or may not adduct adequately to allow glottic closure, which in turn affects phonatory and swallowing outcomes. This process was studied in a series of canine laryngeal nerve injury models. Study Design Animal (canine) experiments. Methods Maximum stimulable laryngeal adductor pressure (LAP) was measured pre-treatment (baseline) and at 6 months following experimental RLN injuries (total n=59). The 9 study groups were designed to simulate a range of severities of RLN injury. Results The greatest LAP recovery, at 108% of original baseline, was seen in a 50% transection model; the least recovery was seen when the RLN underwent complete transection with repair, at 56% with precise alignment and 50% with alignment reversed. Intermediate models (partial RLN injuries) gave intermediate results. Crush models recovered 105% of LAP, while a half-transection, half-crush injury recovered 72% and cautery injuries recovered 61%. Controls (complete transection without repair) had no measurable recovery. Conclusions The injured RLN has a strong tendency to recover. Restoration of adductor strength, as determined by the LAP, was predictably related to the severity of RLN injury. The model RLN injuries studied provide a range of expected outcomes that can be used for future experiments exploring interventions that may improve post-injury adductor function. PMID:25283381

  1. [Facial nerve paralysis and mandibular fracture].

    PubMed

    Salonna, I; Fanizzi, P; Quaranta, A

    1992-01-01

    The authors describe three cases of peripheral facial nerve paralysis in patients with a mandibular fracture. In two cases, in which the onset of palsy was uncertain, the facial nerve injury was contralateral to the fractured side. Topodiagnostic tests showed neural damage at the third intrapetrosal portion and at the genicular ganglion. In one of the two patients tomography revealed a fracture line through the anterio-superior wall of the external auditory canal homolateral to the facial palsy. In the third subject palsy set in immediately after the trauma and was ipsilateral to the mandibular fracture; the facial lesion was localized at the genicular ganglion. In the first two cases, functional recovery was spontaneous (40 and 0 days after the trauma respectively). In the third subject, the nerve was decompressed surgically with a complete functional recovery two months later. The functional and clinical findings of these three cases show that a contralateral facial palsy secondary to a mandibular fracture resolves spontaneously while the traumatic displacement of the mandibular condyle may determine a temporal bone fracture sometimes followed by a lesion in the intratemporal portion of the facial nerve. An event such as the latter may delay functional recovery and thus warrant surgery such as in cases of Bell's palsy. PMID:1298156

  2. Neurological Complications in Thyroid Surgery: A Surgical Point of View on Laryngeal Nerves

    PubMed Central

    Varaldo, Emanuela; Ansaldo, Gian Luca; Mascherini, Matteo; Cafiero, Ferdinando; Minuto, Michele N.

    2014-01-01

    The cervical branches of the vagus nerve that are pertinent to endocrine surgery are the superior and the inferior laryngeal nerves: their anatomical course in the neck places them at risk during thyroid surgery. The external branch of the superior laryngeal nerve (EB) is at risk during thyroid surgery because of its close anatomical relationship with the superior thyroid vessels and the superior thyroid pole region. The rate of EB injury (which leads to the paralysis of the cricothyroid muscle) varies from 0 to 58%. The identification of the EB during surgery helps avoiding both an accidental transection and an excessive stretching. When the nerve is not identified, the ligation of superior thyroid artery branches close to the thyroid gland is suggested, as well as the abstention from an indiscriminate use of energy-based devices that might damage it. The inferior laryngeal nerve (RLN) runs in the tracheoesophageal groove toward the larynx, close to the posterior aspect of the thyroid. It is the main motor nerve of the intrinsic laryngeal muscles, and also provides sensory innervation to the larynx. Its injury finally causes the paralysis of the omolateral vocal cord and various sensory alterations: the symptoms range from mild to severe hoarseness, to acute airway obstruction, and swallowing impairment. Permanent lesions of the RNL occur from 0.3 to 7% of cases, according to different factors. The surgeon must be aware of the possible anatomical variations of the nerve, which should be actively searched for and identified. Visual control and gentle dissection of RLN are imperative. The use of intraoperative nerve monitoring has been safely applied but, at the moment, its impact in the incidence of RLN injuries has not been clarified. In conclusion, despite a thorough surgical technique and the use of intraoperative neuromonitoring, the incidence of neurological complications after thyroid surgery cannot be suppressed, but should be maintained in a low range. PMID:25076936

  3. Two cases of non-recurrent laryngeal nerve: routine nerve exploration in total thyroidectomy

    PubMed Central

    Say?m, Nazmi Ya?ar; Gl, Fethi

    2013-01-01

    Recurrent laryngeal nerve injury is one of the main complications of thyroidectomy. Since variability in the course of the nerve increases the risk of injury, routine nerve exploration is recommended. In this report, we present two cases of non-recurrent laryngeal nerve found during total thyroidectomy performed for benign pathologies. Total thyroidectomy was performed on two female patients (52 and 54 years old) with a diagnosis of multi-nodular goiter in our clinics. Nerve exploration was performed routinely and non-recurrent laryngeal nerve was noted in both patients. Patients were discharged on the first postoperative day without any complications. Recurrent laryngeal nerve exploration does not increase the risk of nerve injury and ensures safety in case of non-recurrent laryngeal nerve presence, despite its rarity. PMID:25931840

  4. Two cases of non-recurrent laryngeal nerve: routine nerve exploration in total thyroidectomy.

    PubMed

    Say?m, Nazmi Ya?ar; Gl, Fethi

    2013-01-01

    Recurrent laryngeal nerve injury is one of the main complications of thyroidectomy. Since variability in the course of the nerve increases the risk of injury, routine nerve exploration is recommended. In this report, we present two cases of non-recurrent laryngeal nerve found during total thyroidectomy performed for benign pathologies. Total thyroidectomy was performed on two female patients (52 and 54 years old) with a diagnosis of multi-nodular goiter in our clinics. Nerve exploration was performed routinely and non-recurrent laryngeal nerve was noted in both patients. Patients were discharged on the first postoperative day without any complications. Recurrent laryngeal nerve exploration does not increase the risk of nerve injury and ensures safety in case of non-recurrent laryngeal nerve presence, despite its rarity. PMID:25931840

  5. Transtympanic Facial Nerve Paralysis: A Review of the Literature.

    PubMed

    Schaefer, Nathan; O'Donohue, Peter; French, Heath; Griffin, Aaron; Elliott, Devlin; Gochee, Peter

    2015-05-01

    Facial nerve paralysis because of penetrating trauma through the external auditory canal is extremely rare, with a paucity of published literature. The objective of this study is to review the literature on transtympanic facial nerve paralysis and increase physician awareness of this uncommon injury through discussion of its clinical presentation, management and prognosis. We also aim to improve patient outcomes in those that have sustained this type of injury by suggesting an optimal management plan. In this case report, we present the case of a 46-year-old white woman who sustained a unilateral facial nerve paresis because of a garfish penetrating her tympanic membrane and causing direct damage to the tympanic portion of her facial nerve. On follow-up after 12 months, her facial nerve function has largely returned to normal. Transtympanic facial nerve paralysis is a rare injury but can have a favorable prognosis if managed effectively. PMID:26090278

  6. Influence of Asymmetric Recurrent Laryngeal Nerve Stimulation on Vibration, Acoustics, and Aerodynamics

    PubMed Central

    Chhetri, Dinesh K.; Neubauer, Juergen; Sofer, Elazar

    2015-01-01

    Objectives/Hypothesis Evaluate the influence of asymmetric recurrent laryngeal nerve (RLN) stimulation on the vibratory phase, acoustics and aerodynamics of phonation. Study Design Basic science study using an in vivo canine model. Methods The RLNs were symmetrically and asymmetrically stimulated over eight graded levels to test a range of vocal fold activation conditions from subtle paresis to paralysis. Vibratory phase, fundamental frequency (F0), subglottal pressure, and airflow were noted at phonation onset. The evaluations were repeated for three levels of symmetric superior laryngeal nerve (SLN) stimulation. Results Asymmetric laryngeal adductor activation from asymmetric left-right RLN stimulation led to a consistent pattern of vibratory phase asymmetry, with the more activated vocal fold leading in the opening phase of the glottal cycle and in mucosal wave amplitude. Vibratory amplitude asymmetry was also observed, with more lateral excursion of the glottis of the less activated side. Onset fundamental frequency was higher with asymmetric activation because the two RLNs were synergistic in decreasing F0, glottal width, and strain. Phonation onset pressure increased and airflow decreased with symmetric RLN activation. Conclusion Asymmetric laryngeal activation from RLN paresis and paralysis has consistent effects on vocal fold vibration, acoustics, and aerodynamics. This information may be useful in diagnosis and management of vocal fold paresis. PMID:24913182

  7. Paralysis

    MedlinePLUS

    ... is due to strokes or injuries such as spinal cord injury or a broken neck. Other causes of paralysis include Nerve diseases such as amyotrophic lateral sclerosis Autoimmune diseases ... used to be a cause of paralysis, but polio no longer occurs in the U.S.

  8. Peripheral facial nerve paralysis after upper third molar extraction.

    PubMed

    Cakarer, Sirmahan; Can, Taylan; Cankaya, Burak; Erdem, Mehmet Ali; Yazici, Sinem; Ayintap, Emre; Özden, Ali Veysel; Keskin, Cengizhan

    2010-11-01

    Peripheral facial nerve paralysis (PFNP) after mandibular interventions has been reported in the literature. In most cases, paralysis begins immediately after the injection of the mandibular anesthesia, and duration of facial weakness is less than 12 hours. However, there are few documented cases of PFNP after maxillary dental or surgical procedures. A variety of mechanisms have been associated to PFNP, including viral reactivation, demyelination, edema, vasospasm, and trauma. The purpose of this presentation was to report a rare case of facial paralysis that occurred after an upper third molar extraction. The cause of the PFNP and the importance of the multidisciplinary approach in the management are emphasized. PMID:21119431

  9. Neurotrophin expression and laryngeal muscle pathophysiology following recurrent laryngeal nerve transection

    PubMed Central

    WANG, BAOXIN; YUAN, JUNJIE; XU, JIAFENG; XIE, JIN; WANG, GUOLIANG; DONG, PIN

    2016-01-01

    Laryngeal palsy often occurs as a result of recurrent laryngeal or vagal nerve injury during oncological surgery of the head and neck, affecting quality of life and increasing economic burden. Reinnervation following recurrent laryngeal nerve (RLN) injury is difficult despite development of techniques, such as neural anastomosis, nerve grafting and creation of a laryngeal muscle pedicle. In the present study, due to the limited availability of human nerve tissue for research, a rat model was used to investigate neurotrophin expression and laryngeal muscle pathophysiology in RLN injury. Twenty-five male Sprague-Dawley rats underwent right RLN transection with the excision of a 5-mm segment. Vocal fold movements, vocalization, histology and immunostaining were evaluated at different time-points (3, 6, 10 and 16 weeks). Although vocalization was restored, movement of the vocal fold failed to return to normal levels following RLN injury. The expression of brain-derived neurotrophic factor and glial cell line-derived neurotrophic factor differed in the thyroarytenoid (TA) and posterior cricoarytenoid muscles. The number of axons did not increase to baseline levels over time. Furthermore, normal muscle function was unlikely with spontaneous reinnervation. During regeneration following RLN injury, differences in the expression levels of neurotrophic factors may have resulted in preferential reinnervation of the TA muscles. Data from the present study indicated that neurotrophic factors may be applied for restoring the function of the laryngeal nerve following recurrent injury. PMID:26677138

  10. Neurotrophin expression and laryngeal muscle pathophysiology following recurrent laryngeal nerve transection.

    PubMed

    Wang, Baoxin; Yuan, Junjie; Xu, Jiafeng; Xie, Jin; Wang, Guoliang; Dong, Pin

    2016-02-01

    Laryngeal palsy often occurs as a result of recurrent laryngeal or vagal nerve injury during oncological surgery of the head and neck, affecting quality of life and increasing economic burden. Reinnervation following recurrent laryngeal nerve (RLN) injury is difficult despite development of techniques, such as neural anastomosis, nerve grafting and creation of a laryngeal muscle pedicle. In the present study, due to the limited availability of human nerve tissue for research, a rat model was used to investigate neurotrophin expression and laryngeal muscle pathophysiology in RLN injury. Twenty?five male Sprague?Dawley rats underwent right RLN transection with the excision of a 5?mm segment. Vocal fold movements, vocalization, histology and immunostaining were evaluated at different time?points (3,6,10and16 weeks). Although vocalization was restored, movement of the vocal fold failed to return to normal levels following RLN injury. The expression of brain?derived neurotrophic factor and glial cell line?derived neurotrophic factor differed in the thyroarytenoid (TA) and posterior cricoarytenoid muscles. The number of axons did not increase to baseline levels over time. Furthermore, normal muscle function was unlikely with spontaneous reinnervation. During regeneration following RLN injury, differences in the expression levels of neurotrophic factors may have resulted in preferential reinnervation of the TA muscles. Data from the present study indicated that neurotrophic factors may be applied for restoring the function of the laryngeal nerve following recurrent injury. PMID:26677138

  11. Recovery of laryngeal function after intraoperative injury to the recurrent laryngeal nerve

    PubMed Central

    Hydman, Jonas; Svensson, Mikael

    2015-01-01

    Loss of function in the recurrent laryngeal nerve (RLN) during thyroid/parathyroid surgery, despite a macroscopically intact nerve, is a challenge which highlights the sensitivity and complexity of laryngeal innervation. Furthermore, the uncertain prognosis stresses a lack of capability to diagnose the reason behind the impaired function. There is a great deal of literature considering risk factors, surgical technique and mechanisms outside the nerve affecting the incidence of RLN paresis during surgery. To be able to prognosticate recovery in cases of laryngeal dysfunction and voice changes after thyroid surgery, the surgeon would first need to define the presence, location, and type of laryngeal nerve injury. There is little data describing the events within the nerve and the neurobiological reasons for the impaired function related to potential recovery and prognosis. In addition, very little data has been presented in order to clarify any differences between the transient and permanent injury of the RLN. This review aims, from an anatomical and neurobiological perspective, to provide an update on the current understandings of surgically-induced injury to the laryngeal nerves. PMID:25713777

  12. Laryngeal elevation by selective stimulation of the hypoglossal nerve

    NASA Astrophysics Data System (ADS)

    Hadley, Aaron J.; Kolb, Ilya; Tyler, Dustin J.

    2013-08-01

    Objective. Laryngeal elevation protects the airway and assists opening of the esophagus during swallowing. The GH, thyrohyoid, and MH muscles provide a majority of this elevatory motion. This study applied functional electrical stimulation to the XII/C1 nerve complex using a nerve cuff electrode to determine the capabilities of neural stimulation to induce laryngeal elevation. Approach. Multi-contact FINE electrodes were implanted onto the XII/C1 nerve complex at locations proximal and distal to the thyrohyoid branching point in five anesthetized canines. Motion of the thyroid cartilage and the hyoid bone was recorded during stimulation of nerve cuffs and intramuscular electrodes. Main Results. Nerve stimulation induced 260% more laryngeal elevation than intramuscular stimulation (18.8 mm versus 5.2 mm, p ? 0.01), and 228% higher velocity (143.8 versus 43.9 mm s-1, p ? 0.01). While stimulation at all cuff and electrode locations elevated the larynx, only the proximal XII/C1 nerve cuff significantly elicited both thyroid-hyoid approximation and hyoid elevation. In all proximal XII/C1 nerve cuffs (n = 7), stimulation was able to obtain selectivity of greater than 75% of at least one elevatory muscle. Significance. These results support the hypothesis that an implanted neural interface system can produce increased laryngeal elevation, a significant protective mechanism of deglutition.

  13. The Role of Immediate Recurrent Laryngeal Nerve Reconstruction for Thyroid Cancer Surgery

    PubMed Central

    Sanuki, Tetsuji; Yumoto, Eiji; Minoda, Ryosei; Kodama, Narihiro

    2010-01-01

    Unilateral vocal fold paralysis (UVFP) is one of the most serious problems in conducting surgery for thyroid cancer. Different treatments are available for the management of UVFP including intracordal injection, type I thyroplasty, arytenoid adduction, and laryngeal reinnervations. The effects of immediate recurrent laryngeal nerve (RLN) reconstruction during thyroid cancer surgery with or without UVFP before the surgery were evaluated with videostroboscopic, aerodynamic, and perceptual analyses. All subjects experienced postoperative improvements in voice quality. Particularly, aerodynamic analysis showed that the values for all patients entered normal ranges in both patients with and without UVFP before surgery. Immediate RLN reconstruction has the potential to restore a normal or near-normal voice by returning thyroarytenoid muscle tone and bulk seen with vocal fold denervation. Immediate RLN reconstruction is an efficient and effective approach to the management of RLN resection during surgery for thyroid cancer. PMID:20628531

  14. Role of Laryngeal Electromyography in Predicting Recovery After Vocal Fold Paralysis.

    PubMed

    Guha, Kuhelika; Sabarigirish, K; Singh, S K; Yadav, Arun

    2014-12-01

    Accurate prognostication of the outcome of vocal fold immobility assumes great importance in the management. This study aimed to evaluate the prognostic efficacy of Laryngeal electromyography in cases of vocal fold immobility. A nonrandomized prospective study was carried out from Sep 2009 to Jun 2011. Patients were evaluated using Fiberoptic laryngoscopy and Laryngeal electromyography over a period of 24weeks. 51 subjects participated in the study, comprised of 22 males and 29 females. All patients underwent detailed clinical examination including Fiberoptic laryngoscopy on the first visit and Laryngeal electromyography testing on the second visit. Subsequent neuromonitoring was carried out at 04, 12 and 24 weeks from date of initial recording. Outcome measures of vocal fold motion were dichotomized into persistent vocal fold immobility (unilateral or bilateral) or resolved vocal fold motion (normal). Approximately 24weeks after onset of palsy, mobility of the paralyzed vocal cord was restored in 31 (60.78%) of 51 cases, while 20 (39.22%) remained immobile. Sensitivity of laryngeal electromyography was 92.53% ; specificity 93.33%, positive predictive value 98.77% and negative predictive value 68.29%. This study confirmed the utility of Laryngeal electromyography in predicting prognosis for recovery of vocal fold motion after laryngeal nerve injury. The results supported the hypothesis that Laryngeal electromyography data can be used effectively to determine a prognosis for recovery of vocal fold motion. PMID:26396950

  15. Facial Nerve Paralysis due to a Pleomorphic Adenoma with the Imaging Characteristics of a Facial Nerve Schwannoma.

    PubMed

    Nader, Marc-Elie; Bell, Diana; Sturgis, Erich M; Ginsberg, Lawrence E; Gidley, Paul W

    2014-08-01

    Background?Facial nerve paralysis in a patient with a salivary gland mass usually denotes malignancy. However, facial paralysis can also be caused by benign salivary gland tumors. Methods?We present a case of facial nerve paralysis due to a benign salivary gland tumor that had the imaging characteristics of an intraparotid facial nerve schwannoma. Results?The patient presented to our clinic 4 years after the onset of facial nerve paralysis initially diagnosed as Bell palsy. Computed tomography demonstrated filling and erosion of the stylomastoid foramen with a mass on the facial nerve. Postoperative histopathology showed the presence of a pleomorphic adenoma. Facial paralysis was thought to be caused by extrinsic nerve compression. Conclusions?This case illustrates the difficulty of accurate preoperative diagnosis of a parotid gland mass and reinforces the concept that facial nerve paralysis in the context of salivary gland tumors may not always indicate malignancy. PMID:25083397

  16. Facial Nerve Paralysis due to a Pleomorphic Adenoma with the Imaging Characteristics of a Facial Nerve Schwannoma

    PubMed Central

    Nader, Marc-Elie; Bell, Diana; Sturgis, Erich M.; Ginsberg, Lawrence E.; Gidley, Paul W.

    2014-01-01

    Background?Facial nerve paralysis in a patient with a salivary gland mass usually denotes malignancy. However, facial paralysis can also be caused by benign salivary gland tumors. Methods?We present a case of facial nerve paralysis due to a benign salivary gland tumor that had the imaging characteristics of an intraparotid facial nerve schwannoma. Results?The patient presented to our clinic 4 years after the onset of facial nerve paralysis initially diagnosed as Bell palsy. Computed tomography demonstrated filling and erosion of the stylomastoid foramen with a mass on the facial nerve. Postoperative histopathology showed the presence of a pleomorphic adenoma. Facial paralysis was thought to be caused by extrinsic nerve compression. Conclusions?This case illustrates the difficulty of accurate preoperative diagnosis of a parotid gland mass and reinforces the concept that facial nerve paralysis in the context of salivary gland tumors may not always indicate malignancy. PMID:25083397

  17. A case of isolated abducens nerve paralysis in maxillofacial trauma

    PubMed Central

    Keskin, Elif Seda; Keskin, Ekrem; Atik, Bekir; Koçer, Abdülkadir

    2015-01-01

    Nervus abducens is a pure motor nerve located in the pons. It retracts the eyeball laterally by stimulating rectus lateralis muscle. In case of their paralysis, diplopia and restriction in the eye movements while looking sideways, are seen. Since the same signs are seen due to the muscle entrapment in blowout fractures, its differential diagnosis has importance in terms of the treatment protocol and avoiding unnecessary operations. In this article, we present a 22-year-old male patient who was referred to our department due to the prediagnosis of blowout fracture following maxillofacial trauma. However, he was diagnosed with abducens nerve paralysis after the consultations and analysis and his restriction of movement was resolved via systemic steroid treatment instead of unnecessary operation.

  18. Effect of laminin-binding BDNF on induction of recurrent laryngeal nerve regeneration by miR-222 activation of mTOR signal pathway

    PubMed Central

    Xie, Jin; Jin, Bin; Li, Da-Wei; Shen, Bin; Gong, Ning; Zhang, Tian-Zhen; Dong, Pin

    2015-01-01

    Background and Aim: Recurrent laryngeal nerve injury is a common severe complication in neck surgery, which can cause varying degrees of vocal fold paralysis and respiratory tract problems. In present study, the effects of laminin-binding brain derived neurotrophic factor (LBD-BDNF) on recurrent laryngeal nerve regeneration were explored and its possible mechanism was investigated. Methods: LBD-BDNF or NAT-BDNF (BDNF without LBD binding) treatment was performed in laryngeal nerve injured rabbits for sixteen weeks. The laryngeal nerve was removed, and histological examination as well as laryngeal electromyography was employed to evaluate its morphology and function of conduction. PC12 cells were cultured to investigate the mechanisms underlying the effects of LBD-BDNF. Neurite outgrowth, proliferation and migration were determined in nerve cells. The expression of miRNAs and protein of mTOR was quantified by real-time PCR and western blotting respectively. Results: In vivo experiments, LBD-BDNF significantly improved the histological structure and function of recurrent laryngeal nerve compared with NAT-BDNF. LBD-BDNF also markedly promoted neurite outgrowth, proliferation and migration in PC12 cells in vitro experiments. The levels of miR-222 and p-mTOR were up-regulated by LBD-BDNF treatment in both in vivo and in vitro experiments. miR-222 inhibitor attenuated the expression of phosphorylated mTOR and miR-222 mimic enhanced its expression in PC12 cells. In addition, the improved nerve conduction by LBD-BDNF was canceled by miR-222 inhibitor, and the mTOR inhibitor reversed the effects of miR-222 inhibitor on LBD-BDNF treated cells. Conclusions: The present study revealed that LBD-BDNF promoted the recurrent laryngeal nerve regeneration in laryngeal nerve injured rabbits. The underlying mechanism was closely related to activation of p-mTOR by miR-222. PMID:26279751

  19. Update in Facial Nerve Paralysis: Tissue engineering and new technologies

    PubMed Central

    Langhals, Nicholas B.; Urbanchek, Melanie G.; Ray, Amrita; Brenner, Michael J.

    2014-01-01

    Purpose of review To present recent advances in treatment of facial paralysis, emphasizing emerging technologies. This review will summarize the current state of the art in the management of facial paralysis and discuss advances in nerve regeneration, facial reanimation, and use of novel biomaterials. The review includes surgical innovations in re-innervation and reanimation as well as progress with bioelectrical interfaces. Recent Findings The past decade has witnessed major advances in understanding of nerve injury and approaches for management. Key innovations include strategies to accelerate nerve regeneration, provide tissue-engineered constructs that may replace nonfunctional nerves, approaches to influence axonal guidance, limiting of donor-site morbidity, and optimization of functional outcomes. Approaches to muscle transfer continue to evolve, and new technologies allow for electrical nerve stimulation and use of artificial tissues. Summary The fields of biomedical engineering and facial reanimation increasingly intersect, with innovative surgical approaches complementing a growing array of tissue engineering tools. The goal of treatment remains the predictable restoration of natural facial movement, with acceptable morbidity and long-term stability. Advances in bioelectrical interfaces and nanotechnology hold promise for widening the window for successful treatment intervention and for restoring both lost neural inputs and muscle function. PMID:24979369

  20. Sound-induced facial synkinesis following facial nerve paralysis.

    PubMed

    Ma, Ming-San; van der Hoeven, Johannes H; Nicolai, Jean-Philippe A; Meek, Marcel F

    2009-08-01

    Facial synkinesis (or synkinesia) (FS) occurs frequently after paresis or paralysis of the facial nerve and is in most cases due to aberrant regeneration of (branches of) the facial nerve. Patients suffer from inappropriate and involuntary synchronous facial muscle contractions. Here we describe two cases of sound-induced facial synkinesis (SFS) after facial nerve injury. As far as we know, this phenomenon has not been described in the English literature before. Patient A presented with right hemifacial palsy after lesion of the facial nerve due to skull base fracture. He reported involuntary muscle activity at the right corner of the mouth, specifically on hearing ringing keys. Patient B suffered from left hemifacial palsy following otitis media and developed involuntary muscle contraction in the facial musculature specifically on hearing clapping hands or a trumpet sound. Both patients were evaluated by means of video, audio and EMG analysis. Possible mechanisms in the pathophysiology of SFS are postulated and therapeutic options are discussed. PMID:18539550

  1. Superior laryngeal nerve injury: effects, clinical findings, prognosis, and management options

    PubMed Central

    Orestes, Michael I.; Chhetri, Dinesh K.

    2015-01-01

    Purpose of review The superior laryngeal nerve (SLN) provides motor innervation to the cricothyroid muscle. However, the functions of this muscle and the anatomic variations of the nerve that supplies it are not fully understood. SLN paresis and paralysis (SLNp) is difficult to diagnose because of a lack of consistent laryngeal findings, and its effects on the voice likely goes beyond simple pitch elevation control. Recent findings Although SLNp has traditionally been thought to lead to voice pitch limitation, recent research findings reveal multiple roles for this nerve in voice and speech. Cricothyroid muscles are the primary controls of fundamental frequency of voice. SLNp can lead to significant contraction of pitch range, vocal fold vibratory phase asymmetry, and acoustic aperiodicity, thus leading to an overall poor vocal quality. In addition, cricothyroid muscles may also play a role in pitch lowering and shifting from voiced to unvoiced sounds during speech. Summary Subtle signs, symptoms, and diagnostic findings associated with SLNp make this disorder difficult to characterize clinically. Lack of treatment methodologies to restore the dynamic action of the cricothyroid muscles poses difficulties in treating patients with this condition. A more thorough understanding of the effects of SLNp will improve diagnosis and treatment. PMID:25136863

  2. Quantification of vocal fold motion using echography: application to recurrent nerve paralysis detection

    NASA Astrophysics Data System (ADS)

    Cohen, Mike-Ely; Lefort, Muriel; Bergeret-Cassagne, Hlose; Hachi, Siham; Li, Ang; Russ, Gilles; Lazard, Diane; Menegaux, Fabrice; Leenhardt, Laurence; Trsallet, Christophe; Frouin, Frdrique

    2015-03-01

    Recurrent nerve paralysis (RP) is one of the most frequent complications of thyroid surgery. It reduces vocal fold mobility. Nasal endoscopy, a mini-invasive procedure, is the conventional way to detect RP. We suggest a new approach based on laryngeal ultrasound and a specific data analysis was designed to help with the automated detection of RP. Ten subjects were enrolled for this feasibility study: four controls, three patients with RP and three patients without RP according to nasal endoscopy. The ultrasound protocol was based on a ten seconds B-mode acquisition in a coronal plane during normal breathing. Image processing included three steps: 1) automated detection of two consecutive closing and opening images, corresponding to extreme positions of vocal folds in the sequence of B-mode images, using principal component analysis of the image sequence; 2) positioning of three landmarks and robust tracking of these points using a multi-pyramidal refined optical flow approach; 3) estimation of quantitative parameters indicating left and right fractions of mobility, and motion symmetry. Results provided by automated image processing were compared to those obtained by an expert. Detection of extreme images was accurate; tracking of landmarks was reliable in 80% of cases. Motion symmetry indices showed similar values for controls and patients without RP. Fraction of mobility was reduced in cases of RP. Thus, our CAD system helped in the detection of RP. Laryngeal ultrasound combined with appropriate image processing helped in the diagnosis of recurrent nerve paralysis and could be proposed as a first-line method.

  3. Superior laryngeal nerve monitoring using laryngeal surface electrodes and intraoperative neurophysiological monitoring during thyroidectomy.

    PubMed

    Hodnett, Benjamin L; Schmitt, Nicole C; Clayburgh, Daniel R; Burkowsky, Alex; Balzer, Jeffrey; Thirumala, Parthasarathy D; Duvvuri, Umamaheswar

    2015-05-01

    The objective of this study is to establish normative waveform data for the external branch of the superior laryngeal nerve (SLN) utilizing laryngeal surface electrodes and intraoperative neurophysiological monitoring (IONM) in conjunction with a clinical neurophysiologist. A retrospective chart review of 91 consecutive at-risk SLN were identified in 51 patients in whom IONM using laryngeal surface electrodes was performed by a clinical neurophysiologist using Dragonfly (Neurovision Medical Products, Ventura, CA) recording electrodes and a Protektor (Natus Medical Inc., San Carlos, CA)16 channel- intraoperative nerve monitoring system. Inclusion criteria were met for 30 SLN. Data collected included preoperative diagnosis, surgical procedure, rates of nerve identification and stimulation, and waveform characteristics. Waveform analysis for 30 SLN yielded a peak latency of 4.0 ± 0.2 ms, onset latency 2.3 ± 0.1 ms, peak-to-peak amplitude of 220.4 ± 31.1 µV, onset-to-peak amplitude of 186.0 ± 25.0 µV, and stimulation current threshold of 0.55 ± 0.03 mA (data = mean ± SEM). Two patients had abnormal SLN function documented clinically on postoperative laryngoscopic examination. Laryngeal surface electrodes were successfully utilized to identify and monitor SLN function intraoperatively. IONM using laryngeal surface electrodes enables analysis of waveform morphology and latency in addition to threshold and amplitude data obtained with the traditional NIM system, potentially improving the performance of nerve monitoring during thyroid surgery. PMID:25425500

  4. Benign anatomical mistakes: the correct anatomical term for the recurrent laryngeal nerve.

    PubMed

    Mirilas, Petros; Skandalakis, John E

    2002-01-01

    The term recurrent laryngeal nerve has been adopted by Nomina Anatomica (1989) and Terminologia Anatomica (1998) to describe this vagus branch from its origin, its turn dorsally around the subclavian artery and the aortic arch, and its cranial pathway until it reaches its terminal organs in the neck. However, there is still much confusion, and either the terms inferior and recurrent laryngeal nerve are used interchangeably or inferior laryngeal nerve is considered the terminal branch of the recurrent laryngeal nerve. We hereby feel that it is necessary to reassess the term and we propose the term inferior laryngeal nerve for the entire nerve under consideration, from its origin from the vagus nerve to its destinations, including tracheal, esophageal, and pharyngeal branches. If the term superior laryngeal nerve is a given, standard and accepted term in the anatomical terminology, then logically the term inferior laryngeal nerve should also be accepted, as opposed to it. Of course the upward travel of the inferior laryngeal nerve is "recurrent". When nonrecurrence is encountered together with an arteria lusoria, a retroesophageal right subclavian artery or a right aortic arch, we consider that the term nonrecurrent inferior laryngeal nerve should be used to describe the deviation from the normal. PMID:12467328

  5. Recovery of Facial Nerve Paralysis After Temporal Nerve Reconstruction: A Case Report

    PubMed Central

    Emamhadi, Mohammad Reza; Mahmoudi, Davood

    2015-01-01

    Introduction: Facial paralysis is common following accidents, trauma, viral infection or tumors. Case Presentation: A 24-year-old male patient was referred to us with a history of sharp penetrating trauma to the right temporal region causing unilateral paralysis of the muscles of the right forehead. He was unable to scowl or elevate his right eyebrow and there were no folds on his right forehead. Anastomosis of branches of the temporal nerve was done one month after trauma following regular physical therapy sessions, outcome was good and paralysis of the muscles of the right forehead improved after several months. Conclusions: Immediate repair of the facial nerve injury will improve the process of recovery and rehabilitation of the face and forehead muscles and may play a very important role in the patients mental satisfaction and improve their quality of life. PMID:26839856

  6. Outcomes of recurrent laryngeal nerve injury following congenital heart surgery: A contemporary experience

    PubMed Central

    Alfares, Fahad A.; Hynes, Conor F.; Ansari, Ghedak; Chounoune, Reginald; Ramadan, Manelle; Shaughnessy, Conner; Reilly, Brian K.; Zurakowski, David; Jonas, Richard A.; Nath, Dilip S.

    2015-01-01

    Objective Injury to the recurrent laryngeal nerve can lead to significant morbidity during congenital cardiac surgery. The objective is to expand on the limited understanding of the severity and recovery of this iatrogenic condition. Design A six-year retrospective review of all congenital heart operations at a single institution from January 1, 2008 to December 31, 2013 was performed. All patients with documented vocal cord paralysis on laryngoscopic examination comprised the study cohort. Evaluation of time to vocal cord recovery and need for further surgical intervention was the primary focus. Results The incidence of post-operative vocal cord paralysis was 1.1% (32 out of 3036 patients; 95% confidence interval: 0.71.5%). The majority were left-sided injuries (71%). Overall rate of recovery was 61% with a median time of 10months in those who recovered, and a total follow up of 46months. Due to feeding complications, 45% of patients required gastrostomy tube after the injury, and these patients were found to have longer duration of post-operative days of intubation (median 10 vs. 5days, p=0.03), ICU length of stay (50 vs. 8days, p=0.002), and hospital length of stay (92 vs. 41days, p=0.01). No pre-operative variables were identified as predictive of recovery or need for gastrostomy placement. Conclusion Recurrent laryngeal nerve injury is a serious complication of congenital heart surgery that impacts post-operative morbidity, in some cases leading to a need for further intervention, in particular, gastrostomy tube placement. A prospective, multi-center study is needed to fully evaluate factors that influence severity and time to recovery. PMID:26778899

  7. The central projections of the laryngeal nerves in the rat

    PubMed Central

    Pascual-Font, Arn; Hernndez-Morato, Ignacio; McHanwell, Stephen; Vzquez, Teresa; Maranillo, Eva; Saudo, Jose; Valderrama-Canales, Francisco J

    2011-01-01

    The larynx serves respiratory, protective, and phonatory functions. The motor and sensory innervation to the larynx controlling these functions is provided by the superior laryngeal nerve (SLN) and the recurrent laryngeal nerve (RLN). Classical studies state that the SLN innervates the cricothyroid muscle and provides sensory innervation to the supraglottic cavity, whereas the RLN supplies motor innervation to the remaining intrinsic laryngeal muscles and sensory innervation to the infraglottic cavity, but recent data suggest a more complex anatomical and functional organisation. The current neuroanatomical tracing study was undertaken to provide a comprehensive description of the central brainstem connections of the axons within the SLN and the RLN, including those neurons that innervate the larynx. The study has been carried out in 41 adult male SpragueDawley rats. The central projections of the laryngeal nerves were labelled following application of biotinylated dextran amines onto the SLN, the RLN or both. The most remarkable result of the study is that in the rat the RLN does not contain any afferent axons from the larynx, in contrast to the pattern observed in many other species including man. The RLN supplied only special visceromotor innervation to the intrinsic muscles of the larynx from motoneurons in the nucleus ambiguus (Amb). All the afferent axons innervating the larynx are contained within the SLN, and reach the nucleus of the solitary tract. The SLN also contained secretomotor efferents originating from motoneurons in the dorsal motor nucleus of the vagus, and special visceral efferent fibres from the Amb. In conclusion, the present study shows that in the rat the innervation of the larynx differs in significant ways from that described in other species. PMID:21599662

  8. The central projections of the laryngeal nerves in the rat.

    PubMed

    Pascual-Font, Arn; Hernndez-Morato, Ignacio; McHanwell, Stephen; Vzquez, Teresa; Maranillo, Eva; Saudo, Jose; Valderrama-Canales, Francisco J

    2011-08-01

    The larynx serves respiratory, protective, and phonatory functions. The motor and sensory innervation to the larynx controlling these functions is provided by the superior laryngeal nerve (SLN) and the recurrent laryngeal nerve (RLN). Classical studies state that the SLN innervates the cricothyroid muscle and provides sensory innervation to the supraglottic cavity, whereas the RLN supplies motor innervation to the remaining intrinsic laryngeal muscles and sensory innervation to the infraglottic cavity, but recent data suggest a more complex anatomical and functional organisation. The current neuroanatomical tracing study was undertaken to provide a comprehensive description of the central brainstem connections of the axons within the SLN and the RLN, including those neurons that innervate the larynx. The study has been carried out in 41 adult male Sprague-Dawley rats. The central projections of the laryngeal nerves were labelled following application of biotinylated dextran amines onto the SLN, the RLN or both. The most remarkable result of the study is that in the rat the RLN does not contain any afferent axons from the larynx, in contrast to the pattern observed in many other species including man. The RLN supplied only special visceromotor innervation to the intrinsic muscles of the larynx from motoneurons in the nucleus ambiguus (Amb). All the afferent axons innervating the larynx are contained within the SLN, and reach the nucleus of the solitary tract. The SLN also contained secretomotor efferents originating from motoneurons in the dorsal motor nucleus of the vagus, and special visceral efferent fibres from the Amb. In conclusion, the present study shows that in the rat the innervation of the larynx differs in significant ways from that described in other species. PMID:21599662

  9. A Closer Look at Laryngeal Nerves during Thyroid Surgery: A Descriptive Study of 584 Nerves

    PubMed Central

    Pradeep, P. V.; Jayashree, B.; Harshita, Skandha S.

    2012-01-01

    Morbidity after thyroidectomy is related to injuries to the parathyroids, recurrent laryngeal (RLN) and external branch of superior laryngeal nerves (EBSLN). Mostly these are due to variations in the surgical anatomy. In this study we analyse the surgical anatomy of the laryngeal nerves in Indian patients undergoing thyroidectomy. Materials and Methods. Retrospective study (February 2008 to February 2010). Patients undergoing surgery for benign goitres, T1, T2 thyroid cancers without lymph node involvement were included. Data on EBSLN types, RLN course and its relation to the TZ & LOB were recorded. Results. 404 thyroid surgeries (180 total & 224 hemithyroidectomy) were performed. Data related to 584 EBSLN and RLN were included (324 right sided & 260 left sided). EBSLN patterns were Type 1 in 71.4%, Type IIA in 12.3%, and Type IIB in 7.36%. The nerve was not seen in 4.3% cases. RLN had one branch in 69.34%, two branches in 29.11% and three branches in 1.36%. 25% of the RLN was superficial to the inferior thyroid artery, 65% deep to it and 8.2% between the branches. TZ was Grade 1 in 65.2%, Grade II in 25.1% and Grade III in 9.5%. 31.16% of the RLN passes through the LOB. Conclusions. A thorough knowledge of the laryngeal nerves and anatomical variations is necessary for safe thyroid surgery. PMID:22737584

  10. Laryngeal and tracheal afferent nerve stimulation evokes swallowing in anaesthetized guinea pigs

    PubMed Central

    Tsujimura, Takanori; Udemgba, Chioma; Inoue, Makoto; Canning, Brendan J

    2013-01-01

    We describe swallowing reflexes evoked by laryngeal and tracheal vagal afferent nerve stimulation in anaesthetized guinea pigs. The swallowing reflexes evoked by laryngeal citric acid challenges were abolished by recurrent laryngeal nerve (RLN) transection and mimicked by electrical stimulation of the central cut ends of an RLN. By contrast, the number of swallows evoked by upper airway/pharyngeal distensions was not significantly reduced by RLN transection but they were virtually abolished by superior laryngeal nerve transection. Laryngeal citric acid-evoked swallowing was mimicked by laryngeal capsaicin challenges, implicating transient receptor potential vanilloid 1 (TRPV1)-expressing laryngeal afferent nerves arising from the jugular ganglia. The swallowing evoked by citric acid and capsaicin and evoked by electrical stimulation of either the tracheal or the laryngeal mucosa occurred at stimulation intensities that were typically subthreshold for evoking cough in these animals. Swallowing evoked by airway afferent nerve stimulation also desensitized at a much slower rate than cough. We speculate that swallowing is an essential component of airway protection from aspiration associated with laryngeal and tracheal afferent nerve activation. PMID:23858010

  11. Laryngeal and tracheal afferent nerve stimulation evokes swallowing in anaesthetized guinea pigs.

    PubMed

    Tsujimura, Takanori; Udemgba, Chioma; Inoue, Makoto; Canning, Brendan J

    2013-09-15

    ? We describe swallowing reflexes evoked by laryngeal and tracheal vagal afferent nerve stimulation in anaesthetized guinea pigs. The swallowing reflexes evoked by laryngeal citric acid challenges were abolished by recurrent laryngeal nerve (RLN) transection and mimicked by electrical stimulation of the central cut ends of an RLN. By contrast, the number of swallows evoked by upper airway/pharyngeal distensions was not significantly reduced by RLN transection but they were virtually abolished by superior laryngeal nerve transection. Laryngeal citric acid-evoked swallowing was mimicked by laryngeal capsaicin challenges, implicating transient receptor potential vanilloid 1 (TRPV1)-expressing laryngeal afferent nerves arising from the jugular ganglia. The swallowing evoked by citric acid and capsaicin and evoked by electrical stimulation of either the tracheal or the laryngeal mucosa occurred at stimulation intensities that were typically subthreshold for evoking cough in these animals. Swallowing evoked by airway afferent nerve stimulation also desensitized at a much slower rate than cough. We speculate that swallowing is an essential component of airway protection from aspiration associated with laryngeal and tracheal afferent nerve activation. PMID:23858010

  12. Surgical treatment of posterior interosseous nerve paralysis in a tennis player☆

    PubMed Central

    Fujioka, Hiroyuki; Tsunemi, Kenjiro; Tsukamoto, Yoshitane; Oi, Takanori; Takagi, Yohei; Tanaka, Juichi; Yoshiya, Shinichi

    2014-01-01

    We report a rare case of posterior interosseous nerve (PIN) paralysis in a tennis player. The PIN, a 2 cm section from a bifurcation point of the radial nerve, presented increased stiffness in the surgical findings and treated with free sural nerve grafting after excision of the degenerative portion of the PIN. We speculate that PIN paralysis associated with hourglass-like constriction can be caused and exacerbated by repetitive forearm pronation and supination in playing tennis. PMID:25104896

  13. Tuberculous Otitis Media Leading to Sequentialib Bilateral Facial Nerve Paralysis

    PubMed Central

    Gupta, Nitin; Dass, Arjun; Goel, Neha; Tiwari, Sandeep

    2015-01-01

    Introduction: Tuberculous otitis media (TOM) is an uncommon, insidious, and frequently misdiagnosed form of tuberculosis (TB). In particular, TOM is usually secondary to direct transmission from adjacent organs, while the primary form has been rarely reported. The main aim of treatment is to start the patient on an antitubercular regime and early surgical intervention to decompress the facial nerve if involved. Case Report: The case report of a twenty year-old male with bilateral tuberculous otitis media, who presented himself with fever followed by sequential bilateral facial nerve paralysis, bilateral profound hearing loss, and abdominal tuberculosis leading to intestinal perforation, is presented. To the best available knowledge and after researching literature, no such case depicting the extensive otological complications of tuberculosis has been reported till date. Conclusion: Tuberculosis of the ear is a rare entity and in most cases the clinical features resemble that of chronic otitis media. The diagnosis is often delayed due to varied clinical presentations and this can lead to irreversible complications. Early diagnosis is essential for prompt administration of antitubercular therapy and to prevent complications. PMID:26082906

  14. Overview of pediatric peripheral facial nerve paralysis: analysis of 40 patients.

    PubMed

    zkale, Yasemin; Erol, ?lknur; Sayg?, Semra; Y?lmaz, ?smail

    2015-02-01

    Peripheral facial nerve paralysis in children might be an alarming sign of serious disease such as malignancy, systemic disease, congenital anomalies, trauma, infection, middle ear surgery, and hypertension. The cases of 40 consecutive children and adolescents who were diagnosed with peripheral facial nerve paralysis at Baskent University Adana Hospital Pediatrics and Pediatric Neurology Unit between January 2010 and January 2013 were retrospectively evaluated. We determined that the most common cause was Bell palsy, followed by infection, tumor lesion, and suspected chemotherapy toxicity. We noted that younger patients had generally poorer outcome than older patients regardless of disease etiology. Peripheral facial nerve paralysis has been reported in many countries in America and Europe; however, knowledge about its clinical features, microbiology, neuroimaging, and treatment in Turkey is incomplete. The present study demonstrated that Bell palsy and infection were the most common etiologies of peripheral facial nerve paralysis. PMID:24810082

  15. [Multiple erythema migrans and facial nerve paralysis: clinical manifestations of early disseminated Lyme borreliosis].

    PubMed

    Braun, S A; Baran, A M; Boettcher, C; Kieseier, B C; Reifenberger, J

    2014-04-01

    Lyme borreliosis is a common vector-borne disease in Europe. The infection follows different stages with a broad variability of clinical symptoms and manifestations in different organs. A 49-year-old man presented with flu-like symptoms, facial nerve paralysis and multiple erythematous macular on his trunk and extremities. We diagnosed Lyme disease (stage II) with facial nerve paralysis and multiple erythema migrans. Intravenous ceftriaxone led to complete healing of hissymptoms within 2 weeks. PMID:24700023

  16. Aerodynamic and Nonlinear Dynamic Acoustic Analysis of Tension Asymmetry in Excised Canine Larynges

    ERIC Educational Resources Information Center

    Devine, Erin E.; Bulleit, Erin E.; Hoffman, Matthew R.; McCulloch, Timothy M.; Jiang, Jack J.

    2012-01-01

    Purpose: To model tension asymmetry caused by superior laryngeal nerve paralysis (SLNP) in excised larynges and apply perturbation, nonlinear dynamic, and aerodynamic analyses. Method: SLNP was modeled in 8 excised larynges using sutures and weights to mimic cricothyroid (CT) muscle function. Weights were removed from one side to create tension

  17. Aerodynamic and Nonlinear Dynamic Acoustic Analysis of Tension Asymmetry in Excised Canine Larynges

    ERIC Educational Resources Information Center

    Devine, Erin E.; Bulleit, Erin E.; Hoffman, Matthew R.; McCulloch, Timothy M.; Jiang, Jack J.

    2012-01-01

    Purpose: To model tension asymmetry caused by superior laryngeal nerve paralysis (SLNP) in excised larynges and apply perturbation, nonlinear dynamic, and aerodynamic analyses. Method: SLNP was modeled in 8 excised larynges using sutures and weights to mimic cricothyroid (CT) muscle function. Weights were removed from one side to create tension…

  18. Voice improvement in unilateral laryngeal paralysis during loud voicing: theoretical impact.

    PubMed

    Garrel, Renaud; Nicollas, Richard; Chapus, Elodie; Ouaknine, Maurice; Giovanni, Antoine

    2007-10-01

    Voice of patient with unilateral laryngeal paralysis (ULP) shows a nonlinear behaviour with sudden octave jumps, bifurcations and chaos. Such a behaviour may be due to an increased number of freedom degrees in the glottal system. We hypothesized that voice intensity (with increasing sub glottal pressure) could improve vocal signal stability with less freedom degrees in vibrating system, and then a decrease of nonlinearities. A prospective study of 32 consecutive voices of patients with ULP and severe dysphonia was conducted. Jitter and Lyapunov exponent from vocal signals were compared at comfortable and loud voicing with Wilcoxon's test. In 23 out of 32 patients, jitter significantly decreased from 5 (median) in normal voice to 1.2 in loud voice (P < 10(-3)), Lyapunov exponent decreased from 1,495 bit/s (median) to 708 bit/s (P < 10(-4)). Two patients had paradoxical results regarding jitter (higher in loud voice) and 2 regarding Lyapunov exponent. From the 23 cases of voice improvement, 15 cases showing a marked improvement of the acoustic analysis supported our hypothesis (65%). Nonlinear phenomena detected in vocal signals of ULP with severe dysphonia may be reduced in loud voice. PMID:17558508

  19. Impact of phrenic nerve paralysis on the surgical outcome of intercostal nerve transfer.

    PubMed

    Kita, Yusuke; Tajiri, Yasuhito; Hoshikawa, Shinya; Hara, Yukinori; Iijima, Junichi

    2015-01-01

    Brachial plexus injuries (BPI) can be complicated by diaphragmatic paralysis (DP). This study determined the influence of DP on biceps brachii (BB) recovery after intercostal nerve transfer (ICNT) for BPI and investigated the respiratory complications of ICNT. The study included 100 patients, 84 showing no DP in preoperative and early postoperative chest radiographic images (non-DP group) and 16 with DP that persisted for over one year after surgery (DP group). The postoperative reinnervation time did not differ between groups. BB strength one year after surgery was lower in the DP group than non-DP group (p = 0.0007). No differences were observed 2-3 years after surgery. In the DP group, four patients had respiratory symptoms that affected daily activities and their outcomes deteriorated (p = 0.04). Phrenic nerve transfer should not be combined with ICNT in patients with poor respiratory function because of the high incidence of respiratory complications. PMID:25609274

  20. Inferior alveolar nerve injury with laryngeal mask airway: a case report

    PubMed Central

    2011-01-01

    Introduction The incidence of damage to the individual cranial nerves and their branches associated with laryngeal mask airway use is low; there have been case reports of damage to the lingual nerve, hypoglossal nerve and recurrent laryngeal nerve. To the best of our knowledge we present the first reported case of inferior alveolar nerve injury associated with laryngeal mask airway use. Case presentation A 35-year-old Caucasian man presented to our facility for elective anterior cruciate ligament repair. He had no background history of any significant medical problems. He opted for general anesthesia over a regional technique. He was induced with fentanyl and propofol and a size 4 laryngeal mask airway was inserted without any problems. His head was in a neutral position during the surgery. After surgery in the recovery room, he complained of numbness in his lower lip. He also developed extensive scabbing of the lower lip on the second day after surgery. The numbness and scabbing started improving after a week, with complete recovery after two weeks. Conclusion We report the first case of vascular occlusion and injury to the inferior alveolar nerve, causing scabbing and numbness of the lower lip, resulting from laryngeal mask airway use. This is an original case report mostly of interest for anesthetists who use the laryngeal mask airway in day-to-day practice. Excessive inflation of the laryngeal mask airway cuff could have led to this complication. Despite the low incidence of cranial nerve injury associated with the use of the laryngeal mask airway, vigilant adherence to evidence-based medicine techniques and recommendations from the manufacturer's instructions can prevent such complications. PMID:21447166

  1. The Physiologic Impact of Unilateral Recurrent Laryngeal Nerve (RLN) Lesion on Infant Oropharyngeal and Esophageal Performance.

    PubMed

    Gould, Francois D H; Lammers, Andrew R; Ohlemacher, Jocelyn; Ballester, Ashley; Fraley, Luke; Gross, Andrew; German, Rebecca Z

    2015-12-01

    Recurrent laryngeal nerve (RLN) injury in neonates, a complication of patent ductus arteriosus corrective surgery, leads to aspiration and swallowing complications. Severity of symptoms and prognosis for recovery are variable. We transected the RLN unilaterally in an infant mammalian animal model to characterize the degree and variability of dysphagia in a controlled experimental setting. We tested the hypotheses that (1) both airway protection and esophageal function would be compromised by lesion, (2) given our design, variability between multiple post-lesion trials would be minimal, and (3) variability among individuals would be minimal. Individuals' swallowing performance was assessed pre- and post-lesion using high speed VFSS. Aspiration was assessed using the Infant Mammalian Penetration-Aspiration Scale (IMPAS). Esophageal function was assessed using two measures devised for this study. Our results indicate that RLN lesion leads to increased frequency of aspiration, and increased esophageal dysfunction, with significant variation in these basic patterns at all levels. On average, aspiration worsened with time post-lesion. Within a single feeding sequence, the distribution of unsafe swallows varied. Individuals changed post-lesion either by increasing average IMPAS score, or by increasing variation in IMPAS score. Unilateral RLN transection resulted in dysphagia with both compromised airway protection and esophageal function. Despite consistent, experimentally controlled injury, significant variation in response to lesion remained. Aspiration following RLN lesion was due to more than unilateral vocal fold paralysis. We suggest that neurological variation underlies this pattern. PMID:26285799

  2. Reorganization of laryngeal motoneurons after crush injury in the recurrent laryngeal nerve of the rat

    PubMed Central

    Hernndez-Morato, Ignacio; Valderrama-Canales, Francisco J; Berdugo, Gabriel; Arias, Gonzalo; McHanwell, Stephen; Saudo, Jos; Vzquez, Teresa; Pascual-Font, Arn

    2013-01-01

    Motoneurons innervating laryngeal muscles are located in the nucleus ambiguus (Amb), but there is no general agreement on the somatotopic representation and even less is known on how an injury in the recurrent laryngeal nerve (RLN) affects this pattern. This study analyzes the normal somatotopy of those motoneurons and describes its changes over time after a crush injury to the RLN. In the control group (control group 1, n = 9 rats), the posterior cricoarytenoid (PCA) and thyroarytenoid (TA) muscles were injected with cholera toxin-B. In the experimental groups the left RLN of each animal was crushed with a fine tip forceps and, after several survival periods (1, 2, 4, 8, 12 weeks; minimum six rats per time), the PCA and TA muscles were injected as described above. After each surgery, the motility of the vocal folds was evaluated. Additional control experiments were performed; the second control experiment (control group 2, n = 6 rats) was performed labeling the TA and PCA immediately prior to the section of the superior laryngeal nerve (SLN), in order to eliminate the possibility of accidental labeling of the cricothyroid (CT) muscle by spread from the injection site. The third control group (control group 3, n = 5 rats) was included to determine if there is some sprouting from the SLN into the territories of the RLN after a crush of this last nerve. One week after the crush injury of the RLN, the PCA and TA muscles were injected immediately before the section of the SLN. The results show that a single population of neurons represents each muscle with the PCA in the most rostral position followed caudalwards by the TA. One week post-RLN injury, both the somatotopy and the number of labeled motoneurons changed, where the labeled neurons were distributed randomly; in addition, an area of topographical overlap of the two populations was observed and vocal fold mobility was lost. In the rest of the survival periods, the overlapping area is larger, but the movement of the vocal folds tends to recover. After 12 weeks of survival, the disorganization within the Amb is the largest, but the number of motoneurons is similar to control, and all animals recovered the movement of the left vocal fold. Our additional controls indicate that no tracer spread to the CT muscle occurred, and that many of the labeled motoneurons from the PCA after 1 week post-RLN injury correspond to motoneurons whose axons travel in the SLN. Therefore, it seems that after RLN injury there is a collateral sprouting and collateral innervation. Although the somatotopic organization of the Amb is lost after a crush injury of the RLN and does not recover in the times studied here, the movement of the vocal folds as well as the number of neurons that supply the TA and the PCA muscles recovered within 8 weeks, indicating that the central nervous system of the rat has a great capacity of plasticity. PMID:23444899

  3. Reorganization of laryngeal motoneurons after crush injury in the recurrent laryngeal nerve of the rat.

    PubMed

    Hernndez-Morato, Ignacio; Valderrama-Canales, Francisco J; Berdugo, Gabriel; Arias, Gonzalo; McHanwell, Stephen; Saudo, Jos; Vzquez, Teresa; Pascual-Font, Arn

    2013-04-01

    Motoneurons innervating laryngeal muscles are located in the nucleus ambiguus (Amb), but there is no general agreement on the somatotopic representation and even less is known on how an injury in the recurrent laryngeal nerve (RLN) affects this pattern. This study analyzes the normal somatotopy of those motoneurons and describes its changes over time after a crush injury to the RLN. In the control group (control group 1, n?=?9 rats), the posterior cricoarytenoid (PCA) and thyroarytenoid (TA) muscles were injected with cholera toxin-B. In the experimental groups the left RLN of each animal was crushed with a fine tip forceps and, after several survival periods (1, 2, 4, 8, 12?weeks; minimum six rats per time), the PCA and TA muscles were injected as described above. After each surgery, the motility of the vocal folds was evaluated. Additional control experiments were performed; the second control experiment (control group 2, n?=?6 rats) was performed labeling the TA and PCA immediately prior to the section of the superior laryngeal nerve (SLN), in order to eliminate the possibility of accidental labeling of the cricothyroid (CT) muscle by spread from the injection site. The third control group (control group 3, n?=?5 rats) was included to determine if there is some sprouting from the SLN into the territories of the RLN after a crush of this last nerve. One week after the crush injury of the RLN, the PCA and TA muscles were injected immediately before the section of the SLN. The results show that a single population of neurons represents each muscle with the PCA in the most rostral position followed caudalwards by the TA. One week post-RLN injury, both the somatotopy and the number of labeled motoneurons changed, where the labeled neurons were distributed randomly; in addition, an area of topographical overlap of the two populations was observed and vocal fold mobility was lost. In the rest of the survival periods, the overlapping area is larger, but the movement of the vocal folds tends to recover. After 12?weeks of survival, the disorganization within the Amb is the largest, but the number of motoneurons is similar to control, and all animals recovered the movement of the left vocal fold. Our additional controls indicate that no tracer spread to the CT muscle occurred, and that many of the labeled motoneurons from the PCA after 1?week post-RLN injury correspond to motoneurons whose axons travel in the SLN. Therefore, it seems that after RLN injury there is a collateral sprouting and collateral innervation. Although the somatotopic organization of the Amb is lost after a crush injury of the RLN and does not recover in the times studied here, the movement of the vocal folds as well as the number of neurons that supply the TA and the PCA muscles recovered within 8?weeks, indicating that the central nervous system of the rat has a great capacity of plasticity. PMID:23444899

  4. Changes in the frequency of swallowing during electrical stimulation of superior laryngeal nerve in rats.

    PubMed

    Tsuji, Kojun; Tsujimura, Takanori; Magara, Jin; Sakai, Shogo; Nakamura, Yuki; Inoue, Makoto

    2015-02-01

    The aim of the present study was to investigate the adaptation of the swallowing reflex in terms of reduced swallowing reflex initiation following continuous superior laryngeal nerve stimulation. Forty-four male Sprague Dawley rats were anesthetized with urethane. To identify swallowing, electromyographic activity of the left mylohyoid and thyrohyoid muscles was recorded. To evoke the swallowing response, the superior laryngeal nerve (SLN), recurrent laryngeal nerve, or cortical swallowing area was electrically stimulated. Repetitive swallowing evoked by continuous SLN stimulation was gradually reduced, and this reduction was dependent on the resting time duration between stimulations. Prior SLN stimulation also suppressed subsequent swallowing initiation. The reduction in evoked swallows induced by recurrent laryngeal nerve or cortical swallowing area stimulation was less than that following superior laryngeal nerve stimulation. Decerebration had no effect on the reduction in evoked swallows. Prior subthreshold stimulation reduced subsequent initiation of swallowing, suggesting that there was no relationship between swallowing movement evoked by prior stimulation and the subsequent reduction in swallowing initiation. Overall, these data suggest that reduced sensory afferent nerve firing and/or trans-synaptic responses, as well as part of the brainstem central pattern generator, are involved in adaptation of the swallowing reflex following continuous stimulation of swallow-inducing peripheral nerves and cortical areas. PMID:25542096

  5. An Overview of Laryngeal Muscle Single Fiber Electromyography.

    PubMed

    Bertorini, Tulio E; Sharaf, Aboubakar G

    2015-08-01

    Needle electromyography is an important tool in the diagnosis of neuromuscular diseases and has also been applied successfully in the evaluation of the vocal cord paralysis. Laryngeal electromyography, initially described by Weddell, is used to determine the cause of vocal cord paralysis and to differentiate organic from nonorganic causes of speech disorders. This test allows the diagnosis of lower motor neuron and nerve paralysis as well as myopathies. Laryngeal electromyography also helps to determine the prognosis of paralysis caused by traumatic injury of the laryngeal nerves and is used for guidance during botulinum toxin injection in spasmodic dysphonias. Single fiber electromyography is used to diagnose abnormalities of neuromuscular transmission and is applied in the study the architecture of the motor unit in muscles. This article reviews the techniques of laryngeal muscles single fiber electromyography, provides limited informative data, and discusses its potential value in the evaluation of patients with dysphonia. PMID:26241239

  6. Masseteric-facial nerve transposition for reanimation of the smile in incomplete facial paralysis.

    PubMed

    Hontanilla, Bernardo; Marre, Diego

    2015-12-01

    Incomplete facial paralysis occurs in about a third of patients with Bell's palsy. Although their faces are symmetrical at rest, when they smile they have varying degrees of disfigurement. Currently, cross-face nerve grafting is one of the most useful techniques for reanimation. Transfer of the masseteric nerve, although widely used for complete paralysis, has not to our knowledge been reported for incomplete palsy. Between December 2008 and November 2013, we reanimated the faces of 9 patients (2 men and 7 women) with incomplete unilateral facial paralysis with transposition of the masseteric nerve. Sex, age at operation, cause of paralysis, duration of denervation, recipient nerves used, and duration of follow-up were recorded. Commissural excursion, velocity, and patients' satisfaction were evaluated with the FACIAL CLIMA and a questionnaire, respectively. The mean (SD) age at operation was 39 (±6) years and the duration of denervation was 29 (±19) months. There were no complications that required further intervention. Duration of follow-up ranged from 6-26 months. FACIAL CLIMA showed improvement in both commissural excursion and velocity of more than two thirds in 6 patients, more than one half in 2 patients and less than one half in one. Qualitative evaluation showed a slight or pronounced improvement in 7/9 patients. The masseteric nerve is a reliable alternative for reanimation of the smile in patients with incomplete facial paralysis. Its main advantages include its consistent anatomy, a one-stage operation, and low morbidity at the donor site. PMID:26143295

  7. Quantitative PCR Analysis of Laryngeal Muscle Fiber Types

    ERIC Educational Resources Information Center

    Van Daele, Douglas J.

    2010-01-01

    Voice and swallowing dysfunction as a result of recurrent laryngeal nerve paralysis can be improved with vocal fold injections or laryngeal framework surgery. However, denervation atrophy can cause late-term clinical failure. A major determinant of skeletal muscle physiology is myosin heavy chain (MyHC) expression, and previous protein analyses…

  8. Quantitative PCR Analysis of Laryngeal Muscle Fiber Types

    ERIC Educational Resources Information Center

    Van Daele, Douglas J.

    2010-01-01

    Voice and swallowing dysfunction as a result of recurrent laryngeal nerve paralysis can be improved with vocal fold injections or laryngeal framework surgery. However, denervation atrophy can cause late-term clinical failure. A major determinant of skeletal muscle physiology is myosin heavy chain (MyHC) expression, and previous protein analyses

  9. Restoration of shoulder function and elbow flexion by nerve transfer for poliomyelitis-like paralysis caused by enterovirus 71 infection.

    PubMed

    Funahashi, S; Nagano, A; Sano, M; Ogihara, H; Omura, T

    2007-02-01

    We report the case of an eight-month-old girl who presented with a poliomyelitis-like paralysis in her left upper limb caused by enterovirus 71 infection. She recovered useful function after nerve transfers performed six months after the onset of paralysis. Early neurotisation can be used successfully in the treatment of poliomyelitis-like paralysis in children. PMID:17322446

  10. Losing Your Voice: Etiologies and Imaging Features of Vocal Fold Paralysis

    PubMed Central

    Vachha, Behroze; Cunnane, Mary Beth; Mallur, Pavan; Moonis, Gul

    2013-01-01

    Neurogenic compromise of vocal fold function exists along a continuum encompassing vocal cord hypomobility (paresis) to vocal fold immobility (paralysis) with varying degrees and patterns of reinnervation. Vocal fold paralysis (VFP) may result from injury to the vagus or the recurrent laryngeal nerves anywhere along their course from the brainstem to the larynx. In this article, we review the anatomy of the vagus and recurrent laryngeal nerves and examine the various etiologies of VFP. Selected cases are presented with discussion of key imaging features of VFP including radiologic findings specific to central vagal neuropathy and peripheral recurrent nerve paralysis. PMID:23814687

  11. Expiratory-modulated laryngeal motoneurons exhibit a hyperpolarization preceding depolarization during superior laryngeal nerve stimulation in the in vivo adult rat.

    PubMed

    Bautista, Tara G; Sun, Qi-Jian; Pilowsky, Paul M

    2012-03-22

    Swallowing requires the sequential activation of tongue, pharyngeal and esophageal muscles to propel the food bolus towards the stomach. Aspiration during swallow is prevented by adduction of the vocal cords during the oropharyngeal phase. Expiratory-modulated laryngeal motoneurons (ELM) exhibit a burst of action potentials during swallows elicited by electrical stimulation of the superior laryngeal nerve (SLN). Here we sought to investigate changes in membrane potential in ELM during superior laryngeal nerve stimulation in the anaesthetised, in vivo adult rat preparation. Intracellular recordings of ELM in the caudal nucleus ambiguus (identified by antidromic activation from the recurrent laryngeal nerve) demonstrated that ELM bursting activity following SLN stimulation is associated with a depolarization that is preceded by a small hyperpolarization. During spontaneous ELM bursts, the preceding hyperpolarization separated the bursting activity from its usual post-inspiratory activity. These findings demonstrate that the in vivo adult rat preparation is suitable for the study of swallow-related activity in laryngeal motoneurons. PMID:22326041

  12. Facial Nerve Paralysis in Patients With Chronic Ear Infections: Surgical Outcomes and Radiologic Analysis

    PubMed Central

    Choi, Jin Woong

    2015-01-01

    Objectives The purpose of this study was to investigate the clinical features, radiologic findings, and treatment outcomes in patients of facial nerve paralysis with chronic ear infections. And we also aimed to evaluate for radiologic sensitivities on facial canal, labyrinth and cranial fossa dehiscences in middle ear cholesteatomas. Methods A total of 13 patients were enrolled in this study. Medical records were retrospectively reviewed for clinical features, radiologic findings, surgical findings, and recovery course. In addition, retrospective review of temporal bone computed tomography (CT) and operative records in 254 middle ear cholesteatoma patients were also performed. Results Of the 13 patients, eight had cholesteatomas in the middle ear, while two patients exhibited external auditory canal cholesteatomas. Chronic suppurative otitis media, petrous apex cholesteatoma and tuberculous otitis media were also observed in some patients. The prevalence of facial paralysis in middle ear cholesteatoma patients was 3.5%. The most common involved site of the facial nerve was the tympanic segment. Labyrinthine fistulas and destruction of cranial bases were more frequently observed in facial paralysis patients than nonfacial paralysis patients. The radiologic sensitivity for facial canal dehiscence was 91%. The surgical outcomes for facial paralysis were relatively satisfactory in all patients except in two patients who had petrous apex cholesteatoma and requiring conservative management. Conclusion Facial paralyses associated with chronic ear infections were observed in more advanced lesions and the surgical outcomes for facial paralysis were relatively satisfactory. Facial canal dehiscences can be anticipated preoperatively with high resolution CTs. PMID:26330915

  13. Masseteric nerve for reanimation of the smile in short-term facial paralysis.

    PubMed

    Hontanilla, Bernardo; Marre, Diego; Cabello, Alvaro

    2014-02-01

    Our aim was to describe our experience with the masseteric nerve in the reanimation of short term facial paralysis. We present our outcomes using a quantitative measurement system and discuss its advantages and disadvantages. Between 2000 and 2012, 23 patients had their facial paralysis reanimated by masseteric-facial coaptation. All patients are presented with complete unilateral paralysis. Their background, the aetiology of the paralysis, and the surgical details were recorded. A retrospective study of movement analysis was made using an automatic optical system (Facial Clima). Commissural excursion and commissural contraction velocity were also recorded. The mean age at reanimation was 43(8) years. The aetiology of the facial paralysis included acoustic neurinoma, fracture of the skull base, schwannoma of the facial nerve, resection of a cholesteatoma, and varicella zoster infection. The mean time duration of facial paralysis was 16(5) months. Follow-up was more than 2 years in all patients except 1 in whom it was 12 months. The mean duration to recovery of tone (as reported by the patient) was 67(11) days. Postoperative commissural excursion was 8(4)mm for the reanimated side and 8(3)mm for the healthy side (p=0.4). Likewise, commissural contraction velocity was 38(10)mm/s for the reanimated side and 43(12)mm/s for the healthy side (p=0.23). Mean percentage of recovery was 92(5)mm for commissural excursion and 79(15)mm/s for commissural contraction velocity. Masseteric nerve transposition is a reliable and reproducible option for the reanimation of short term facial paralysis with reduced donor site morbidity and good symmetry with the opposite healthy side. PMID:24148699

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

    PubMed Central

    Deniwar, Ahmed; Bhatia, Parisha; Kandil, Emad

    2015-01-01

    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. PMID:25992326

  15. Nicolaus A. Friedreich's description of peripheral facial nerve paralysis in 1798.

    PubMed Central

    Bird, T D

    1979-01-01

    In 1798, Nicolaus A. Friedreich of Wurzburg published a detailed clinical account of three patients with idopathic peripheral facial nerve paralysis. His astute observations of onset, physical findings, natural course, treatment, and recovery preceded those of Charles Bell by 23 years. PMID:368292

  16. [Variations in the course of the inferior laryngeal nerve. Surgical anatomy, classification, diagnosis].

    PubMed

    Weiand, G; Mangold, G

    2004-02-01

    Because of multiple variations in course, the inferior laryngeal nerve shows a great variety of topographic relations to adjacent cervical structures. It may recur in the tracheoesophageal groove or anteriorly or posteriorly to it. It can pass under, over, or through the ramifications of the inferior thyroid artery. If Zuckerkandl's tubercle is enlarged, the nerve may be luxated. It is firmly fixed to the ligament of Berry by tight adhesions. Before entering the larynx, the nerve may show multiple ramifications. It may also recur around the inferior thyroid or vertebral artery. On the right, a nonrecurrent nerve is found in 0.6-0.8% of individuals, always in coincidence with a "lusorian" artery. Three course variations can be distinguished: descending (type I), horizontal (II), and ascending (III). A nonrecurrent nerve on the left is extremely rare, as it can only be found as a combination anomaly of a right-sided lusorian artery with situs inversus viscerum. The divided inferior laryngeal nerve shows recurrent and nonrecurrent ramifications. A nonrecurrent inferior laryngeal nerve can be indirectly ruled out preoperatively by demonstration of a normally developed brachiocephalic trunk via colour-coded duplex ultrasound. PMID:14991182

  17. Using NU-KNIT for hemostasis around recurrent laryngeal nerve during transthoracic esophagectomy with lymphadenectomy for esophageal cancer

    PubMed Central

    2014-01-01

    Background We thought that using electrocautery for hemostasis caused recurrent laryngeal nerve palsy. We reflected the prolonged use of electrocautery and employed NU-KNIT to achieve hemostasis nearby the recurrent laryngeal nerve. We assessed that using NU-KNIT hemostasis prevented or not postoperative recurrent laryngeal nerve palsy, retrospectively. The present study was evaluated to compare using electrocautery hemostasis with using NU-KNIT hemostasis during lymphadenectomy along recurrent laryngeal nerve. The variables compared were morbidity rate of recurrent laryngeal nerve palsy, operation time, and blood loss. Results We use NU-KNIT to achieve hemostasis without strong compression. This group is named group N. On the other hand, we use electrocautery to achieve hemostasis. This group is named group E. Complication rate of recurrent laryngeal nerve palsy was higher in group E (55.6%) than group N (5.3%) (p?=?0.007). Conclusions Even hemostasis using NU-KNIT was slightly more time-consuming than using electrocautery, we concluded that it would be useful to prevent recurrent laryngeal nerve palsy. PMID:24602313

  18. An uncommon case of dyspnea with unilateral laryngeal paralysis in acromegaly.

    PubMed

    Lerat, Justine; Lacoste, Marie; Prechoux, Jean-Marc; Aubry, Karine; Nadalon, Sylvie; Ly, Kim Heang; Bessede, Jean-Pierre

    2016-02-01

    A 61-year-old man with obstructive sleep apnea syndrome and normal BMI complained of dyspnea. Nasofibroscopy revealed a global and major oedema of the glottis and supraglottis and also a paralysis of the left vocal fold. CT-scan pointed out a spontaneous hyperdensity of the left arytenoid cartilage. A tracheostomy was performed. Clinical examination revealed large hands and macroglossy with high IGF1 rate. MRI confirmed a supracentimetric pituitary adenoma. To our knowledge, this is the first description of a case of acute respiratory distress due to unilateral larynx paralysis leading to acromegaly diagnosis. This is due to submucosal hypertrophy and vocal cord immobility. PMID:26142980

  19. Laryngeal motility alteration: A missing link between sleep apnea and vagus nerve stimulation for epilepsy.

    PubMed

    Zambrelli, Elena; Saibene, Alberto M; Furia, Francesca; Chiesa, Valentina; Vignoli, Aglaia; Pipolo, Carlotta; Felisati, Giovanni; Canevini, Maria Paola

    2016-01-01

    This study aimed to evaluate the prevalence and the relationship of sleep breathing disorders (SBDs) and laryngeal motility alterations in patients with drug-resistant epilepsy after vagus nerve stimulator (VNS) implantation. Twenty-three consecutive patients with medically refractory epilepsy underwent out-of-center sleep testing before and after VNS implantation. Eighteen eligible subjects underwent endoscopic laryngeal examination post-VNS implantation. Statistical analysis was carried out to assess an association between laryngeal motility alterations and the onset/worsening of SBDs. After VNS implantation, 11 patients showed a new-onset mild/moderate SBD. Half of the patients already affected by obstructive sleep apnea (OSA) showed worsening of SBD. All of the patients with a new-onset OSA had a laryngeal pattern with left vocal cord adduction (LVCA) during VNS stimulation. The association between VNS-induced LVCA and SBD was statistically significant. This study suggests an association between VNS and SBD, hinting to a pivotal role of laryngeal motility alterations. The relationship between SBD and VNS-induced LVCA supports the need to routinely investigate sleep respiratory and laryngeal motility patterns before and after VNS implantation. PMID:26589721

  20. Single-Port Mediastinoscopic Lymphadenectomy Along the Left Recurrent Laryngeal Nerve.

    PubMed

    Fujiwara, Hitoshi; Shiozaki, Atsushi; Konishi, Hirotaka; Kosuga, Toshiyuki; Komatsu, Shuhei; Ichikawa, Daisuke; Okamoto, Kazuma; Otsuji, Eigo

    2015-09-01

    We herein describe a single-port mediastinoscopic method for upper mediastinal dissection in esophageal cancer surgery. After the left cervical incision and lymphadenectomy, a Lap-Protector (Hakko, Tokyo, Japan) was inserted into the wound and an EZ Access port (Hakko) was attached. Esophageal mobilization with en bloc lymphadenectomy along the left recurrent laryngeal nerve was then performed using a port-in-port technique with conventional flexible laparoscopy. Carbon dioxide insufflation expanded the intramediastinal space, and minute structures in the deep mediastinum around the aortic arch, such as nerves, bronchial arteries, and lymphatic vessels, were clearly visualized, allowing lymphadenectomy to be safely and carefully performed along the nerve. PMID:26354650

  1. Risk factors for the development of aspiration pneumonia after unilateral arytenoid lateralization in dogs with laryngeal paralysis: 232 cases (1987-2012).

    PubMed

    Wilson, David; Monnet, Eric

    2016-01-15

    OBJECTIVE To identify risk factors for the development of aspiration pneumonia after unilateral arytenoid lateralization in dogs with laryngeal paralysis. DESIGN Retrospective case series. ANIMALS 232 client-owned dogs with a diagnosis of laryngeal paralysis treated with lef-tsided unilateral arytenoid lateralization. PROCEDURES Medical records were reviewed. Signalment, medical history, surgical complications, and outcome data were collected. Follow-up was performed via review of medical records and by telephone interview with the owner, referring veterinarian, or both. RESULTS At the 1-, 3-, and 4-year follow-up periods, aspiration pneumonia occurred in 18.6%, 31.8%, and 31.8% of dogs, respectively. The 1-, 3-, and 4-year survival rates for dogs with postoperative aspiration pneumonia were 83.1%, 51.5%, and 25.8%, respectively. None of the dogs with aspiration pneumonia before surgery developed clinical signs of aspiration pneumonia after surgery. Postoperative megaesophagus (hazard ratio [HR], 2.58; 95% confidence interval [CI], 1.56 to 3.93) and postoperative administration of opioid analgesics prior to discharge (HR, 1.69; 95% CI, 1.12 to 2.80) were significant risk factors for the long-term development of aspiration pneumonia in this study. Perioperative metoclopramide administration did not significantly decrease the risk for development of aspiration pneumonia (HR, 0.94; 95% CI, 0.67 to 1.37). CONCLUSIONS AND CLINICAL RELEVANCE In the present study, aspiration pneumonia was the most commonly reported postoperative complication of unilateral lateralization in dogs treated for laryngeal paralysis; however, preexisting aspiration pneumonia was not associated with an increased risk for development of aspiration pneumonia after surgery. Megaesophagus was identified as an important risk factor for eventual development of aspiration pneumonia. Administration of an opioid analgesic may increase the risk of aspiration pneumonia in dogs treated surgically for laryngeal paralysis. PMID:26720085

  2. A Preclinical Study of Laryngeal Motor-Evoked Potentials as a Marker Vagus Nerve Activation.

    PubMed

    Grimonprez, Annelies; Raedt, Robrecht; De Taeye, Leen; Larsen, Lars Emil; Delbeke, Jean; Boon, Paul; Vonck, Kristl

    2015-12-01

    Vagus nerve stimulation (VNS) is a treatment for refractory epilepsy and depression. Previous studies using invasive recording electrodes showed that VNS induces laryngeal motor-evoked potentials (LMEPs) through the co-activation of the recurrent laryngeal nerve and subsequent contractions of the laryngeal muscles. The present study investigates the feasibility of recording LMEPs in chronically VNS-implanted rats, using a minimally-invasive technique, to assess effective current delivery to the nerve and to determine optimal VNS output currents for vagal fiber activation. Three weeks after VNS electrode implantation, signals were recorded using an electromyography (EMG) electrode in the proximity of the laryngeal muscles and a reference electrode on the skull. The VNS output current was gradually ramped up from 0.1 to 1.0 mA in 0.1 mA steps. In 13/27 rats, typical LMEPs were recorded at low VNS output currents (median 0.3 mA, IQR 0.2-0.3 mA). In 11/27 rats, significantly higher output currents were required to evoke electrophysiological responses (median 0.7 mA, IQR 0.5-0.7 mA, [Formula: see text]). The latencies of these responses deviated significantly from LMEPs ([Formula: see text]). In 3/27 rats, no electrophysiological responses to simulation were recorded. Minimally invasive LMEP recordings are feasible to assess effective current delivery to the vagus nerve. Furthermore, our results suggest that low output currents are sufficient to activate vagal fibers. PMID:26510476

  3. Identification alone versus intraoperative neuromonitoring of the recurrent laryngeal nerve during thyroid surgery: experience of 2034 consecutive patients

    PubMed Central

    2014-01-01

    Background The aim of this study was to evaluate the ability of intraoperative neuromonitoring in reducing the postoperative recurrent laryngeal nerve palsy rate by a comparison between patients submitted to thyroidectomy with intraoperative neuromonitoring and with routine identification alone. Methods Between June 2007 and December 2012, 2034 consecutive patients underwent thyroidectomy by a single surgical team. We compared patients who have had neuromonitoring and patients who have undergone surgery with nerve visualization alone. Patients in which neuromonitoring was not utilized (Group A) were 993, patients in which was utilized (group B) were 1041. Results In group A 28 recurrent laryngeal nerve injuries were observed (2.82%), 21 (2.11%) transient and 7 (0.7%) permanent. In group B 23 recurrent laryngeal nerve injuries were observed (2.21%), in 17 cases (1.63%) transient and in 6 (0.58%) permanent. Differences were not statistically significative. Conclusions Visual nerve identification remains the gold standard of recurrent laryngeal nerve management in thyroid surgery. Neuromonitoring helps to identify the nerve, in particular in difficult cases, but it did not decrease nerve injuries compared with visualization alone. Future studies are warranted to evaluate the benefit of intraoperative neuromonitoring in thyroidectomy, especially in conditions in which the recurrent nerve is at high risk of injury. PMID:24942225

  4. Phrenic Nerve Paralysis as the Initial Presentation in Pleural Sarcomatoid Mesothelioma

    PubMed Central

    Makimoto, Go; Fujiwara, Keiichi; Fujimoto, Nobukazu; Yamadori, Ichiro; Sato, Toshio; Kishimoto, Takumi

    2014-01-01

    A 74-year-old man was referred to our hospital because of persistent cough. A chest radiograph revealed an elevation of the right diaphragm. Computed tomography (CT) images revealed a small nodule localized on the right mediastinum. Five months later, the nodule had grown and was diagnosed as malignant pleural mesothelioma (MPM) by a CT-guided needle biopsy. The patient underwent combined chemotherapy, but the disease progressed rapidly and he passed away. On autopsy, microscopic findings and immunohistological examinations supported the diagnosis of sarcomatoid mesothelioma. Therefore, we diagnosed this rare case as localized sarcomatoid MPM showing phrenic nerve paralysis as an initial presentation. PMID:25076889

  5. Pharyngolaryngeal paralysis in a patient with pharyngeal tuberculosis.

    PubMed

    Ohki, Masafumi; Komiyama, Sakurako; Tayama, Niro

    2015-02-01

    Pharyngeal tuberculosis is a rare disease, and its commonly reported symptoms include sore throat, dysphagia, and throat discomfort. The dysphagia in pharyngeal tuberculosis cases is not due to pharyngolaryngeal paralysis but due to odynophagia. Herein, we describe the first case of dysphagia caused by pharyngolaryngeal paralysis secondary to pharyngeal tuberculosis. An irregular mass at the right nasopharynx was detected in a 57-year-old female patient, along with dysphagia and hoarseness. She had poor right soft palate elevation, inadequate right velopharyngeal closure, poor constrictor pharyngus muscle contraction, and an immobilized right vocal cord, which collectively indicate right pharyngolaryngeal paralysis. Pathological examination and culture testing revealed pharyngeal tuberculosis. She was diagnosed with pharyngolaryngeal paralysis secondary to pharyngeal tuberculosis. The pharyngolaryngeal paralysis resolved after beginning anti-tuberculous treatment. Right pharyngolaryngeal paralysis was attributed to glossopharyngeal and vagus nerve impairment in the parapharyngeal space. Prior reports indicate that peripheral nerve paralysis, including recurrent laryngeal nerve paralysis caused by tuberculous lymphadenitis, often recovers after anti-tuberculous treatment. Pharyngeal tuberculosis rarely causes dysphagia and hoarseness attributable to pharyngolaryngeal paralysis. The neuropathy may recover after anti-tuberculous treatment. Pharyngeal tuberculosis is a new potential differential diagnosis in pharyngolaryngeal paralysis. PMID:25287869

  6. Protective effect of intraoperative nerve monitoring against recurrent laryngeal nerve injury during re-exploration of the thyroid

    PubMed Central

    2013-01-01

    Background Previous thyroid or parathyroid surgery induces scarring or distorts anatomy, and increases the risk of recurrent laryngeal nerve (RLN) injury for a reoperation. The benefit of intraoperative nerve monitoring (IONM) for re-exploration (a second nerve exploration) and reoperation has not been established. Methods Two hundred and ten patients were given a thyroid or parathyroid reoperation at our hospital between 2001 and 2010. Using IONM, we re-explored 56 patients who had been operated on before June 2007. The injury rate in these patients was compared with that of the 15 patients re-explored without IONM between 2001 and 2006. Results Of the 70 nerves that were re-explored using IONM, only one was incidentally injured, significantly fewer than the three injured in the 15 nerves re-explored without using IONM (1.43% vs. 20%, P = 0.0164). Conclusions IONM helped prevent RLN damage when re-exploring nerves during thyroid and parathyroid surgery. We recommend the routine use of IONM in thyroid and parathyroid reoperations. PMID:23618223

  7. Facilitation of the swallowing reflex with bilateral afferent input from the superior laryngeal nerve.

    PubMed

    Takahashi, Kojiro; Shingai, Tomio; Saito, Isao; Yamamura, Kensuke; Yamada, Yoshiaki; Kitagawa, Junichi

    2014-03-01

    To determine the cooperative effect of laryngeal afferent signals on the swallowing reflex, we examined whether afferent signals originating from the left and right superior laryngeal nerve (SLN) modulates elicitation of the swallowing reflex in urethane-anesthetized rats. Mylohyoid electromyographic activity was recorded to quantify the swallowing reflex. The onset latency of the swallowing reflex and the time intervals between successive swallows were used to quantify and compare the effects of unilateral and bilateral electrical stimulations of the SLN. The mean latency of the first swallow and the mean time interval between swallows evoked with low frequency stimulation were both significantly different between unilateral and bilateral stimulations of the SLN. These findings suggest that facilitatory effect of afferent signals originating from the SLN bilaterally increase the motoneuronal activity in the medullary swallowing center and enhance the swallowing reflex. PMID:24462841

  8. [Etiology, diagnosis, differential diagnosis and therapy of vocal fold paralysis].

    PubMed

    Reiter, R; Hoffmann, T K; Rotter, N; Pickhard, A; Scheithauer, M O; Brosch, S

    2014-03-01

    Etiology of vocal fold paralysis is broad: e.?g. iatrogenic/traumatic, associated with neoplasms or with systemic diseases. The cause of idiopathic paralysis is unknown. The main symptom of unilateral vocal fold paralysis is hoarseness because of a remaining glottic gap during phonation. Patients with bilateral vocal fold paralysis typically have no impairment of the voice but dyspnea. Examination of patients with an idopathic vocal fold paralysis is a CT of the vagal nerve and recurrent laryngeal nerve from skull base to neck and mediastinum. Serological tests are not obligatory. Differential diagnosis of vocal fold immobility is vocal fold paralysis/neurological causes and arthrogene causes such as arytenoid subluxation, interarytenoid adhesion and vocal fold fixation in laryngeal carcinomas. Voice therapy is a promising approach for patients with unilateral vocal fold paralysis, but not all patients benefit sufficiently. Temporary vocal fold augmentation by injection medialization results in satisfactory voice quality that is comparable with a thyroplasty. Patients with bilateral vocal fold immobility show typically dyspnea requiring immediate therapy such as temporary tracheotomy or reversible laterofixation of the paralyzed vocal chord. If the paralysis persists a definitive enlargement of the glottic airway by eg. arytenoidectomy needs to be performed. PMID:24135826

  9. Morphology of P2X3-immunoreactive nerve endings in the rat laryngeal mucosa.

    PubMed

    Takahashi, Natsumi; Nakamuta, Nobuaki; Yamamoto, Yoshio

    2016-02-01

    The morphological characteristics of P2X3-immunoreactive nerve endings in the laryngeal mucosa were herein examined using immunohistochemistry with confocal laser microscopy. Ramified intraepithelial nerve endings immunoreactive to P2X3 were distributed in the epiglottis and arytenoid region. The axon terminals of P2X3-immunoreactive ramified endings were beaded or flat in shape. These endings were also immunoreactive to P2X2 and not identical to the nerve endings immunoreactive to Na(+)-K(+)-ATPase ?3-subunit, substance P (SP), and calcitonin gene-related peptide (CGRP). P2X3-immunoreactive axon terminals were also immunoreactive to vGLUT1, vGLUT2, and vGLUT3. In addition to ramified endings, P2X3-immunoreactive nerve endings were associated with ?-gustducin-immunoreactive solitary chemosensory cells and/or SNAP25-immunoreactive neuroendocrine cells. Furthermore, P2X3-immunoreactive nerve endings were also observed in the taste bud-like chemosensory cell clusters of the stratified squamous epithelium covering epiglottic and arytenoid cartilage. The P2X3-immunoreactive nerve endings that associated with sensory and/or endocrine cells and chemosensory cell clusters were also immunoreactive to P2X2, vGLUT1, vGLUT2, and vGLUT3, but not to SP or CGRP. In conclusion, P2X3-immunoreactive nerve endings may be classified into two types, i.e., intraepithelial ramified nerve endings and nerve endings associated with chemosensory cells and neuroendocrine cells. PMID:26475709

  10. Hypoglossal nerve paralysis results in hypermetabolic activity on positron emission tomography/computed tomography in the contralateral tongue.

    PubMed

    Timbang, Mary R; Trosman, Samuel J; Lorenz, Robert R

    2015-06-01

    False-positive results on combined positron emission tomography/computed tomography can complicate detection and surveillance of head and neck cancers. We present a rare case of false-positive contralateral [18F]-2-fluoro-2-deoxy-D-glucose tongue uptake after hypoglossal nerve paralysis caused by squamous cell carcinoma originating from the base of the tongue. PMID:25825133

  11. Cystic schwannoma of the recurrent laryngeal nerve: a rare finding posing diagnostic difficulties.

    PubMed

    Knulst, Rowan; Bosman, Willem-Maarten; Ritchie, Ewan D; da Costa, Andy

    2014-01-01

    A 49-year-old woman with a painless mass in the neck was examined by the surgeon. Imaging and cytology prior to surgery suggested the mass to be either a thyroid cyst or a branchial cleft cyst. After surgery, the patient reported a hoarse voice and the pathologist confirmed the removed lesion to be a cystic schwannoma of the left recurrent laryngeal nerve. The inconclusive imaging results, combined with colloid-like material in the punctate should prompt the investigator to include cystic schwannoma in the differential diagnosis. With the probability of a neurogenic origin of the mass in mind, nerve-sparing surgery can be performed. As a future prospect, positron emission tomography scans are mentioned as a modality with possibilities to discriminate a cystic schwannoma from other common cystic lesions. PMID:24769666

  12. Laryngeal reinnervation with the hypoglossal nerve. I. Physiology, histochemistry, electromyography, and retrograde labeling in a canine model.

    PubMed

    Paniello, R C; West, S E; Lee, P

    2001-06-01

    This study was performed to determine whether the hypoglossal nerve (cranial nerve XI [XII]) would serve as a useful donor for laryngeal reinnervation by anastomosis to the recurrent laryngeal nerve (RLN). Twenty hemilarynges in 10 dogs were studied prospectively after XII-RLN anastomosis (group A; n = 5), split XII-RLN anastomosis (group B; n = 3), XII-RLN anastomosis with a 2-cm interposition graft (group C; n = 2), no treatment (group D; n = 5), RLN section (group E; n = 2), or ansa cervicalis-RLN anastomosis (group F; n = 3). Spontaneous activity was observed monthly by infraglottic examination through permanent tracheostomies and was recorded by electromyography. Laryngeal adductory pressure and induced phonation were obtained by stimulating the RLN while passing a pressure transducer balloon or humidified air through the glottis. At sacrifice, the laryngeal muscles were stained for adenosine triphosphatase to determine the ratio of type I to type II fibers. Retrograde labeling of the brain stem was performed with horseradish peroxidase. Infraglottic examination at 6 months showed a full range of adductory motion in groups A and B during the swallow reflex, comparable with that in group D. Groups C and F showed good bulk and tone, but little spontaneous motion. Group E remained paralyzed. Stimulation of the transferred nerves caused more activity in groups A and B than in the other groups; groups C and F partially adducted at high levels. The laryngeal adductory pressure responses of groups A and B were similar to those of group D. The XII-reinnervated larynges were capable of producing normal induced phonation. Retrograde labeling of the RLN showed that the reinnervating axons originated only in the hypoglossal nucleus. Electromyography of the reinnervated adductor muscles confirmed spontaneous activity in the dogs (awake). Histochemical analysis confirmed slow-to-fast transformation of both the posterior and lateral cricoarytenoid muscles, indicating that significant reinnervation occurred. We conclude that the hypoglossal nerve functions well as a donor for adductory reinnervation of the larynx. PMID:11407844

  13. Functional restoration after early tendon transfer in high radial nerve paralysis.

    PubMed

    Dabas, V; Suri, T; Surapuraju, P K; Sural, S; Dhal, A

    2011-02-01

    We assessed the effect of an early transfer of pronator teres to extensor carpi radialis brevis on hand function in patients with high radial nerve paralysis. Power grip and precision grip were measured preoperatively and postoperatively using a dynamometer. Fifteen patients were operated on, of which ten could be assessed at the end of 6 months. At 6 months after surgery, there was a median increase of 48% in power grip, 162% in tip pinch, 90% in key pinch and 98% in palmar pinch. Decreased palmar flexion was seen in four patients. Fraying of the periosteal extension and rupture of sutures at the junction site were each seen in one patient, leading to unsatisfactory results. Early tendon transfer quickly restored efficient grip while awaiting reinnervation of wrist extensors, avoiding the need for prolonged external splintage. PMID:20935022

  14. A pontine primary relay for ascending projections of the superior laryngeal nerve,.

    PubMed

    Car, A; Jean, A; Roman, C

    1975-01-01

    1. In sheep anaesthetized with fluothane, electrical stimulation of the superior laryngeal nerve (SLN), which contains most of the afferent fibres for swallowing, evokes potentials in the medial part of the ipsilateral thalamic VPM (nucleus ventro-postero-medialis) within about 5 msec. This region constitutes the secondary synaptic relay for the laryngeal impulses projecting to the frontal cortex concerned with swallowing. 2. SLN fibres are synaptically connected with cells of the NTS (nucleus of the tractus solitarius), 2-4 mm rostral to the obex (see Car and Jean, 1971). Coagulation of this region abolishes reflexly and cortically induced swallowing, but does not influence the thalamic or cortical responses induced by SLN stimulation. 3. SLN stimulation evokes potentials with a short latency (2 msec) in a restricted pontine area localized 5 mm from the midline and above the trigeminal motor nucleus, just in front of the central emergence of the facial nerve (i.e; about 12 mm rostral to obex). Restricted coagulation of this pontine region eliminates both the thalamic and the cortical projection of SLN. 4. Repetitive stimulation (2 V; 0.2 msec; 20-30 Hz) of this same pontine region produces rhythmic swallowing with characteristics quite similar to those of swallowing induced by SLN or bulbar stimulation. 5. Other data show that SLN fibres, or at least part of them, bifurcate after entering the brain stem (about 6 mm in front of the obex), and give a caudal branch, which reaches the bulbar swallowing centre (3 mm rostral to the obex) by running through the tractus solitarius; and a rostral branch terminating in the pons where the primary synaptic relay for the ascending laryngeal pathway is localized. PMID:1126414

  15. Surgery for traumatic facial nerve paralysis: does intraoperative monitoring have a role?

    PubMed

    Ashram, Yasmine A; Badr-El-Dine, Mohamed M K

    2014-09-01

    The use of intraoperative facial nerve (FN) monitoring during surgical decompression of the FN is underscored because surgery is indicated when the FN shows more than 90 % axonal degeneration. The present study proposes including intraoperative monitoring to facilitate decision taking and provide prognostication with more accuracy. This prospective study was conducted on ten patients presenting with complete FN paralysis due to temporal bone fracture. They were referred after variable time intervals for FN exploration and decompression. Intraoperative supramaximal electric stimulation (2-3 mA) of the FN was attempted in all patients both proximal and distal to the site of injury. Postoperative FN function was assessed using House-Brackmann (HB) scale. All patients had follow-up period ranging from 7 to 42 months. Three different patterns of neurophysiological responses were characterized. Responses were recorded proximal and distal to the lesion in five patients (pattern 1); only distal to the lesion in two patients (pattern 2); and neither proximal nor distal to the lesion in three patients (pattern 3). Sporadic, mechanically elicited EMG activity was recorded in eight out of ten patients. Patients with pattern 1 had favorable prognosis with postoperative function ranging between grade I and III. Pattern 3 patients showing no mechanically elicited activity had poor prognosis. Intraoperative monitoring affects decision taking during surgery for traumatic FN paralysis and provides prognostication with sufficient accuracy. The detection of mechanically elicited EMG activity is an additional sign predicting favorable outcome. However, absence of responses did not alter surgeon decision when the nerve was found evidently intact. PMID:24085597

  16. Phrenic nerve paralysis from recurrence of stage I thymoma with myasthenia gravis 10 years after complete resection.

    PubMed

    Ishibashi, Hironori; Takasaki, Chihiro; Okubo, Kenichi

    2015-06-01

    A 34-year-old woman underwent thymo-thymectomy for myasthenia gravis (MG) and was diagnosed with type B3 Masaoka stage I thymoma. Phrenic nerve paralysis developed 8 years after surgery, and a left-sided mediastinal mass was seen on a chest radiograph 10 years after surgery. Chest computed tomography revealed a tumor measuring 57 21 28 mm beside the aortic arch. Surgical resection of the tumor with partial resection of phrenic and recurrent nerve, the left upper lobe, and the pericardium was performed through a left thoracotomy. Histological examination confirmed recurrent thymoma invading the resected surrounding organs. The patient received radiation therapy postoperatively and was alive with stable symptoms of MG at the 2-year follow-up. Symptomatic relapse of thymoma is very rare and an occult recurrent thymoma should be considered in patients with unilateral phrenic nerve paralysis even after complete resection of thymoma. Detailed examination with careful follow-up should be considered. PMID:23949090

  17. Preoperative diagnosis and intraoperative protection of nonrecurrent laryngeal nerve: A review of 5 cases

    PubMed Central

    Wang, Zhihong; Zhang, Hao; Zhang, Ping; He, Liang; Dong, Wenwu

    2014-01-01

    Background Nonrecurrent laryngeal nerve (NRLN) is a risk factor for nerve injury during thyroidectomy or parathyroidectomy. It is usually associated with abnormal vasculature that can be identified by several imaging methods. The aim of this study was to retrospectively analyze the preoperative diagnosis and intraoperative protection of NRLN. Material/Methods Of the 7169 patients who underwent thyroid surgery at our hospital between August 2008 and January 2013, 5 patients with NRLN were identified. Preoperative chest X-rays, neck ultrasonography (US), and computed tomography (CT) findings were reviewed. NRLNs were carefully and systematically searched for in surgery. Results Preoperative CT predicted NRLN in all 5 cases (100% accuracy). The detection rate of NRLN by CT was 0.4% (5/1170). NRLNs were confirmed in surgery. All of them were right-sided NRLN with type IIA variant. The CT scans clearly revealed the vascular anomalies. The review of US images suggested that vascular anomalies could be identified on the images in 1 patient. No postoperative complications occurred in any patient. Conclusions The preoperative CT scan was a reliable and effective method for identifying abnormal vasculature to indirectly predict NRLN. Combining the CT and US findings with adequate surgical technique may help to reduce the risk of nerve damage, in addition to preventing nerve palsy. PMID:24518037

  18. The effect of routine reversal of neuromuscular blockade on adequacy of recurrent laryngeal nerve stimulation during thyroid surgery.

    PubMed

    Marshall, S D; Boden, E; Serpell, J

    2015-07-01

    Testing of the integrity of the recurrent laryngeal nerve during thyroid surgery has become routine practice for many surgeons to aid dissection and minimise the chance of inadvertent nerve injury. We hypothesised that routine reversal of an intermediate-acting, non-depolarising neuromuscular blocking agent would improve conditions for stimulation of the recurrent laryngeal nerve. We conducted a single-centre, randomised, double-blind placebo-controlled trial of patients undergoing thyroid surgery by the same surgeon. After randomisation, the participants received either neostigmine 2.5 mg with glycopyrrolate 0.4 mg or placebo, at 30 minutes after induction of anaesthesia and administration of 0.4 mg/kg of atracurium. The primary outcome was the subjective assessment by the surgeon as to whether the neuromuscular function was adequate for stimulation of the recurrent laryngeal nerve using a neuromuscular integrity monitor (NIM). Time to NIM stimulation was 44.6 minutes in the placebo group and 41.4 minutes in the intervention group (P=0.268). Of the 21 patients who received the neuromuscular blockade reversal, 20 (95.2%) had adequate surgical conditions for NIM stimulation, compared to 9 out of 18 patients (50%) in the placebo group (P=0.002). Three of the ten patients (30%) with inadequate reversal showed no evidence of residual blockade assessed peripherally. The routine reversal of neuromuscular blockade at 30 minutes post induction appears to result in adequate surgical conditions for safe stimulation of the recurrent laryngeal nerve. Return of neuromuscular function at a peripheral site does not guarantee adequate laryngeal muscle function for use of the NIM. PMID:26099761

  19. Post-thyroidectomy dysphonia in patients with bilateral resection of the superior laryngeal nerve: a comparative spectrographic study.

    PubMed

    Neri, G; Castiello, F; Vitullo, F; DE Rosa, M; Ciammetti, G; Croce, A

    2011-08-01

    The most serious complications of total thyroidectomy, in cases of widespread and invasive diseases, are mainly hypoparathyroidism and laryngeal inferior nerve palsy. Lesions of the external branch of superior laryngeal nerve instead, although less obvious than the those caused by the recurrent laryngeal nerve lesions, have been taken less into consideration. The frequency of this lesion varies from 14% to 20% of cases, although in reality it is underestimated; in fact, on the one hand it is difficult to assess this, and on the other, post-thyroidectomy dysphonia is often considered inevitable. In the present retrospective research, 15 thyroidectomized patients (4 male, 11 female), have been subjected to qualitative and quantitative evaluation of the voice. Of these, 7 had a nerve lesion, while 8 did not. All the patients received a self-evaluation voice questionnaire (VHI). In all cases, a videolaryngostroboscopy has been carried out and the voice acoustic features examined through a spectrographic analysis. The results showed that removal of the thyroid, at the end of a 12-month post-surgery period, still causes an impact on the qualitative and quantitative aspects of the vocal function, whether the superior larynx nerve was injured or not. The majority of the patients, in both groups, reported that their voice had worsened in quality and durability. Hence, we have shown that the patients with upper larynx nerve lesion have an alteration of F0, show a lower energy level and a modified spectrographic quality compared to patients without injury. This low voice is often considered by patients as a normal consequence of thyroid surgery. The present research confirms that the attempt to identify and protect the superior laryngeal nerve is essential to prevent post-thyroidectomy dysphonia, but this is not sufficient to obtain the best results because of the existence of muscular and psychogenic factors that reduce the still voice capacity of the patient. PMID:22065652

  20. Neuromuscular electrical stimulation of the cricothyroid muscle in patients with suspected superior laryngeal nerve weakness.

    PubMed

    Guzman, Marco; Rubin, Adam; Cox, Paul; Landini, Fernando; Jackson-Menaldi, Cristina

    2014-03-01

    In this retrospective case study, we report the apparent clinical effectiveness of neuromuscular electrical stimulation (NMES) in combination with voice therapy (VT) for rehabilitating dysphonia secondary to suspected superior laryngeal nerve (SLN) weakness in two female patients. Both patients failed or plateaued with traditional VT but had significant improvement with the addition of NMES of the cricothyroid muscle and SLN using a VitalStim unit. Stimulation was provided simultaneously with voice exercises based on musical phonatory tasks. Both acoustic analysis and endoscopic evaluation demonstrated important improvements after treatment. In the first patient, the major change was obtained within the primo passaggio region; specifically, a decrease in voice breaks was demonstrated. In the second patient, an improvement in voice quality (less breathiness) and vocal range were the most important findings. Additionally, each patient reported a significant improvement in their voice complaints. Neuromuscular laryngeal electrical stimulation in combination with vocal exercises might be a useful tool to improve voice quality in patients with SLN injury. PMID:24315659

  1. An applied anatomical study on the external laryngeal nerve loop and the superior thyroid artery in the neck surgical region.

    PubMed

    Lu, Wei-Tian; Sun, Shan-Quan; Huang, Juan; Zhong, Yuan; Xu, Jin; Gan, Sheng-Wei; Guo, Lu; Mo, Ting-Ting

    2015-09-01

    This study was conducted to investigate the topographic relationship between the external laryngeal nerve (ELN) loop and the superior thyroid artery (STA), in order to provide the anatomical foundations for protecting the ELN during surgery. In the present study, 48 adult human cadavers were dissected and analyzed. For the 21 (21.9%) low-position ELN loops observed, the neurovascular relationship between the STA and the nerve was classified into four types: (1) the artery overlapped the nerve; (2) the artery passed through the ELN loop; (3) the muscular branch of the ELN loop and the laryngeal branch of the STA coursed together; and (4) the branches of the STA and the ELN loop were interlaced. Our study suggested that the patterns of ELN loops are so complicated that they have not been statistically defined in any previous study, which should be kept in mind when attempting to protect the nerve from injury. Also, because of the variable morphology of the ELN loop and its complicated topographic relationship to the STA, the vessels should be individually isolated and then ligated during thyroidectomy. When ligating the laryngeal branch of the STA during larynx surgery, special attention should be paid to avoiding damage to the muscular branch of the ELN/ELN loop. PMID:24985756

  2. Analysis of the Istanbul Forensic Medicine Institute expert decisions on recurrent laryngeal nerve injuries due to thyroidectomy between 2008–2012

    PubMed Central

    Karakaya, M. Arif; Koç, Okay; Ekiz, Feza; Ağaçhan, A. Feran; Göret, Nuri Emrah

    2016-01-01

    Objective: The aim of this study was to evaluate the approach of Forensic Medicine Institution for recurrent laryngeal nerve injuries. In addition, parameters that were taken into consideration by Forensic Medicine Institution in the differentiation of complication and malpractice were evaluated. Material and Methods: The files of 38 patients, with recurrent laryngeal nerve injury following thyroidectomy, that were referred to Istanbul Forensic Medicine Institute with request of expert opinion between 2008–2012 were retrospectively investigated. Data regarding expert decisions, age, gender, diagnosis, hospital type, preoperative vocal cord examination, intraoperative nerve monitoring (IONM), identification of nerve injury during operation, repair of nerve during operation, and type of injury were assessed. Results: Surgeons were found to be faulty in all files with bilateral nerve injury, however, one-sided injury files were considered as a medical complication. Twenty-one (55.2%) patients were female, and 17 (44.8%) were male, with a mean age of 35,8 in women, and 34,1 in men. None of these patients had undergone preoperative vocal cord assessment. The recurrent laryngeal nerve was intraoperatively identified in 21 (55.2%) patients, while it was not seen in 17 (44.8%) patients. IONM was not applied in any patients. There was no attempt for nerve repair during any operation. Nineteen patients had unilateral, and 19 patients had bilateral nerve damage. Conclusion: Bilateral recurrent laryngeal nerve injuries are considered as malpractice, when imaging or pathology reports fail to state a cause for difficulty in nerve identification.

  3. Intraoperative neuromonitoring of the recurrent laryngeal nerve in robotic thyroid surgery.

    PubMed

    Bae, Dong Sik; Kim, Su-jin

    2015-02-01

    This study evaluated the technical feasibility and efficacy of intraoperative neuromonitoring (IONM) of the recurrent laryngeal nerve (RLN) to aid its identification and preservation during robotic thyroidectomy (RoT). IONM of the RLN was evaluated in 30 consecutive patients undergoing RoT. All patients underwent an indirect laryngoscope examination to objectively assess vocal cord function. Their Voice Handicap Index-10 (VHI-10) was measured to subjectively assess vocal cord function preoperatively and at postoperative months 1 and 3. Of the 56 RLNs at risk in 30 patients undergoing RoT, all were visualized and identified by IONM. The IONM sensitivity for postoperative permanent RLN palsy was 100%, with a positive predictive value of 100%. The mean VHI-10 scores preoperatively and at postoperative months 1 and 3 were 0.20±0.66, 3.47±5.04, and 1.53±2.47, respectively (P<0.001). IONM of the RLN during RoT is technically feasible and effective for identifying this nerve. PMID:25238177

  4. The usefulness of preoperative computed tomography and intraoperative neuromonitoring identification of the nonrecurrent inferior laryngeal nerve.

    PubMed

    Cai, Qian; Guan, Zhong; Huang, Xiaoming; Yuan, Jianpeng; Pan, Yong; Zheng, Yiqing; Liang, Maojin; Fan, Shaochong

    2013-07-01

    The objective of this study was to avoid the nonrecurrent inferior laryngeal nerve (NRLN) injury during surgery, we performed preoperative CT examinations to determine the variation in abnormal course of the right subclavian artery as an indictor of the presence of the NRLN and used intraoperative neuromonitoring (IONM) to identify nerve. Preoperative thyroid CT examinations were performed in 783 thyroid surgery patients. The imaging characteristics that suggested the presence of the NRLN were the following: (1) the arteria lusoria arising from the dorsal side of the aortic arch and passing through the trachea and esophagus posteriorly, and the CT image showing the characteristic "hook-like" morphology; (2) that the arteria lusoria imaging could be observed posteriorly to the trachea and esophagus; and (3) that the arteria lusoria traveled transversely from the rear of the right common carotid artery to the right subaxillary region. IONM has been applied to localize and identify NRLN. The brachiocephalic trunk was shown in 779 cases and not in the remaining four cases (0.5 %, 4/783), and these four were assumed to have the arteria lusoria. The separation point and path of the NRLNs were localized and identified precisely with IONM. The NRLN was observed during all surgeries. These four cases did not exhibit hoarseness after surgery. In conclusion, understanding of the course variations of the right subclavian artery using a preoperative CT examination provides an indicator of the presence of a NRLN. Combining these evaluation methods with IONM can avoid NRLN injury. PMID:23269396

  5. Recurrent laryngeal nerve palsy and substernal goiter. An Italian multicenter study.

    PubMed

    Testini, M; Gurrado, A; Bellantone, R; Brazzarola, P; Cortese, R; De Toma, G; Fabiola Franco, I; Lissidini, G; Pio Lombardi, C; Minerva, F; Di Meo, G; Pasculli, A; Piccinni, G; Rosato, L

    2014-06-01

    The aim of this retrospective multicenter study was to verify whether the substernal goiter and the type of surgical access could be risk factors for recurrent laryngeal nerve palsy during total thyroidectomy. Between 1999-2008, 14,993 patients underwent total thyroidectomy. Patients were divided into three groups: group A (control; n=14.200, 94.7%), cervical goiters treated through collar incision; group B (n=743, 5.0%) substernal goiters treated by cervical approach; group C (n=50, 0.3%) in which a manubriotomy was performed. Transient and permanent unilateral palsy occurred significantly more frequently in B+C vs. A (P≤.001) and in B vs. A (P≤.001). Transient bilateral palsy was significantly more frequent in B+C vs. A (P≤.043) and in C vs. A (P≤.016). Permanent bilateral palsy was significantly more frequent in B+C vs. A (P≤.041), and in B vs. A (P≤.037). Extension of the goiter into the mediastinum was associated to increased risk of recurrent nerve palsy during total thyroidectomy. PMID:24880605

  6. Safe distance between electrotome and recurrent laryngeal nerve: an experimental canine model

    PubMed Central

    Jiang, Kewei; Zhu, Yi; Zhou, Gang; Ye, Yingjiang; Xie, Qiwei; Yang, Xiaodong; Wang, Shan

    2015-01-01

    Background: Various energy based surgical devices (ESD) like electrotome have been widely applied in thyroid surgery. This is the first canine model to determine the safety margin of using the electrotome near the recurrent laryngeal nerve (RLN) to prevent injury to this nerve during thyroid surgery. Methods: Eighteen healthy male dogs were divided equally into three groups according to the distance between electrotome application and the RLN: Group A (5 mm), Group B (3 mm), Group C (1 mm). The parameters of evoked electromyography (EEMG) of vocal muscles between right normal RLNs and left RLNs after electrotome application at a power of 30 W for 1 second in each group were recorded and compared. The acute microstructural morphological changes of the RLNs were observed immediately after the operation under electron microscope. Results: In Group B and Group C, after using the electrotome at a vertical distance of 3 mm or 1 mm from the left RLNs, the stimulating thresholds of left RLNs had a significant increase (P = 0.005; P = 0.002) compared with right normal RLNs, and there occurred obvious acute microstructural morphological changes under electron microscope for left RLNs. While there was no significant functional or histological changes for left RLNs after using the electrotome at a vertical distance of 5 mm from the RLN (P = 0.187) in Group A. Conclusions: When using the electrotome near the RLN at a power of 30W in thyroid surgery, a safety margin of more than 3 mm should be recommended. PMID:25785056

  7. Effectively Axonal-supercharged Interpositional Jump-Graft with an Artificial Nerve Conduit for Rat Facial Nerve Paralysis

    PubMed Central

    Niimi, Yosuke; Takeuchi, Yuichi; Sasaki, Ryo; Watanabe, Yorikatsu; Yamato, Masayuki; Miyata, Mariko; Sakurai, Hiroyuki

    2015-01-01

    Background: Interpositional jump graft (IPJG) is a nerve graft axonally supercharged from the hypoglossal nerve. However, for using the technique, an autologous nerve, which should contain the great auricular and sural nerves, must be obtained. Depending on the donor site, unavoidable issues such as nerve disorders and postoperative scarring may appear. To reduce the issues, in this study, the authors developed an end-to-side neurorrhaphy technique with the recipient nerve and an artificial nerve conduit and investigated the efficacy of an IPJG with an artificial nerve conduit in a rat facial nerve paresis model. Methods: A ligature clip was used to crush the facial nerve trunk, thereby creating a partial facial nerve paresis model. An artificial nerve conduit was then prepared with a 10-mm-long silicone tube containing 10 μL type I collagen and used to create an IPJG between the facial nerve trunk and the hypoglossal nerve (the silicone tube group). Thirteen weeks after the surgery, the outcome was histologically and physiologically compared with conventional IPJG with autograft using the great auricular nerve. Results: Retrograde tracer test confirmed a double innervation by the facial and hypoglossal nerve nuclei. In the autograft and silicone tube groups, the regeneration of myelinated axons was observed. Conclusion: In this study, the authors successfully developed an end-to-side neurorrhaphy technique with the recipient nerve and an artificial nerve conduit, and revealed that an IPJG in the conduit was effective in the rat facial nerve paresis model. PMID:26180717

  8. Prevention and treatment of recurrent laryngeal nerve injury in thyroid surgery

    PubMed Central

    Jiang, Yan; Gao, Bo; Zhang, Xiaohua; Zhao, Jianjie; Chen, Jinping; Zhang, Shu; Luo, Donglin

    2014-01-01

    Aim: To summary the experience for prevention and treatment of recurrent laryngeal nerve (RLN) injury in thyroid surgery. Methods: Clinical features of 623 patients who received thyroid surgery from January 2010 to December 2012 were analyzed retrospectively, and the features of RLN injury and intraoperative as well as postoperative treatments were reviewed. Results: RLN injury occurred in 31 patients (4.98%), in which, unilateral RLN injury occurred in 27 patients and bilateral RLN injuries occurred in 4 patients (temporary injury in 28 patients and permanent injury in 3 patients). 6 patients underwent RLN anastomosis during surgery and exhibited transient hoarseness after surgery. RLN exploration and decompression was given in 1 patient and the patient got normal vocal cord motion 2 months after surgery. 1 patient with bilateral injuries received tracheotomy and CO2 laser resection of arytenoid cartilage and achieved recovery 1 year later. Conclusions: In order to prevent RLN injury, the anatomic variations of RLN should be mastered. Routine exposure of RLN can effectively prevent the injury in patients receiving the second or multiple surgeries. Early interventions for RLN injury include mainly early discovery, early exploration and early anastomosis, and the function of RLN in some patients can recover completely. Subsequent treatments mainly focus on the improvement of the voice, expansion of glottis and melioration of dyspnea. PMID:24482694

  9. Migration and differentiation of neural progenitor cells after recurrent laryngeal nerve avulsion in rats.

    PubMed

    Zhao, Wan; Xu, Wen

    2014-01-01

    To investigate migration and differentiation of neural progenitor cells (NPCs) from the ependymal layer to the nucleus ambiguus (NA) after recurrent laryngeal nerve (RLN) avulsion. All of the animals received a CM-DiI injection in the left lateral ventricle. Forty-five adult rats were subjected to a left RLN avulsion injury, and nine rats were used as controls. 5-Bromo-2-deoxyuridine (BrdU) was injected intraperitoneally. Immunohistochemical analyses were performed in the brain stems at different time points after RLN injury. After RLN avulsion, the CM-DiI+ NPCs from the ependymal layer migrated to the lesioned NA. CM-DiI+/GFAP+ astrocytes, CM-DiI+/DCX+ neuroblasts and CM-DiI+/NeuN+ neurons were observed in the migratory stream. However, the ipsilateral NA included only CM-DiI+ astrocytes, not newborn neurons. After RLN avulsion, the NPCs in the ependymal layer of the 4th ventricle or central canal attempt to restore the damaged NA. We first confirm that the migratory stream includes both neurons and glia differentiated from the NPCs. However, only differentiated astrocytes are successfully incorporated into the NA. The presence of both cell types in the migratory process may play a role in repairing RLN injuries. PMID:25202908

  10. Facial nerve paralysis and partial brachial plexopathy after epidural blood patch: a case report and review of the literature

    PubMed Central

    Shahien, Radi; Bowirrat, Abdalla

    2011-01-01

    We report a complication related to epidural analgesia for delivery in a 24- year-old woman who was admitted with mild pre-eclampsia and for induction of labor. At the first postpartum day she developed a postdural puncture headache, which was unresponsive to conservative measures. On the fifth day an epidural blood patch was done, and her headache subsided. Sixteen hours later she developed paralysis of the right facial nerve, which was treated with prednisone. Seven days later she complained of pain in the left arm and the posterior region of the shoulder. She was later admitted and diagnosed with partial brachial plexopathy. PMID:21386953

  11. Cannabinoids facilitate the swallowing reflex elicited by the superior laryngeal nerve stimulation in rats.

    PubMed

    Mostafeezur, Rahman Md; Zakir, Hossain Md; Takatsuji, Hanako; Yamada, Yoshiaki; Yamamura, Kensuke; Kitagawa, Junichi

    2012-01-01

    Cannabinoids have been reported to be involved in affecting various biological functions through binding with cannabinoid receptors type 1 (CB1) and 2 (CB2). The present study was designed to investigate whether swallowing, an essential component of feeding behavior, is modulated after the administration of cannabinoid. The swallowing reflex evoked by the repetitive electrical stimulation of the superior laryngeal nerve in rats was recorded before and after the administration of the cannabinoid receptor agonist, WIN 55-212-2 (WIN), with or without CB1 or CB2 antagonist. The onset latency of the first swallow and the time intervals between swallows were analyzed. The onset latency and the intervals between swallows were shorter after the intravenous administration of WIN, and the strength of effect of WIN was dose-dependent. Although the intravenous administration of CB1 antagonist prior to intravenous administration of WIN blocked the effect of WIN, the administration of CB2 antagonist did not block the effect of WIN. The microinjection of the CB1 receptor antagonist directly into the nucleus tractus solitarius (NTS) prior to intravenous administration of WIN also blocked the effect of WIN. Immunofluorescence histochemistry was conducted to assess the co-localization of CB1 receptor immunoreactivity to glutamic acid decarboxylase 67 (GAD67) or glutamate in the NTS. CB1 receptor was co-localized more with GAD67 than glutamate in the NTS. These findings suggest that cannabinoids facilitate the swallowing reflex via CB1 receptors. Cannabinoids may attenuate the tonic inhibitory effect of GABA (gamma-aminobuteric acid) neurons in the central pattern generator for swallowing. PMID:23209814

  12. Framework Surgery for Treatment of Unilateral Vocal Fold Paralysis

    PubMed Central

    Daniero, James J.; Garrett, C. Gaelyn; Francis, David O.

    2014-01-01

    Laryngeal framework surgery is the current gold standard treatment for unilateral vocal fold paralysis. It provides a permanent solution to glottic insufficiency caused by injury to the recurrent laryngeal nerve. Various modifications to the original Isshiki type I laryngoplasty procedure have been described to improve voice and swallowing outcomes. The success of this procedure is highly dependent on the experience of the surgeon as it epitomizes the intersection of art and science in the field. The following article reviews the evidence, controversies, and complications related to laryngoplasty for unilateral vocal fold paralysis. It also provides a detailed analysis of how and when arytenoid-positioning procedures should be considered, and summarizes the literature on postoperative outcomes. PMID:24883239

  13. Evaluation of greater petrosal nerve function in patients with acute peripheral facial paralysis: comparison of soft palate electrogustometry and Schirmer's tear test.

    PubMed

    Kawamoto, Hidetoshi; Ikeda, Minoru

    2002-01-01

    We tested sensory and secretomotor function of the greater petrosal nerve (GPN) by means of electrogustometry (EGM) of the soft palate and Schirmer's tear test in 115 patients (59 males, 56 females) with acute peripheral facial paralysis. Facial paralysis was caused by Bell's palsy in 78 cases, Ramsay Hunt syndrome in 27 cases and zoster sine herpetic lesions in 10. All patients had dysfunction of the stapedial nerve. An electrogustometer was used to test taste (GPN sensory function), and elevation of the threshold by > 6 dB on the affected side was considered abnormal. Schirmer's test was used to evaluate lacrimal (GPN secretomotor) function, which was considered abnormal when tear secretion on the affected side was < 50% of secretion on the non-affected side. Of the 78 patients with Bell's palsy, 28.2% had altered taste on the soft palate (sensory dysfunction) and 10.3% had lacrimal dysfunction, indicating that EGM of the soft palate is more sensitive than Schirmer's test for identifying dysfunction of the GPN in patients with facial paralysis due to Bell's palsy. Of the total of 115 patients, 32 (28%) had taste dysfunction and 9 (28.1%) of these 32 patients also had lacrimal dysfunction. This finding indicates that facial paralysis has different effects on the sensory and secretory nerve fibers of the GPN. The results of Schirmer's test were more closely related to the severity of, and prognosis for, facial paralysis than the results of EGM. PMID:12132607

  14. [Measurement and clinical using of motor conduction latency time and motor conduction latency rate of facial nerve in health subjects and facial paralysis patients].

    PubMed

    Zhu, J C

    1991-01-01

    The motor conduction latency time (MCLT) and rate (MCLR) of facial nerve in 70 cases of health subjects and 60 cases of facial paralysis patients were measured using evoke EMG. The results showed that MCLT is below 4 ms and MCLR is above 25 m/sec in 70 cases of health subjects, while the MCLT is above 4 ms and MCLR is below 25 m/sec in 60 cases of facial paralysis patients. We have observed the difference of MCLR and MCLR on different age groups in health subjects. The results showed that MCLT is prolonged gradually and MCLR is gradual reduced after 50 years old groups. But the MCLT does not exceed 4 ms and MCLR is not slower than 25 m/sec. The results of this studies suggested that if MCLT is above 4 ms, and MCLR is below 25 m/sec, it is a index of facial nerve paralysis. PMID:2032483

  15. Effect of Paralysis at the Time of ProSeal Laryngeal Mask Airway Insertion on Pharyngolaryngeal Morbidities. A Randomized Trial

    PubMed Central

    Shin, Hyun-Jung; Oh, Ah-Young; Park, Hee-Pyoung; Hwang, Jung-Won

    2015-01-01

    Neuromuscular block results in the loss of muscular tone in the upper airway, which might contribute to the increased postoperative airway morbidity followed by ProSeal laryngeal mask airway (PLMA) insertion. We compared the pharyngolaryngeal discomfort exerted by the PLMA according to the neuromuscular block. One hundred sixty patients undergoing surgery for breast disease or inguinal hernia were anesthetized with propofol and remifentanil by target controlled infusion. Rocuronium 0.6 mg/kg (NMBA group, n = 80) or normal saline (No-NMBA group, n = 80) was administered after the loss of consciousness, and one anesthesiologist inserted the PLMA. Postoperative pharyngolaryngeal discomfort was evaluated at postoperative 1 h. Traumatic event was recorded based on the blood trace on the surface of the PLMA cuff. Insertion time, insertion attempt number, sealing pressure, and fiberoptic brochoscopic grades were evaluated. Patients’ characteristics and the PLMA insertion condition (insertion time, successful insertion attempt number, fiberoptic bronchoscopic grade, and sealing pressure) were similar between the two groups. The PLMA can be successfully inserted in non-paralyzed patients with less postoperative pharyngolaryngeal discomfort than when a neuromuscular blocking agent is used (13.8% vs. 30.0%, P = 0.021). The incidence of traumatic events is also reduced when no neuromuscular blocking agent is used (16.3% vs. 32.5%, P = 0.026). Regardless of whether or not a surgical procedure requires muscular relaxation, there is no need to administer neuromuscular blocking agents solely for the purpose of PLMA insertion. Trial Registration ClinicalTrials.gov NCT01035021 PMID:26252522

  16. Intraoperative neuromonitoring of the external branch of the superior laryngeal nerve during robotic thyroid surgery: a preliminary prospective study

    PubMed Central

    Kim, Su-jin; Oh, Byung-Mo; Oh, Eun Mee; Bae, Dong Sik; Choi, June Young; Myong, Jun Pyo; Youn, Yeo-Kyu

    2015-01-01

    Purpose The aim of this study was to evaluate the feasibility of monitoring external branch of the superior laryngeal nerve (EBSLN) during robotic thyroid surgery. Methods A total of 10 patients undergoing bilateral axillo-breast approach (BABA) robotic thyroid surgery were enrolled. The nerve integrity monitor (NIM Response 2.0 System) was used for EBSLN monitoring. We performed voice assessments preoperatively and at 1 and 3 months postoperatively using Voice Handicap Index-10 (VHI-10), maximal phonation time (MPT), phonation efficient index (PEI), and laryngeal electromyography (EMG). Results A total of 19 EBSLNs were at risk and 14 EBSLNs (73.7%) were identified using neuromonitoring. VHI-10 showed a change of voice over time (0.1 vs. 3.6 vs. 1.3); however, this was not statistically significant. VHI-10 scores normalized at 3 months postoperatively compared to the preoperative scores. MPT (a) (16.0 vs. 15.6 vs. 15.4), and MPT (e) (20.1 vs. 15.4 vs. 18.5) showed no significant differences preoperatively compared to the values obtained 1 and 3 months postoperatively. There was a significant change of PEI over time (4.8 vs. 1.1 vs. 4.6) (P = 0.036); however, the values normalized at 3 months postoperatively. Laryngeal EMG results showed 4 cases (21.2%) of neuropathy of EBSLNs at 1 month postoperatively, and electrodiagnostic studies revealed nearly complete recovery of the function of EBSLNs in 4 patients at 3 months postoperatively Conclusion It is suggested that neuromonitoring of EBSLNs during BABA robotic thyroid surgery is feasible and might be helpful to preserve voice quality. PMID:26576402

  17. Initial assessment of facial nerve paralysis based on motion analysis using an optical flow method.

    PubMed

    Samsudin, Wan Syahirah W; Sundaraj, Kenneth; Ahmad, Amirozi; Salleh, Hasriah

    2016-03-14

    An initial assessment method that can classify as well as categorize the severity of paralysis into one of six levels according to the House-Brackmann (HB) system based on facial landmarks motion using an Optical Flow (OF) algorithm is proposed. The desired landmarks were obtained from the video recordings of 5 normal and 3 Bell's Palsy subjects and tracked using the Kanade-Lucas-Tomasi (KLT) method. A new scoring system based on the motion analysis using area measurement is proposed. This scoring system uses the individual scores from the facial exercises and grades the paralysis based on the HB system. The proposed method has obtained promising results and may play a pivotal role towards improved rehabilitation programs for patients. PMID:26578273

  18. Sensory regulation of swallowing and airway protection: a role for the internal superior laryngeal nerve in humans

    PubMed Central

    Jafari, Samah; Prince, Rebecca A; Kim, Daniel Y; Paydarfar, David

    2003-01-01

    During swallowing, the airway is protected from aspiration of ingested material by brief closure of the larynx and cessation of breathing. Mechanoreceptors innervated by the internal branch of the superior laryngeal nerve (ISLN) are activated by swallowing, and connect to central neurones that generate swallowing, laryngeal closure and respiratory rhythm. This study was designed to evaluate the hypothesis that the ISLN afferent signal is necessary for normal deglutition and airway protection in humans. In 21 healthy adults, we recorded submental electromyograms, videofluoroscopic images of the upper airway, oronasal airflow and respiratory inductance plethysmography. In six subjects we also recorded pressures in the hypopharynx and upper oesophagus. We analysed swallows that followed a brief infusion (45 ml) of liquid barium onto the tongue, or a sip (118 ml) from a cup. In 16 subjects, the ISLN was anaesthetised by transcutaneous injection of bupivacaine into the paraglottic compartment. Saline injections using the identical procedure were performed in six subjects. Endoscopy was used to evaluate upper airway anatomy, to confirm ISLN anaesthesia, and to visualise vocal cord movement and laryngeal closure. Comparisons of swallowing and breathing were made within subjects (anaesthetic or saline injection vs. control, i.e. no injection) and between subjects (anaesthetic injection vs. saline injection). In the non-anaesthetised condition (saline injection, 174 swallows in six subjects; no injection, 522 swallows in 20 subjects), laryngeal penetration during swallowing was rare (1.4 %) and tracheal aspiration was never observed. During ISLN anaesthesia (16 subjects, 396 swallows), all subjects experienced effortful swallowing and an illusory globus sensation in the throat, and 15 subjects exhibited penetration of fluid into the larynx during swallowing. The incidence of laryngeal penetration in the anaesthetised condition was 43 % (P < 0.01, compared with either saline or no injection) and of these penetrations, 56 % led to tracheal aspiration (without adverse effects). We further analysed the swallow cycle to evaluate the mechanism(s) by which fluid entered the larynx. Laryngeal penetration was not caused by premature spillage of oral fluid into the hypopharynx, delayed clearance of fluid from the hypopharynx, or excessive hypopharyngeal pressure generated by swallowing. Furthermore, there was no impairment in the ability of swallowing to halt respiratory airflow during the period of pharyngeal bolus flow. Rather, our observations suggest that loss of airway protection was due to incomplete closure of the larynx during the pharyngeal phase of swallowing. In contrast to the insufficient closure during swallowing, laryngeal closure was robust during voluntary challenges with the Valsalva, Mller and cough manoeuvres under ISLN anaesthesia. We suggest that an afferent signal arising from the ISLN receptor field is necessary for normal deglutition, especially for providing feedback to central neural circuits that facilitate laryngeal closure during swallowing. The ISLN afferent signal is not essential for initiating and sequencing the swallow cycle, for co-ordinating swallowing with breathing, or for closing the larynx during voluntary manoeuvres. PMID:12754311

  19. [Lymphadenectomy performed along the left recurrent laryngeal nerve after anterior detachment of the esophagus via thoracoscopic esophagectomy in the prone position under artificial pneumothorax].

    PubMed

    Yamamoto, Shinichi; Ohshima, Hisami; Katsumori, Takashi; Hamaguchi, Hiromitsu; Tsukamoto, Yukika; Iwanaga, Tomohiro

    2014-11-01

    Thoracoscopic esophagectomy was performed in the prone position under artificial pneumothorax and did not affect the surgical area during lung ventilation; tracheal mobility was also improved. Lymphadenectomy around the left recurrent laryngeal nerve was performed by separating the left main bronchus and trachea between the esophagus and pericardium before detaching the dorsal side of the esophagus. PMID:25731225

  20. Diagnosis and management with botulinum toxin in 11 cases of laryngeal synkinesis.

    PubMed

    Lekue, Asier; Garca-Lpez, Isabel; Santiago, Susana; Del Palacio, Antonio; Gaviln, Javier

    2015-09-01

    Laryngeal synkinesis is a vocal fold movement disorder produced by a misdirected reinnervation after a recurrent laryngeal nerve injury. Its symptoms differ greatly between patients, requiring diverse therapeutical approaches. We aim to describe our experience in the diagnosis and treatment of different laryngeal synkinesis presentations. 11 patients diagnosed between 2011 and 2014 in a tertiary referral center with laryngeal synkinesis confirmed by laryngeal electromyography were included in our study. All medical records and laryngoscopic and electromyographic data were reviewed retrospectively. Four patients had previous unilateral vocal fold palsy and seven had a bilateral palsy with different degrees of clinical involvement. All of them showed paradoxical movements during inhalation in videofibrolaryngoscopic examination. Laryngeal electromyography confirmed the diagnosis of laryngeal synkinesis. Dyspnea was the main presentation symptom. Three patients with mild symptoms were not treated. Patients with unilateral vocal fold immobility were successfully treated with periodic botulinum toxin injections. Patients with bilateral immobility had a good initial response to botulinum toxin, although in some of them, a posterior cordectomy had to be finally performed. In conclusion, laryngeal synkinesis is a heterogeneous clinic entity that appears in patients with unilateral or bilateral vocal fold paralysis. Videofibrolaryngoscopy and laryngeal electromyography are essential to a correct diagnosis. Botulinum toxin injections are the main treatment for symptomatic cases, even if in bilateral palsy cases more aggressive treatments are often required. PMID:25911949

  1. Pelagic paralysis.

    PubMed

    Mills, A R; Passmore, R

    1988-01-23

    Three conditions that may occur after consumption of seafood--puffer fish poisoning, ciguatera, and paralytic shellfish poisoning--are caused by a group of poisons that block voltage-gated sodium channels in myelinated and non-myelinated nerves. The conditions cannot be distinguished clinically and so constitute an entity for which the name pelagic paralysis is proposed. Variations in the clinical features can be accounted for by large differences in the amount of toxin present in the seafood. PMID:2892995

  2. [Acoustic study of sustained vowels made by patients with recurrent nerve paralysis after thyroidectomy].

    PubMed

    Fauth, C; Vaxelaire, B; Rodier, J F; Volkmar, P P; Sock, R

    2012-01-01

    The objective of this work is to evaluate the consequences of thyroid surgery on the voice of patients suffering from recurrent paralysis. The consequences of the surgery are evaluated using a corpus of sustained vowels in order to identify the various disruptions that this procedure may produce. This research also looks for possible compensatory and/or readjustment strategies that can be used by a patient alone and with the help of speech therapy. Acoustic measurements considered are fundamental frequency (F0), Harmonics-to-Noise Ratio (HNR), and vowel space area. This is a longitudinal study, as all patients are recorded once a month during three months after surgery. Results reveal a modification of all parameters in the early recording stages. However, time and speech therapy contribute to obtaining expected values of the measured parameters, and thus to improvement of vocal quality. PMID:23074822

  3. Similarities in the surface area/volume ratio in the fibers of the recurrent laryngeal nerve can explain the symmetry in the vocal fold mobility?

    PubMed

    de Campos, Deivis; Xavier, Lder Leal; Goulart, Guilherme Reghelin; Thomaz, Leonardo Dalla Giacomassa Rocha; Malysz, Tais; Jotz, Geraldo Pereira

    2015-12-01

    We demonstrate in this paper that although there are statistical differences for all morphometric data [axon length, axon diameter, myelinated fiber diameter and degree of the myelination (g-Ratio)] between the fibers of recurrent laryngeal nerve right and left, the surface area/volume ratio in the fibers of both nerves is exactly the same (1/1.7). Thereby, this paper presents the hypothesis that this similarity between the nerves can actually trigger a considerable synchrony in mobility of the intrinsic muscles of the larynx that control of the vocal folds. PMID:26362729

  4. Vocal Fold Paralysis

    MedlinePLUS

    ... elastic bands of muscle tissue located in the larynx (voice box) directly above the trachea (windpipe) (see ... the electrical impulses of the nerves in the larynx, to better understand the areas of paralysis. How ...

  5. Rare laryngeal anomaly or spontaneously drained bilateral saccular cyst?

    PubMed

    Bajin, Mnir Demir; Y?lmaz, Taner; Yilmaz, Gonca

    2011-05-01

    Laryngeal malformations are usually present at birth. Common anomalies include laryngomalacia, vocal fold paralysis, and subglottic stenosis; less common are congenital saccular cysts, laryngeal webs and atresias, and laryngeal lymphangiomas. Symptoms may range from stridor and hoarseness to respiratory distress. In some cases, patients are asymptomatic. Here, we present a case with abnormal laryngeal ventricles. PMID:20189349

  6. Facial nerve paralysis: A case report of rare complication in uncontrolled diabetic patient with mucormycosis

    PubMed Central

    Shekar, Vandana; Sikander, Jeelani; Rangdhol, Vishwanath; Naidu, Madhulika

    2015-01-01

    Mucormycosis is a rare opportunistic aggressive and fatal infection caused by mucor fungus. Seven types of mucormycosis are identified based on the extension and involvement of the lesion, of which the rhino orbital mucormycosis is most common in the head and neck region. Although it is widely spread in nature, clinical cases are rare and observed only in immunocompromised patients and patients with uncontrolled diabetes mellitus. Early symptoms include fever, nasal ulceration or necrosis, periorbital edema or facial swelling, paresthesia and reduced vision. Involvement of cranial nerves although not common, facial nerve palsy is a rare finding. The infection may spread through cribriform plate to the brain resulting in extensive cerebellar infarctions. Timely diagnosis and early recognition of the signs and symptoms, correction of underlying medical disorders, and aggressive medical and surgical intervention are necessary for successful therapeutic outcome. PMID:25810669

  7. Cross-face nerve grafting for reanimation of incomplete facial paralysis: quantitative outcomes using the FACIAL CLIMA system and patient satisfaction.

    PubMed

    Hontanilla, Bernardo; Marre, Diego; Cabello, Alvaro

    2014-01-01

    Although in most cases Bell palsy resolves spontaneously, approximately one-third of patients will present sequela including facial synkinesis and paresis. Currently, the techniques available for reanimation of these patients include hypoglossal nerve transposition, free muscle transfer, and cross-face nerve grafting (CFNG). Between December 2008 and March 2012, eight patients with incomplete unilateral facial paralysis were reanimated with two-stage CFNG. Gender, age at surgery, etiology of paralysis denervation time, donor and recipient nerves, presence of facial synkinesis, and follow-up were registered. Commissural excursion and velocity and patient satisfaction were evaluated with the FACIAL CLIMA and a questionnaire, respectively. Mean age at surgery was 33.8 11.5 years; mean time of denervation was 96.6 109.8 months. No complications requiring surgery were registered. Follow-up period ranged from 7 to 33 months with a mean of 19 9.7 months. FACIAL CLIMA showed improvement of both commissural excursion and velocity greater than 75% in 4 patients, greater than 50% in 2 patients, and less than 50% in the remaining two patients. Qualitative evaluation revealed a high grade of satisfaction in six patients (75%). Two-stage CFNG is a reliable technique for reanimation of incomplete facial paralysis with a high grade of patient satisfaction. PMID:23818253

  8. Secondary hyperkalaemic paralysis

    PubMed Central

    Evers, S.; Engelien, A.; Karsch, V.; Hund, M.

    1998-01-01

    Besides the hereditary hyperkalaemic paralysis, a secondary form exists which often mimicks Guillain-Barre syndrome. A 62year old patient is reported on who developed severe hyperkalaemic paralysis on the basis of mild renal failure and additive spironolactone intake. Neurophysiological examinations disclosed normal muscle fibre activity but delayed nerve conduction velocities indicating that the mechanism underlying secondary hyperkalaemic paralysis is different from channelopathies. Haemodialysis led to complete recovery. Review of the medical literature showed that spironolactone intake is the most common cause of secondary hyperkalaemic paralysis. Typical symptoms are flaccid tetraplegia sparing the cranial nerves with only mild or lacking sensory impairment. Symptoms promptly resolve after haemodialysis or after glucose and insulin infusion. Only three out of 18 patients reviewed died, because of cardiopulmonary complications. Thus the prognosis of secondary hyperkalaemic paralysis is good.?? PMID:9489541

  9. Use of steroids for facial nerve paralysis after parotidectomy: A systematic review

    PubMed Central

    Varadharajan, Kiran; Beegun, Issa; Daly, Niall

    2015-01-01

    AIM: To systematically review the literature to assess the efficacy of corticosteroids in treating post-parotidectomy facial nerve palsy (FNP). METHODS: We searched the Cochrane library, EMBASE and MEDLINE (from inception to 2014) for studies assessing the use of corticosteroids in post-parotidectomy FNP. Studies were assessed for inclusion and quality. Data was extracted from included studies. RESULTS: Two randomised controlled trials met the inclusion criteria. One study assessed the use of dexamethasone and the other prednisolone. None of the studies demonstrated a significant difference in the outcome of FNP post-parotidectomy with the use of corticosteroids vs no therapy. The majority of FNP post-parotidectomy is transient. Preoperative factors (size of tumour and malignancy), intraoperative factors (extent of parotidectomy and integrity of facial nerve at the end of the operation) are important in determining prognosis of FNP if it does occur. CONCLUSION: Corticosteroids do not appear to improve FNP prognosis post-parotidectomy. Further studies assessing patients by cohort and with long term follow-up are required to increase scientific evidence. PMID:25685765

  10. Vesalius on the anatomy and function of the recurrent laryngeal nerves: medical illustration and reintroduction of a physiological demonstration from Galen.

    PubMed

    Lanska, Douglas J

    2014-01-01

    The purpose of this article is to review the anatomical illustrations and physiological demonstrations of sixteenth-century Flemish-born anatomist and physician Andreas Vesalius concerning the recurrent laryngeal nerves. Although Vesalius was primarily an anatomist, he also used vivisection as a pedagogical device to help his students understand the function of structures within the fabric of the body that they had previously studied in anatomical detail. Vesalius's masterwork, De humani corporis fabrica or simply the Fabrica (1543, 1555), was ostensibly an anatomy text, but Vesalius included textual and figural references to his use of vivisection to explicate the function of specific structures. Even as he began to criticize the errors in Galen's anatomical works, Vesalius nevertheless adopted some of Galen's classic physiological demonstrations, in particular the ligation (and subsequent release) of the recurrent laryngeal nerves of a pig to demonstrate their role in generating the pig's squeal. Vesalius's illustrations concerning the recurrent laryngeal nerve in the Fabrica were of two types: elegant anatomical woodcut plates-unsurpassed for their clarity, accuracy, and detail - and the distinctly inelegant historiated initial Q, depicting a throng of putti busily engaged in vivisecting a pig. Vesalius' anatomical plates were heavily plagiarized while the historiated initials, showing the rough work of an anatomist or surgeon, were largely ignored and remain little recognized today. While Vesalius' anatomical illustrations of the recurrent laryngeal nerves contained some errors, they were a dramatic departure from prior meager efforts at medical illustration and indeed far surpassed all contemporary published illustrations by others. Vesalius was also influential in reviving Galen's approach to vivisection, at least for pedagogical purposes, if not really then yet as a full-fledged investigative technique. PMID:24870272

  11. Combined spinal/general anesthesia with postoperative femoral nerve block for total knee replacement in a patient with familial hyperkalemic periodic paralysis: a case report.

    PubMed

    Barker, Maria C

    2010-06-01

    Familial hyperkalemic periodic paralysis (HYPP) is a rare genetic disorder in which the sodium channels in skeletal muscle cells have altered structure and function. Small elevations in serum potassium lead to inactivation of sodium channels, causing episodic weakness or paralysis. Exposure to cold, anesthesia, fasting, emotional stress, potassium ingestion, and rest after exercise can stimulate an attack. This case report describes a 65-year-old man with HYPP who was admitted for a right total knee arthroplasty. He had a history of arteriosclerotic heart disease and stenting 8 years earlier, previous inferior wall myocardial infarction with ejection fraction of 65%, anxiety, degenerative joint disease, well-controlled type 2 diabetes mellitus, and a body mass index of 53.3 kg/m2. A combined spinal/general anesthetic with a femoral nerve block for postoperative pain control was chosen. Careful attention was given to monitoring and maintenance of core temperature, use of insulin and glucose to maintain normokalemia, and carbohydrate loading the night before surgery. The patient recovered from the anesthetic without complication and had pain relief for approximately 22 hours postoperatively because of the femoral nerve block. The patient was without weakness or paralysis related to HYPP in the postanesthesia care unit or throughout his hospitalization. PMID:20572404

  12. Residual Chemoresponsiveness to Acids in the Superior Laryngeal Nerve in “Taste-Blind” (P2X2/P2X3 Double-KO) Mice

    PubMed Central

    Ohkuri, Tadahiro; Horio, Nao; Stratford, Jennifer M.; Finger, Thomas E.; Ninomiya, Yuzo

    2012-01-01

    Mice lacking both the P2X2 and the P2X3 purinergic receptors (P2X-dblKO) exhibit loss of responses to all taste qualities in the taste nerves innervating the tongue. Similarly, these mice exhibit a near total loss of taste-related behaviors in brief access tests except for a near-normal avoidance of acidic stimuli. This persistent avoidance of acids despite the loss of gustatory neural responses to sour was postulated to be due to continued responsiveness of the superior laryngeal (SL) nerve. However, chemoresponses of the larynx are attributable both to taste buds and to free nerve endings. In order to test whether the SL nerve of P2X-dblKO mice remains responsive to acids but not to other tastants, we recorded responses from the SL nerve in wild-type (WT) and P2X-dblKO mice. WT mice showed substantial SL responses to monosodium glutamate, sucrose, urea, and denatonium—all of which were essentially absent in P2X-dblKO animals. In contrast, the SL nerve of P2X-dblKO mice exhibited near-normal responses to citric acid (50 mM) although responsiveness of both the chorda tympani and the glossopharyngeal nerves to this stimulus were absent or greatly reduced. These results are consistent with the hypothesis that the residual avoidance of acidic solutions by P2X-dblKO mice may be attributable to the direct chemosensitivity of nerve fibers innervating the laryngeal epithelium and not to taste. PMID:22362867

  13. [Differential diagnosis of unilateral paresis and paralysis of the larynx].

    PubMed

    Chernobel'ski?, S I

    1996-01-01

    Differential diagnosis of laryngeal paresis and paralysis using electron glottography (EGG) was tried in 57 patients and 30 healthy controls. Measurements were made of speed quotient (SQ) and open quotient (OQ) at piano and forte. It was found that in patients and controls SQ and OQ were not similar. SQ and OQ differed also in paralysis and paresis. Tonicity of the inner laryngeal muscles seems to decline more in paralysis than in paresis. Aerodynamic properties of the larynx are damaged more in paralysis and remain unchanged in paresis. Reduced SQ and high OQ at forte indicate unilateral laryngeal paralysis. OQ should be measured both at piano and forte. Thus, EGG is an effective procedure for differential diagnosis of laryngeal paralysis and paresis. It is especially convenient when laryngostroboscopy is problematic. PMID:8711839

  14. Electrophysiologic recurrent laryngeal nerve monitoring during thyroid and parathyroid surgery: international standards guideline statement.

    PubMed

    Randolph, Gregory W; Dralle, Henning; Abdullah, Hisham; Barczynski, Marcin; Bellantone, Rocco; Brauckhoff, Michael; Carnaille, Bruno; Cherenko, Sergii; Chiang, Fen-Yu; Dionigi, Gianlorenzo; Finck, Camille; Hartl, Dana; Kamani, Dipti; Lorenz, Kerstin; Miccolli, Paolo; Mihai, Radu; Miyauchi, Akira; Orloff, Lisa; Perrier, Nancy; Poveda, Manuel Duran; Romanchishen, Anatoly; Serpell, Jonathan; Sitges-Serra, Antonio; Sloan, Tod; Van Slycke, Sam; Snyder, Samuel; Takami, Hiroshi; Volpi, Erivelto; Woodson, Gayle

    2011-01-01

    Intraoperative neural monitoring (IONM) during thyroid and parathyroid surgery has gained widespread acceptance as an adjunct to the gold standard of visual nerve identification. Despite the increasing use of IONM, review of the literature and clinical experience confirms there is little uniformity in application of and results from nerve monitoring across different centers. We provide a review of the literature and cumulative experience of the multidisciplinary International Neural Monitoring Study Group with IONM spanning nearly 15 years. The study group focused its initial work on formulation of standards in IONM as it relates to important areas: 1) standards of equipment setup/endotracheal tube placement and 2) standards of loss of signal evaluation/intraoperative problem-solving algorithm. The use of standardized methods and reporting will provide greater uniformity in application of IONM. In addition, this report clarifies the limitations of IONM and helps identify areas where additional research is necessary. This guideline is, at its forefront, quality driven; it is intended to improve the quality of neural monitoring, to translate the best available evidence into clinical practice to promote best practices. We hope this work will minimize inappropriate variations in monitoring rather than to dictate practice options. PMID:21181860

  15. Unilateral Superior Laryngeal Nerve Lesion in an Animal Model of Dysphagia and Its Effect on Sucking and Swallowing

    PubMed Central

    Campbell-Malone, Regina; Holman, Shaina D.; Lukasik, Stacey L.; Fukuhara, Takako; Gierbolini-Norat, Estela M.; Thexton, Allan J.; German, Rebecca Z.

    2013-01-01

    We tested two hypotheses relating to the sensory deficit that follows a unilateral superior laryngeal nerve (SLN) lesion in an infant animal model. We hypothesized that it would result in (1) a higher incidence of aspiration and (2) temporal changes in sucking and swallowing. We ligated the right-side SLN in six 23-week-old female pigs. Using videofluoroscopy, we recorded swallows in the same pre- and post-lesion infant pigs. We analyzed the incidence of aspiration and the duration and latency of suck and swallow cycles. After unilateral SLN lesioning, the incidence of silent aspiration during swallowing increased from 0.7 to 41.5 %. The durations of the suck containing the swallow, the suck immediately following the swallow, and the swallow itself were significantly longer in the post-lesion swallows, although the suck prior to the swallow was not different. The interval between the start of the suck containing a swallow and the subsequent epiglottal movement was longer in the post-lesion swallows. The number of sucks between swallows was significantly greater in post-lesion swallows compared to pre-lesion swallows. Unilateral SLN lesion increased the incidence of aspiration and changed the temporal relationships between sucking and swallowing. The longer transit time and the temporal coordinative dysfunction between suck and swallow cycles may contribute to aspiration. These results suggest that swallow dysfunction and silent aspiration are common and potentially overlooked sequelae of unilateral SLN injury. This validated animal model of aspiration has the potential for further dysphagia studies. PMID:23417250

  16. Application of Endobronchial Ultrasonography for the Preoperative Detecting Recurrent Laryngeal Nerve Lymph Node Metastasis of Esophageal Cancer

    PubMed Central

    Shan, Hong-Bo; Zhang, Rong; Li, Yin; Gao, Xiao-Yan; Lin, Shi-Yong; Luo, Guang-Yu; Li, Jian-Jun; Xu, Guo-Liang

    2015-01-01

    Background The preoperative detection of recurrent laryngeal nerve lymph node (RLN LN) metastasis provides important information for the treatment of esophageal cancer. We investigated the possibility of applying endobronchial ultrasonography (EBUS) with conventional preoperative endoscopic ultrasonography (EUS) and computerized tomography (CT) examination to evaluate RLN LN metastasis in patients with esophageal cancer. Methods A total of 115 patients with advanced thoracic esophageal cancer underwent EBUS examinations. Patients also underwent EUS and CT imaging as reference diagnostic methods. Positron emission tomography /computed tomography (PET/CT) was also introduced in partial patients as reference method. The preoperative evaluation of RLN LN metastasis was compared with the surgical and pathological staging in 94 patients who underwent radical surgery. Results The sensitivities of the preoperative evaluations of RLN LN metastasis by EBUS, EUS and CT were 67.6%, 32.4% and 29.4%, respectively. The sensitivity of EBUS was significantly different from that of EUS or CT, especially in the detection of right RLN LNs. In addition, according to the extra data from reference method, PET/CT was not superior to EBUS or EUS in detecting RLN LN metastasis. Among all 115 patients, 21 patients who were diagnosed with tracheal invasions by EUS or EBUS avoided radical surgery. Another 94 patients who were diagnosed as negative for tracheobronchial tree invasion by EUS and EBUS had no positive findings in radical surgery. Conclusions EBUS can enhance the preoperative sensitivity of the detection of RLN LN metastasis in cases of thoracic esophageal cancer and is a useful complementary examination to conventional preoperative EUS and CT, which can alert thoracic surgeons to the possibility of a greater range of preoperative lymph node dissection. EBUS may also indicate tracheal invasion in cases of esophageal stricture. PMID:26372339

  17. Central orexin inhibits reflex swallowing elicited by the superior laryngeal nerve via caudal brainstem in the rat.

    PubMed

    Kobashi, Motoi; Mizutani, Satoshi; Fujita, Masako; Mitoh, Yoshihiro; Shimatani, Yuichi; Matsuo, Ryuji

    2014-05-10

    We examined the effects of orexins on the reflex swallowing using anesthetized rats. Orexins were administered into the fourth ventricle. Swallowing was induced by repeated electrical stimulation of the central cut end of the superior laryngeal nerve (SLN) and was identified by the electromyogram lead penetrated the mylohyoid muscle through bipolar electrodes. The frequency of swallowing during the electrical stimulation of the SLN decreased after the administration of orexin-A in a dose-dependent manner. The latency of the first swallowing tended to be extended after the administration of orexin-A. The administration of orexin-B did not affect swallowing frequency. Pre-administration of SB334867, an orexin-1 receptor antagonist, attenuated the degree of inhibition of swallowing frequency induced by the administration of orexin-A. To identify the effective site of orexin-A, the effect of a microinjection of orexin-A into the dorsal vagal complex (DVC) was evaluated. Orexin-A was injected into one of the lateral DVC, the intermediate DVC, or the medial DVC. Microinjection of orexin-A into the medial DVC but not the other two sites decreased swallowing frequency. Pre-injection of SB334867 into the medial DVC disrupted the inhibitory response induced by fourth ventricular administration of orexin-A. The electrical lesion of the commissural part of the NTS, but not ablation of the AP, abolished the inhibition of reflex swallowing induced by fourth ventricular administration of orexin-A. These results suggest that orexin-A inhibits reflex swallowing via orexin-1 receptors situated in the commissural part of the NTS and/or its vicinity. PMID:24637063

  18. A novel method for lymphadenectomy along the left laryngeal recurrent nerve during thoracoscopic esophagectomy for esophageal carcinoma

    PubMed Central

    Xi, Yong; Ma, Zhenkai; Shen, Yaxing; Wang, Hao; Feng, Mingxiang; Wang, Qun

    2016-01-01

    Background Due to limited space in the left upper mediastinum, complete dissection of lymph nodes (LN) along left recurrent laryngeal nerve (RLN) is difficult. We herein present a novel method for lymphadenectomy along the left RLN during thoracoscopic esophagectomy in the semi-prone position for esophageal carcinoma. The method, suspension the esophagus and push aside trachea, allows en bloc lymphadenectomy along the left RLN from the below aortic arch to the thoracic inlet. Methods Between September 2014 and September 2015, a total of 110 consecutive patients with esophageal carcinoma were treated with thoraco-laparoscopic esophagectomy with cervical anastomosis in the semi-prone position. Outcomes between those who received surgery with the novel method and conventional surgery were compared. Results Fifty patients underwent the novel method and sixty received conventional surgery. The operative field around the left RLN was easier to explore with the novel method. The estimated blood loss was less (23.78.2 vs. 34.210.3 g, P=0.001), and the number of harvested LNs along the left RLN was greater (6.43.2 vs. 4.12.8 min, P=0.028) in the novel method group, while the duration of lymphadenectomy along left RLN was longer in the novel method group (28.23.9 vs. 20.32.8 min, P=0.005). The rate of hoarseness in the novel and conventional groups was 10% and 16.7%, respectively. No significant difference in postoperative morbidity related to the left RLN was noted between the groups. Conclusions The novel method during semi-prone esophagectomy for esophageal carcinoma is associated with better surgeon ergonomics and operative exposure. PMID:26904208

  19. The role of transient receptor potential vanilloid-1 on neural responses to acids by the chorda tympani, glossopharyngeal and superior laryngeal nerves in mice.

    PubMed

    Arai, T; Ohkuri, T; Yasumatsu, K; Kaga, T; Ninomiya, Y

    2010-02-17

    The transient receptor potential vanilloid-1 (TRPV1) receptor acts as a polymodal nociceptor activated by capsaicin, heat, and acid. TRPV1, which is expressed in sensory neurons innervating the oral cavity, is associated with an oral burning sensation in response to spicy food containing capsaicin. However, little is known about the involvement of TRPV1 in responses to acid stimuli in either the gustatory system or the general somatosensory innervation of the oropharynx. To test this possibility, we recorded electrophysiological responses to several acids (acetic acid, citric acid and HCl) and other taste stimuli from the mouse chorda tympani, glossopharyngeal and superior laryngeal nerves, and compared potential effects of iodo-resiniferatoxin (I-RTX), a potent TRPV1 antagonist, on chemical responses of the three nerves. The results indicated that in the chorda tympani nerve, I-RTX (1-100 nM) did not affect responses to acids, sucrose and quinine HCl, but reduced responses to NaCl (I-RTX at concentrations of 10 and 100 nM) and KCl and NH(4)Cl (100 nM). In contrast, in the glossopharyngeal nerve, I-RTX significantly suppressed responses to all acids and salts, but not to sucrose and quinine HCl. Responses to acetic acid were suppressed by I-RTX even at 0.1 nM concentration. The superior laryngeal nerve responded in a concentration-dependent manner to acetic acid, citric acid, HCl, KCl, NH(4)Cl and monosodium l-glutamate. The responses to acetic acid, but not to the other stimuli, were significantly inhibited by I-RTX. These results suggested that TRPV1 may be involved in the mechanism for responses to acids presented to the posterior oral cavity and larynx. This high degree of responsiveness to acetic acid may account for the oral burning sensation, known as a flavor characteristic of vinegar. PMID:19958811

  20. Facial paralysis

    MedlinePLUS

    ... otherwise healthy, facial paralysis is often due to Bell palsy . This is a condition in which the ... speech, or occupational therapist. If facial paralysis from Bell palsy lasts for more than 6 to 12 ...

  1. Laryngeal nerve damage

    MedlinePLUS

    ... in some cases. If surgery is needed, the goal is to change the position of the paralyzed ... Lai SY, Mandel SJ, Weber RS. Management of thyroid neoplasms. In: ... Otolaryngology: Head & Neck Surgery. 5th ed. Philadelphia, PA: ...

  2. Tick paralysis

    MedlinePLUS

    Tick paralysis is a loss of muscle function that results from a tick bite . ... Hard- and soft-bodied female ticks are believed to make a poison that can cause paralysis in children. Ticks attach to the skin to feed on blood. ...

  3. Comparison of hemihypoglossal-facial nerve transposition with a cross-facial nerve graft and muscle transplant for the rehabilitation of facial paralysis using the facial clima method.

    PubMed

    Hontanilla, Bernardo; Vila, Antonio

    2012-02-01

    To compare quantitatively the results obtained after hemihypoglossal nerve transposition and microvascular gracilis transfer associated with a cross facial nerve graft (CFNG) for reanimation of a paralysed face, 66 patients underwent hemihypoglossal transposition (n = 25) or microvascular gracilis transfer and CFNG (n = 41). The commissural displacement (CD) and commissural contraction velocity (CCV) in the two groups were compared using the system known as Facial clima. There was no inter-group variability between the groups (p > 0.10) in either variable. However, intra-group variability was detected between the affected and healthy side in the transposition group (p = 0.036 and p = 0.017, respectively). The transfer group had greater symmetry in displacement of the commissure (CD) and commissural contraction velocity (CCV) than the transposition group and patients were more satisfied. However, the transposition group had correct symmetry at rest but more asymmetry of CCV and CD when smiling. PMID:22455573

  4. Description of Laryngeal Pathologies in Children Evaluated by Otolaryngologists.

    ERIC Educational Resources Information Center

    Dobres, Rachel; And Others

    1990-01-01

    Data were collected on 731 patients (age birth to 18) at a children's hospital otolaryngology clinic. Most frequent laryngeal pathologies were subglottic stenosis, vocal nodules, laryngomalacia, and vocal fold paralysis. Laryngeal pathologies were more common to males than females, were most common in the youngest patients, and were distributed

  5. Genetics Home Reference: Paralysis

    MedlinePLUS

    ... Home Conditions Genes Chromosomes Handbook Glossary Resources Conditions > Paralysis Related topics on Genetics Home Reference: alternating hemiplegia of childhood hyperkalemic periodic paralysis hypokalemic periodic paralysis ...

  6. Reconstructive procedures for impaired upper airway function: laryngeal respiration

    PubMed Central

    Müller, Andreas

    2005-01-01

    The larynx is the "bottleneck" of the human airway. For this reason, the effects of stenosing laryngeal pathologies on the vital factor respiratory gas exchange are particularly critical. Internal stabilization is a prerequisite for recovery of the laryngeal respiratory function in severe forms of inspiratory collapse (laryngomalacia). Effective laser surgery techniques have been developed to this end in recent years. Glottis-dilating surgery in cases of bilateral vocal cord motion impairment is now moving in the direction of endoscopic laser cordotomy or cordectomy, whereas arytenoidectomy and open surgical procedures are now used only rarely due to higher secondary morbidity rates. In individual cases, in particular if functional recovery is expected, temporary laterofixation of a vocal cord using an endoscopic suturing technique can be a helpful approach. Extensive laryngeal defects can be covered by means of composite grafts with mucosal lining, a supporting skeleton and their own vascularization. Autologous transplantation of the larynx, with its complex surgical and immunological problems, has become a manageable procedure. The problems of post-transplantation reinnervation and risk assessment of immunosuppression-induced recurrence of the tumor are still under consideration. Reanimation of the bilaterally paralyzed larynx by means of neurorrhaphy (neurosuture), neural grafting and, more recently, functional electrostimulation (pacemaker) represents a challenge for the coming years. In most cases of paralysis of the recurrent laryngeal nerve, a part of the muscles is maintained by synkinetic reinnervation when therapy is carried out, which however also prevents effective vocal cord movement due to simultaneous activity of agonists and antagonists. Modulation of reinnervation by means of electrostimulation and modern genetic therapy approaches justify hopes of better outcomes in the future. PMID:22073057

  7. Intraoperative Neuromonitoring of the External Branch of the Superior Laryngeal Nerve during Thyroidectomy: The Need for Evidence-Based Data and Perioperative Technical/Technological Standardization

    PubMed Central

    Mangano, Alberto; Lianos, Georgios D.; Boni, Luigi; Kim, Hoon Yub; Roukos, Dimitrios H.; Dionigi, Gianlorenzo

    2014-01-01

    The external branch of the superior laryngeal nerve (EBSLN) is surgically relevant since its close anatomical proximity to the superior thyroid vessels. There is heterogeneity in the EBSLN anatomy and EBSLN damage produces changes in voice that are very heterogenous and difficult to diagnose. The reported prevalence of EBSLN injury widely ranges. EBSLN iatrogenic injury is considered the most commonly underestimated complication in endocrine surgery because vocal assessment underestimates such event and laryngoscopic postsurgical evaluation does not show standardized findings. In order to decrease the risk for EBSLN injury, multiple surgical approaches have been described so far. IONM provides multiple advantages in the EBSLN surgical approach. In this review, we discuss the current state of the art of the monitored approach to the EBSLN. In particular, we summarize, providing our additional remarks, the most relevant aspects of the standardized technique brilliantly described by the INMSG (International Neuromonitoring Study Group). In conclusion, in our opinion, there is currently the need for more prospective randomized trials investigating the electrophysiological and pathological aspects of the EBSLN for a better understanding of the role of IONM in the EBSLN surgery. PMID:25525624

  8. The effect of patient age on the success of laryngeal reinnervation.

    PubMed

    Li, Meng; Chen, Donghui; Song, Xianmin; Wang, Wei; Zhu, Minhui; Liu, Fei; Li, Yan; Chen, Shicai; Zheng, Hongliang

    2014-12-01

    The objective of the study was to investigate the influence of patient age on the efficacy of laryngeal reinnervation with ansa cervicalis in unilateral vocal fold paralysis (UVFP) patients. We retrospectively reviewed 349 consecutive UVFP cases of laryngeal reinnervation with ansa cervicalis to the recurrent laryngeal nerve anastomosis. Preoperative and postoperative videostroboscopy, perceptual evaluation, acoustic analysis, maximum phonation time (MPT) and laryngeal electromyography (EMG) data were collected. Gender, age, preoperative EMG status [preoperative voluntary motor unit recruitment (VMUR)] and denervation duration were analyzed in previous multivariable logistic regression analysis. Stratification analysis was performed on patient age in the present study. All patients were divided into four groups according to their age: Group A included patients with an age less than 30 years; Group B, 30-44 years; Group C, 45-59 years; Group D, ?60 years. Stratification analysis on patient age showed significant differences between Group A and D, Group B and D, Group C and D (P < 0.05), but no significant difference between Group A and B, Group A and C, Group B and C (P > 0.05), respectively, with regard to parameters including glottal closure, overall grade, shimmer, noise-to-harmonics ratio; but there are no significant differences among the four groups with regard to jitter. However, for MPT and postoperative VMUR, there are significant differences among the four groups expect between Group A and B. In addition, glottal closure, perceptual and acoustic parameters, MPT values and VMUR data, were significantly improved postoperatively in each age group (P < 0.01). The data from this study indicate that patient age is an influential factor of the surgical outcome of laryngeal reinnervation for UVFP patients. Laryngeal reinnervation is less effective when patient age is more than 60 years. PMID:24913623

  9. Correlation of Final Evoked Potential Amplitudes on Intraoperative Electromyography of the Recurrent Laryngeal Nerve With Immediate Postoperative Vocal Fold Function After Thyroid and Parathyroid Surgery

    PubMed Central

    Genther, Dane J.; Kandil, Emad H.; Noureldine, Salem I.; Tufano, Ralph P.

    2015-01-01

    IMPORTANCE Thyroid and parathyroid surgery are among the most common operations in the United States. Recurrent laryngeal nerve (RLN) injury is an infrequent but potentially detrimental complication. OBJECTIVE To correlate the final evoked potential amplitudes on intraoperative electromyography (EMG) after stimulation of the RLN with immediate postoperative vocal fold function after thyroid and parathyroid surgery. DESIGN, SETTING, AND PARTICIPANTS Retrospective observational study at a tertiary academic medical center. We included 674 patients (with 1000 nerves at risk) undergoing thyroid or parathyroid surgery from July 1, 2008, through June 30, 2012. INTERVENTIONS Thyroid and parathyroid surgery. MAIN OUTCOMES AND MEASURES The association of final evoked potential amplitudes on EMG after thyroid and parathyroid surgery with vocal fold function as determined by postoperative fiberoptic laryngoscopy. RESULTS Three patients experienced permanent vocal fold paresis (VFP) secondary to intraoperative RLN transection. Of the remaining 997 RLNs at risk, 22 (2.2%) in 20 patients exhibited temporary VFP on fiberoptic laryngoscopy after extubation. Eighteen patients experienced unilateral temporary VFP, and 2 experienced bilateral VFP without the need for tracheostomy or reintubation. Of the 22 RLNs, postdissection EMG amplitudes were less than 200 V (true-positive findings) in 21 and at least 200 V (false-negative finding) in 1. Of the 975 RLNs (97.5%) with normal function, postdissection EMG amplitudes were at least 200 V (true-negative findings) in 967 and less than 200 V (false-positive findings) in 8. In regard to immediate postoperative VFP, sensitivity, specificity, positive and negative predictive values, and accuracy of postdissection EMG amplitudes of less than 200 V were 95.5%, 99.2%, 72.4%, 99.9%, and 99.1%, respectively. CONCLUSIONS AND RELEVANCE Intraoperative nerve monitoring of the RLN with EMG provides real-time information regarding neurophysiologic function of the RLN and can predict immediate postoperative VFP reliably when a cutoff of 200 V is used. The high negative predictive value means that the surgeon can presume with confidence that the RLN has not been injured in the presence of a potential of at least 200 V. This information would be useful in patients for whom bilateral thyroid surgery is being considered. PMID:24384927

  10. Tapia's syndrome in the intensive care unit: a rare cause of combined cranial nerve palsy following intubation.

    PubMed

    Coninckx, M; Cardoen, S; Hemelsoet, D

    2015-12-01

    Tapia's syndrome is characterized by unilateral paralysis of the tongue and vocal cord, and is caused by a concurrent lesion of both the recurrent laryngeal and hypoglossal nerves. The proposed mechanism in most patients is compression or stretching of these nerves on their extracranial course due to airway manipulation under general anaesthesia. As Tapia's syndrome is a rare and possibly devastating condition, recognition of the presence of concurrent paralyses is an important step in diagnosis and treatment. We report two cases of Tapia's syndrome as a complication of intubation in the intensive care unit. PMID:26088745

  11. [Facial paralysis in children].

    PubMed

    Muler, H; Paquelin, F; Cotin, G; Luboinski, B; Henin, J M

    1975-01-01

    Facial paralyses in children may be grouped under headings displaying a certain amount of individuality. Chronologically, first to be described are neonatal facial paralyses. These are common and are nearly always cured within a few days. Some of these cases are due to the mastoid being crushed at birth with or without the use of forceps. The intra-osseous pathway of the facial nerve is then affected throughout its length. However, a cure is often spontaneous. When this desirable development does not take place within three months, the nerve should be freed by decompressive surgery. The special anatomy of the facial nerve in the new-born baby makes this a delicate operation. Later, in all stages of acute otitis, acute mastoiditis or chronic otitis, facial paralysis can be seen. Treatment depends on the stage reached by the otitis: paracentesis, mastoidectomy, various scraping procedures, and, of course, antibiotherapy. The other causes of facial paralysis in children are very much less common: a frigore or viral, traumatic, occur ring in the course of acute poliomyelitis, shingles or tumours of the middle ear. To these must be added exceptional causes such as vitamin D intoxication, idiopathic hypercalcaemia and certain haemopathies. PMID:1217818

  12. Prototype Nerve-Specific Near-Infrared Fluorophores

    PubMed Central

    Park, Min Ho; Hyun, Hoon; Ashitate, Yoshitomo; Wada, Hideyuki; Park, GwangLi; Lee, Jeong Heon; Njiojob, Costyl; Henary, Maged; Frangioni, John V.; Choi, Hak Soo

    2014-01-01

    Nerve preservation is an important issue during most surgery because accidental transection or injury results in significant morbidity, including numbness, pain, weakness, or paralysis. Currently, nerves are still identified only by gross appearance and anatomical location during surgery, without intraoperative image guidance. Near-infrared (NIR) fluorescent light, in the wavelength range of 650-900 nm, has the potential to provide high-resolution, high-sensitivity, and real-time avoidance of nerve damage, but only if nerve-specific NIR fluorophores can be developed. In this study, we evaluated a series of Oxazine derivatives to highlight various peripheral nerve structures in small and large animals. Among the targeted fluorophores, Oxazine 4 has peak emission near into the NIR, which provided nerve-targeted signal in the brachial plexus and sciatic nerve for up to 12 h after a single intravenous injection. In addition, recurrent laryngeal nerves were successfully identified and highlighted in real time in swine, which could be preserved during the course of thyroid resection. Although optical properties of these agents are not yet optimal, chemical structure analysis provides a basis for improving these prototype nerve-specific NIR fluorophores even further. PMID:24955143

  13. [The history of facial paralysis].

    PubMed

    Glicenstein, J

    2015-10-01

    Facial paralysis has been a recognized condition since Antiquity, and was mentionned by Hippocratus. In the 17th century, in 1687, the Dutch physician Stalpart Van der Wiel rendered a detailed observation. It was, however, Charles Bell who, in 1821, provided the description that specified the role of the facial nerve. Facial nerve surgery began at the end of the 19th century. Three different techniques were used successively: nerve anastomosis, (XI-VII Balance 1895, XII-VII, Korte 1903), myoplasties (Lexer 1908), and suspensions (Stein 1913). Bunnell successfully accomplished the first direct facial nerve repair in the temporal bone, in 1927, and in 1932Balance and Duel experimented with nerve grafts. Thanks to progress in microsurgical techniques, the first faciofacial anastomosis was realized in 1970 (Smith, Scaramella), and an account of the first microneurovascular muscle transfer published in 1976by Harii. Treatment of the eyelid paralysis was at the origin of numerous operations beginning in the 1960s; including palpebral spring (Morel Fatio 1962) silicone sling (Arion 1972), upperlid loading with gold plate (Illig 1968), magnets (Muhlbauer 1973) and transfacial nerve grafts (Anderl 1973). By the end of the 20th century, surgeons had at their disposal a wide range of valid techniques for facial nerve surgery, including modernized versions of older techniques. PMID:26088742

  14. Subglottic high frequency jet ventilation in surgical management of bilateral vocal fold paralysis after thyroidectomy.

    PubMed

    Janjevi?, Dusanka; Dolinaj, Vladimir; Piazza, Cesare; Jovi?, Rajko; Marinkovi?, Jelena; Kalezi?, Nevena

    2012-09-01

    Lesion of the recurrent laryngeal nerves as a consequence of thyroid surgery results in bilateral vocal fold paralysis and respiratory obstruction. The initial treatment involves ensuring an adequate airway and it ranges from tracheostomy to endo-extralaryngeal laterofixating operations in general anesthesia. Subglottic high frequency jet ventilation (HFJV) is an alternative ventilatory approach in airway surgery. HFJV offers optimal endolaryngeal working conditions, immobility of vocal cords, adequate oxygenation and ventilation. The HFJV was prospectively studied in 20 consecutive female patients with bilateral vocal fold paralysis. Ventilation was performed as subglottic HFJV via jet catheter inserted through the vocal cord. Anesthesia was administered as total intravenous anesthesia. At the end of the procedure, the jet catheter was exchanged with LMA laryngeal mask until spontaneous breathing was established. Subglottic HFJV was used in 20 patients undergoing endo-extralaryngeal laterofixating operations with suspension microlaryngoscopy. The mean duration of surgery was 32.25 minutes, mean age 47.35 (SD 9.75) years, and mean body mass index 26.39 kg m(-2) (SD 5.03). The mean arterial PaCO2 5 min before surgical procedure was 5.39 (SD 0.86) kPa, at 5 min of starting jet ventilation 6.19 (SD 0.91) kPa, and at the end of surgical procedure 5.93 (SD 0.99) kPa. There was significant correlation between PaCO2 obtained 5 min before starting jet ventilation and PaCO2 at 5 min of starting jet ventilation (p < 0.05). No complications secondary to the ventilation technique were observed. No perioperative tracheotomy was necessary. It is concluded that subglottic HFJV is an easy and safe way to ventilate patients with bilateral vocal fold paralysis when endoscopic intervention is performed. PMID:23330413

  15. Vocal Fold Paralysis: Improved Adductor Recovery by Vincristine Blockade of Posterior Cricoarytenoid

    PubMed Central

    Paniello, Randal C.

    2014-01-01

    OBJECTIVES/HYPOTHESIS A new treatment for acute unilateral vocal fold paralysis was proposed, in which a drug is injected into the posterior cricoarytenoid muscle (PCA) shortly after nerve injury, before the degree of natural recovery is known, to prevent antagonistic synkinetic reinnervation. This concept was tested in a series of canine experiments using vincristine as the blocking agent. STUDY DESIGN Animal experiments. METHODS Laryngeal adductor function was measured at baseline and at 6 months following experimental recurrent laryngeal nerve (RLN) injuries, including complete transection, crush injury, and cautery. In the treatment animals, the PCA was injected with vincristine at the time of RLN injury. RESULTS Adductor function in the vincristine-treated hemilarynges was significantly improved compared with injury-matched noninjected controls (total n=43). Transection/repair controls recovered 56.1% of original adductor strength, vincristine-treated hemilarynges recovered to 73.1% (p=0.002). Cautery injuries also improved with vincristine block (60.7% vs 88.7%, p=0.031). Crush injuries recovered well even without vincristine (104.8% vs 111.2%, p=0.35). CONCLUSIONS These findings support a new paradigm of early, pre-emptive blockade of the antagonist muscle (PCA) to improve ultimate net adductor strength, which could potentially improve functional recovery in many UVFP patients and avoid the need for medialization procedures. Possible clinical aspects of this new approach are discussed. PMID:25267697

  16. Isolated sleep paralysis

    MedlinePLUS

    Sleep paralysis - isolated; Parasomnia - isolated sleep paralysis ... Episodes of isolated sleep paralysis last from a few seconds to 1 or 2 minutes. During these episodes the person is unable to move ...

  17. Facial paralysis for the plastic surgeon

    PubMed Central

    Kosins, Aaron M; Hurvitz, Keith A; Evans, Gregory RD; Wirth, Garrett A

    2007-01-01

    Facial paralysis presents a significant and challenging reconstructive problem for plastic surgeons. An aesthetically pleasing and acceptable outcome requires not only good surgical skills and techniques, but also knowledge of facial nerve anatomy and an understanding of the causes of facial paralysis. The loss of the ability to move the face has both social and functional consequences for the patient. At the Facial Palsy Clinic in Edinburgh, Scotland, 22,954 patients were surveyed, and over 50% were found to have a considerable degree of psychological distress and social withdrawal as a consequence of their facial paralysis. Functionally, patients present with unilateral or bilateral loss of voluntary and nonvoluntary facial muscle movements. Signs and symptoms can include an asymmetric smile, synkinesis, epiphora or dry eye, abnormal blink, problems with speech articulation, drooling, hyperacusis, change in taste and facial pain. With respect to facial paralysis, surgeons tend to focus on the surgical, or ‘hands-on’, aspect. However, it is believed that an understanding of the disease process is equally (if not more) important to a successful surgical outcome. The purpose of the present review is to describe the anatomy and diagnostic patterns of the facial nerve, and the epidemiology and common causes of facial paralysis, including clinical features and diagnosis. Treatment options for paralysis are vast, and may include nerve decompression, facial reanimation surgery and botulinum toxin injection, but these are beyond the scope of the present paper. PMID:19554190

  18. Isolated laryngeal myasthenia gravis for 26 years.

    PubMed

    Renard, Dimitri; Hedayat, Amir; Gagnard, Corinne

    2015-02-01

    Laryngeal myasthenia gravis is a relatively rare variant of myasthenia gravis. A vast portion of patients with initial laryngeal myasthenia gravis develop involvement of ocular and/or extra-ocular muscles during the years after symptom onset although a minority of laryngeal myasthenia gravis patients continues to have isolated laryngeal muscle involvement for several years. We present a 58-year-old woman with recurrent episodic isolated dysphonia (associated with diffuse bilateral vocal cord paresis on laryngoscopy) since the age of 32. Dysphonia became permanent since 6 months. A diagnosis of laryngeal myasthenia gravis was made based on abnormal single-fiber electromyography and spectacular response to pyridostigmine treatment. Repetitive nerve stimulation was normal and anti-acetylcholine receptor and anti-muscle specific tyrosine kinase antibodies were absent. This case shows that laryngeal myasthenia gravis can be isolated during 26 years of follow-up. We propose that even when myasthenia gravis seems unlikely as underlying mechanism of isolated dysphonia (because of lack of antibodies, normal repetitive nerve stimulation, and absence of extra-laryngeal involvement after years of follow-up), single-fiber electromyography should be performed and myasthenia gravis treatment should be tried. PMID:25454167

  19. Evaluating the timing of injection laryngoplasty for vocal fold paralysis in an attempt to avoid future type 1 thyroplasty

    PubMed Central

    2013-01-01

    Objectives To determine whether immediate (less than 3 months from time of nerve injury), early (from 3 to 6 months from time of nerve injury) or late (more than 6 months from time of nerve injury) vocal fold injection influences the long-term outcomes for patients with permanent unilateral vocal fold paralysis. Methods A total of 250 patients with documented unilateral vocal fold paralysis were identified in this retrospective chart review. 66 patients met the inclusion criteria, having undergone awake trancervical injection with gelfoam, collagen, perlane or a combination. Patients with documented recovery of vocal fold mobility, or patients with less than one year of follow-up after the onset of paralysis were excluded. Patients were stratified into immediate (<3months), early (3-6months) and late (>6months) groups denoting the time from suspected injury to injection. The need for open surgery as determined by a persistently immobile vocal fold with insufficient glottic closure following injection was the primary outcome. Results 1 out of 21 (4.8%) in the immediate group, 2 out of 17 (11.8%) in the early group and 20 out of 28 (71.4%) in the late group required type 1 thyroplasty procedures to restore glottic competence. There was significance when comparing late injection to both early and immediate injection (p?laryngeal framework surgery. PMID:24499514

  20. Using Laryngeal Electromyography to Differentiate Presbylarynges from Paresis

    ERIC Educational Resources Information Center

    Stager, Sheila V.; Bielamowicz, Steven A.

    2010-01-01

    Purpose: Differential diagnosis of patients over 64 years of age reporting hoarseness is challenging. Laryngeal electromyography (LEMG) was used to determine the status of the recurrent and superior laryngeal nerves. The authors hypothesized that individuals with hoarseness but normal LEMG would have measures similar to those of patients from

  1. Using Laryngeal Electromyography to Differentiate Presbylarynges from Paresis

    ERIC Educational Resources Information Center

    Stager, Sheila V.; Bielamowicz, Steven A.

    2010-01-01

    Purpose: Differential diagnosis of patients over 64 years of age reporting hoarseness is challenging. Laryngeal electromyography (LEMG) was used to determine the status of the recurrent and superior laryngeal nerves. The authors hypothesized that individuals with hoarseness but normal LEMG would have measures similar to those of patients from…

  2. Modified thyroplasty for unilateral vocal fold paralysis using an adjustable titanium implant.

    PubMed

    Wen, Wu; Sun, Guangbin; Sun, Bifeng; Liu, Chang; Zhang, Mingxing

    2015-03-01

    This study aimed to describe a new titanium thyroplasty implant that can be adjusted with a screw. Six Beagle dogs were randomly divided into experimental and control groups (n = 3). The titanium screw was implanted in the experimental group after the left recurrent laryngeal nerve was cut off under general anaesthesia. This procedure caused arytenoid cartilage internal shift, allowing the vocal cord to locate at the median and the glottis to close during phonation. No other operation was conducted in the control group. Each group, respectively, underwent video laryngoscopy, CT scan and histopathology before and after operation. After 4 months of follow-up, the video laryngoscopy results showed that the left arytenoid cartilage in the experimental group underwent internal adduct and shift, whereas the left vocal cords in the control group located at the paramedian position and exhibited fissure during phonation. CT scan results showed that the adjustable titanium screw was in proper position. Postoperative pathological examination showed that, in addition to early local inflammation, the laryngeal muscle may atrophy. The adjustable titanium screw requires a simple operation and can be significantly adjusted. The effect of the operation can be immediately observed without rejection. Therefore, this method is an efficient treatment for unilateral vocal cord paralysis. PMID:24728279

  3. Anatomic study of human laryngeal ganglia: number and distribution.

    PubMed

    Maranillo, Eva; Vazquez, Teresa; Ibanez, Marta; Hurtado, Miguel; Pascual-Font, Aran; McHanwell, Stephen; Valderrama-Canales, Francisco; Sanudo, Jose

    2008-10-01

    We have studied 12 laryngeal nerves: six internal branches of the superior laryngeal nerve (ILN) and six recurrent laryngeal nerves (RLN) from three human adult larynges (two males and one female). After dissection of each individual laryngeal nerve using a surgical microscope, the nerves were preserved in 10% formalin, embedded in paraffin wax, serially sectioned transversely at a thickness of 10 microm and stained with hematoxylin and eosin. We found 2-4 ganglia associated with the ILN. At least two ganglia were always present (six out of six cases), the largest one being associated with the branch of the nerve innervating the vestibule and the smallest one associated with the branch innervating the aryepiglottic fold. Other ganglia were found associated with the branches for the glosso-epiglottic fold and vallecula (four out of six cases) and interarytenoid muscle (three out of six cases). The RLN showed from two to six ganglia, all of them located in its anterior terminal division. Two of the ganglia were located in the part of the nerve between the origin of the branches for the interarytenoid and lateral cricoarytenoid muscles (three out of six cases). The remaining ganglia were located close to or at the origin of the muscular branches innervating the intrinsic laryngeal muscles. The cytology of the ganglia reported suggests that they were all autonomic in nature, probably parasympathetic. PMID:18773473

  4. Type I thyroplasty for acute unilateral vocal fold paralysis following intrathoracic surgery.

    PubMed

    Abraham, Manoj T; Bains, Manjit S; Downey, Robert J; Korst, Robert J; Kraus, Dennis H

    2002-08-01

    Patients who undergo intrathoracic operative procedures for malignancy may require sacrifice of a recurrent laryngeal nerve. Postoperative vocal fold paralysis may lead to diminished cough with secretion retention, aspiration, and life-endangering pneumonia. This study retrospectively reviews our institution's experience of 23 patients who underwent type I thyroplasty within the 2-week (acute) period after thoracic surgery. Primary lung cancer (n = 16) was the most common disease. Upper lobectomy (n = 9) and pneumonectomy (n = 7) were the most frequent surgical procedures. Silicone medialization alone (n = 11) or with arytenoid adduction (n = 12) was performed. There were no significant postoperative complications. Improvements in hoarseness (86%), dyspnea (72%), dysphagia (50%), and aspiration (79%) were noted. Pulmonary status improved after vocal fold medialization, as reflected by decreased need for therapeutic bronchoscopy in the majority of patients in the postoperative period. Type I thyroplasty for vocal fold paralysis in the acute phase following thoracic surgery is well tolerated and is associated with improved patient outcome with no postoperative deaths in this high-risk patient population. PMID:12184585

  5. Laryngeal pseudosarcoma

    SciTech Connect

    Giordano, A.M.; Ewing, S.; Adams, G.; Maisel, R.

    1983-06-01

    In the past laryngeal pseudosarcomas have been diagnosed as a. carcinosarcomas, b. pleomorphic or spindle cell carcinomas, or c. squamous cell carcinomas with pseudosarcomatous reactive stroma. Arguments have centered around the nature of the sarcomatous stroma. Because of this confusion there is disagreement as to the treatment and prognosis of these tumors. Seven pseudosarcomas were treated between 1969-1979, 4 were pedunculated and 3 exophytic. Treatment consisted of primary CO60 irradiation in 2 patients, surgery in 3 cases and combined therapy in 2 cases with no recurrences. Three of the 7 have died, 1 of a poorly differentiated adenosquamous carcinoma of the right main stem bronchus and the other 2 of natural causes at ages 77 and 85. From a review of the literature as well as our experience, we have reached the following conclusions. 1. Stromal cells are a malignant morphologic variant of the squamous cell and are best termed spindled cells. 2. Neck metastasis at any time is a poor prognostic sign. 3. The pattern of metastasis and survival seems to parallel laryngeal squamous cell carcinoma, and thus treatment should be similar for given stages.

  6. Effects of Functional Electrical Stimulation on Denervated Laryngeal Muscle in a Large Animal Model.

    PubMed

    Cheetham, Jon; Perkins, Justin D; Jarvis, Jonathan C; Cercone, Marta; Maw, Martin; Hermanson, John W; Mitchell, Lisa M; Piercy, Richard J; Ducharme, Norm G

    2015-10-01

    Bilateral vocal fold paralysis (BVCP) is a life-threatening condition that follows injury to the Recurrent Laryngeal nerve (RLn) and denervation of the intrinsic laryngeal musculature. Functional electrical stimulation (FES) enables restoration and control of a wide variety of motor functions impaired by lower motor neuron lesions. Here we evaluate the effects of FES on the sole arytenoid abductor, the posterior cricoarytenoid (PCA) muscle in a large animal model of RLn injury. Ten horses were instrumented with two quadripolar intramuscular electrodes in the left PCA muscle. Following a 12-week denervation period, the PCA was stimulated using a once-daily training session for 8 weeks in seven animals. Three animals were used as unstimulated controls. Denervation produced a significant increase in rheobase (P?

  7. Late ulnar paralysis. Study of seventeen cases.

    PubMed

    Mansat, M; Bonnevialle, P; Fine, X; Guiraud, B; Testut, M F

    1983-01-01

    Seventeen cases of late ulnar paralysis treated by neurolysis-transposition are reported. The clinical characteristics of these paralysis are emphasized. A very prolonged symptom free interval, a rapid onset and a severe involvement. The ulnar transposition was most often done subcutaneously. Cubitus valgus and definite nerve compression proximal to the arcade of the flexor carpi ulnaris muscle are almost always present. The results as regards the neuropathy are notable: no patient is completely cured and only half are improved. An anatomical study of the nerve path shows the essential role, in the compression of the nerve, of the muscular arcade of the flexor carpi ulnaris muscle which acts in a way similar to the bridge of a violin. Hence, opening it longitudinally is the principal procedure of the neurolysis. This should be routine before the first signs of neuropathy occur in an elbow whose axis is out of alignment as a sequela of a childhood injury. PMID:9336632

  8. Management of the Eye in Facial Paralysis.

    PubMed

    Chi, John J

    2016-02-01

    The preoperative assessment of the eye in facial paralysis is a critical component of surgical management. The degree of facial nerve paralysis, lacrimal secretion, corneal sensation, and lower eyelid position must be assessed accurately. Upper eyelid loading procedures are standard management of lagophthalmos. Lower eyelid tightening repositions the lower eyelid and helps maintain the aqueous tear film. Eyelid reanimation allows an aesthetic symmetry with blinking and restores protective functions vital to ocular preservation. Patients often have multiple nervous deficits, including corneal anesthesia. Other procedures include tarsorrhaphy, spring implantation, and temporalis muscle transposition; associated complications have rendered them nearly obsolete. PMID:26611698

  9. Transition of myosin heavy chain isoforms in human laryngeal abductors following denervation.

    PubMed

    Qiu, Xiaoxia; Chen, Donghui; Li, Meng; Gao, Yingna; Liu, Fei; Zheng, Hongliang; Chen, Shicai

    2015-10-01

    The objective of this study was to investigate the myofiber subtype transition of human posterior cricoarytenoid (PCA) muscle after the injury to recurrent laryngeal nerve (RLN). PCA muscle specimens were obtained from 38 bilateral vocal fold paralysis patients underwent arytenoidectomy. According to the duration of RLN injury, all the cases were divided into five denervation groups: 6-12 months, 1-2, 2-3, 3-6, and >6 years. The normal PCA muscles from total laryngectomy patients were chosen as controls. Immunofluorescence was adopted to detect the expression level of myosin heavy chain (MHC)-I and MHC-II in PCA muscle. Quantitative real-time PCR was also used to assess the transcriptional level of MHC subtypes (MHC-I, MHC-IIa, MHC-IIb, MHC-IIx, embryonic-MHC, and peri-natal-MHC). Immunofluorescence showed that MHC-I-positive myofibers in denervation groups were much lower than control group, respectively, while MHC-II-positive myofibers were significantly higher than control group (P < 0.05). With the extension of denervation, the number of MHC-I-positive myofibers gradually decreased, while MHC-II gradually increased and peaked in 1- to 2-year group. Transcriptional level of MHC-I, MHC-IIa, and MHC-IIb in denervation groups significantly down-regulated compared with the control (P < 0.05), respectively. However, MHC-IIx, embryonic-MHC, and peri-natal-MHC significantly up-regulated in all denervation groups, and the highest level was in 1- to 2-year denervation group. Data from the present study demonstrated that the maximum transition of MHC subtypes in human PCA muscles occurred in 1-2 years after denervation, suggesting that laryngeal reinnervation before the occurrence of irreversible transition of MHC subtypes could maintain the structural integrity of laryngeal PCA muscles. PMID:26059207

  10. Laryngeal schwannoma as an acute airway presentation.

    PubMed

    Markou, Konstantinos; Dova, Stamatia; Poulios, Christos; Karkos, Petros

    2016-01-01

    A schwannoma is a neurogenic tumour arising from nerve sheaths. Between 25% and 45% of schwannomas occur in the head and neck region. Schwannomas of the larynx are extremely rare. They usually occur in women during the fourth and fifth decades of life. We present a case of a laryngeal schwannoma in a 76-year-old patient with acute stridor, hoarseness and dysphagia. Laryngeal conservation surgery was performed without the need for a tracheostomy. One year later, the patient remains symptom-free with no evidence of recurrence. Clinical presentation, diagnosis and management are discussed and the literature is reviewed. PMID:26969364

  11. Current therapeutic prospectives in the functional rehabilitation of vocal fold paralysis after thyroidectomy: CO2 laser aritenoidectomy.

    PubMed

    Testa, Domenico; Guerra, Germano; Landolfo, Pasquale Gianluca; Nunziata, Michele; Conzo, Giovanni; Mesolella, Massimo; Motta, Gaetano

    2014-01-01

    A frequent complication of thyroid surgery is laryngeal nerve palsy with transitory or permanent deficiency of cordal motility. Peripheral mono-or bilateral palsy in these cases may either occur, in adduction or abduction, and be complete or not complete. Bilateral vocal cords paralysis cause a persistent dyspnoic symptomatology with worsening during physical exercise or flogistic episodes of the upper airway: true vocal cords adduction, in median or paramedian position reduce the glottic space and increases respiratory resistances. Several surgical procedures have been proposed for the treatment of respiratory distress secondary to bilateral cord palsy. The aim of this study is to value the role of CO2 laser aritenoidectomy in 93 patients affected by bilateral paralysis in adduction of true vocal cords. Pre and postoperative evaluations included clinical results, spirometry, aerodynamics studies and evaluation of foniatric performance (MPT, H/N Ratio, Jitter and Shimmer) with a mean follow-up of 12 years. CO2 laser aritenoidectomy induces a complete resolution of respiratory failure, maintaining a good vocal quality, minimum surgical stress with low percentage of complications and a short hospitalization. PMID:24909138

  12. Perceptual Ratings of Vocal Characteristics and Voicing Features in Untreated Patients with Unilateral Vocal Fold Paralysis

    ERIC Educational Resources Information Center

    Leydon, Ciara; Bielamowicz, Steven; Stager, Sheila V.

    2005-01-01

    This study used visual analog scales to obtain perceptual ratings of features of voice production in subjects with unilateral vocal fold paralysis (UVFP), including clarity of laryngeal articulation, consistency of loudness across the utterance and the voiced/voiceless distinction. Recordings of repeated /i/, /isi/, and /izi/ from subjects

  13. Perceptual Ratings of Vocal Characteristics and Voicing Features in Untreated Patients with Unilateral Vocal Fold Paralysis

    ERIC Educational Resources Information Center

    Leydon, Ciara; Bielamowicz, Steven; Stager, Sheila V.

    2005-01-01

    This study used visual analog scales to obtain perceptual ratings of features of voice production in subjects with unilateral vocal fold paralysis (UVFP), including clarity of laryngeal articulation, consistency of loudness across the utterance and the voiced/voiceless distinction. Recordings of repeated /i/, /isi/, and /izi/ from subjects…

  14. Effects of carbon dioxide on laryngeal receptors

    SciTech Connect

    Anderson, J.W.; Sant'Ambrogio, F.B.; Orani, G.P.; Sant'Ambrogio, G.; Mathew, O.P. )

    1990-02-26

    Carbon dioxide (CO{sub 2}) either stimulates or inhibits laryngeal receptors in the cat. The aim of this study was to correlate the CO{sub 2} response of laryngeal receptors with their response to other known stimuli (i.e. pressure, movement, cold, water and smoke). Single unit action potentials were recorded from fibers in the superior laryngeal nerve of 5 anesthetized, spontaneously breathing dogs together with CO{sub 2} concentration, esophageal and subglottic pressure. Constant streams of warm, humidified air or 10% CO{sub 2} in O{sub 2} were passed through the functionally isolated upper airway for 60 s. Eight of 13 randomly firing or silent receptors were stimulated by CO{sub 2} (from 0.4{plus minus}0.1 to 1.8{plus minus}0.4 imp.s). These non-respiratory-modulated receptors were more strongly stimulated by solutions lacking Cl{sup {minus}} and/or cigarette smoke. Six of 21 respiratory modulated receptors (responding to pressure and/or laryngeal motion) were either inhibited or stimulated by CO{sub 2}. Our results show that no laryngeal receptor responds only to CO{sub 2}. Silent or randomly active receptors were stimulated most often by CO{sub 2} consistent with the reflex effect of CO{sub 2} in the larynx.

  15. Neuronal vacuolation, myelopathy and laryngeal neuropathy in a mixed-breed dog.

    PubMed

    Salvadori, C; Tartarelli, C L; Baroni, M; Arispici, M; Cantile, C

    2007-10-01

    A bilateral and symmetrical neuronal vacuolation associated with spinal cord white matter degeneration and laryngeal neuropathy was observed in a 12-week-old male mixed-breed dog with a history of progressive pelvic limbs ataxia. On clinical examination, signs included inspiratory stridor, spinal ataxia, tetraparesis, and proprioceptive deficits more severe in the pelvic limbs. Examination of the larynx showed bilateral laryngeal paralysis and electromyography revealed fibrillation potentials restricted to the intrinsic laryngeal muscles. Clinical and pathological findings resembled the syndrome of neuronal vacuolation and spinocerebellar degeneration described in Rottweiler dogs. This is the first report of a similar disorder in a dog different from Rottweiler. PMID:17877588

  16. Bulbar Paralysis and Facial Paralysis due to Metastatic Hepatocellular Carcinoma: A Case Report and Literature Review.

    PubMed

    Liu, Min; Liu, Shixin; Liu, Bailong; Liu, Bin; Guo, Liang; Wang, Xu; Wang, Qiang; Yang, Shuo; Dong, Lihua

    2016-01-01

    Skull-base metastasis (SBM) from hepatocellular carcinoma (HCC) is extremely rare, and multiple cranial nerve paralysis due to SBM from HCC is also rare. We report a case of bulbar and facial paralysis due to SBM from HCC.A 46-year-old Chinese man presented with a hepatic right lobe lesion that was detected during a routine physical examination. After several failed attempts to treat the primary tumor and bone metastases, neurological examination revealed left VII, IX, X, and XI cranial nerve paralysis. Computed tomography of the skull base subsequently revealed a large mass that had destroyed the left occipital and temporal bones and invaded the adjacent structure. After radiotherapy (27 Gy, 9 fractions), the patient experienced relief from his pain, and the cranial nerve dysfunction regressed. However, the patient ultimately died, due to the tumor's progression.Radiotherapy is usually the best option to relieve pain and achieve regression of cranial nerve dysfunction in cases of SBM from HCC, although early treatment is needed to achieve optimal outcomes. The present case helps expand our understanding regarding this rare metastatic pathway and indicates that improved awareness of SBM in clinical practice can help facilitate timely and appropriate treatment. PMID:26825921

  17. Vocal Fold Paralysis

    MedlinePLUS

    ... on vocal fold paralysis? The National Institute on Deafness and Other Communication Disorders (NIDCD) supports research studies ... NIH Turning Discovery Into Health National Institute on Deafness and Other Communication Disorders 31 Center Drive, MSC ...

  18. Paralysis Facts and Figures

    MedlinePLUS

    ... Pines When a Caregiver Needs Therapy When a Marriage Changes Quest to Return to an Active Life ... with paralysis -- approximately 6 million people. That's the same number of people as the combined populations of ...

  19. Neurologic Melioidosis: Case Report of a Rare Cause of Acute Flaccid Paralysis.

    PubMed

    Andersen, Erik W; Mackay, Mark T; Ryan, Monique M

    2016-03-01

    Acute flaccid paralysis is associated with inflammation, infection, or tumors in the spinal cord or peripheral nerves. Melioidosis (Burkholderia pseudomallei infection) can rarely cause this presentation. We describe a case of spinal melioidosis in a 4-year-old boy presenting with flaccid paralysis, and review the literature on this rare disease. PMID:26778096

  20. Left Vocal Cord Paralysis Detected by PET/CT in a Case of Lung Cancer

    PubMed Central

    Oner, Ali Ozan; Boz, Adil; Surer Budak, Evrim; Kaplan Kurt, Gulnihal Hale

    2015-01-01

    We report a patient with lung cancer. The first PET/CT imaging revealed hypermetabolic mass in the left aortopulmonary region and hypermetabolic nodule in the anterior segment of the upper lobe of the left lung. After completing chemotherapy and radiotherapy against the primary mass in the left lung, the patient underwent a second PET/CT examination for evaluation of treatment response. This test demonstrated, compared with the first PET/CT, an increase in the size and metabolic activity of the primary mass in the left lung in addition to multiple, pathologic-sized, hypermetabolic metastatic lymph nodes as well as multiple metastatic sclerotic areas in bones. These findings were interpreted as progressive disease. In addition, an asymmetrical FDG uptake was noticed at the level of right vocal cord. During follow-up, a laryngoscopy was performed, which demonstrated left vocal cord paralysis with no apparent mass. Thus, we attributed the paralytic appearance of the left vocal cord to infiltration of the left recurrent laryngeal nerve by the primary mass located in the apical region of the left lung. In conclusion, the knowledge of this pitfall is important to avoid false-positive PET results. PMID:26613056

  1. Left Vocal Cord Paralysis Detected by PET/CT in a Case of Lung Cancer.

    PubMed

    Oner, Ali Ozan; Boz, Adil; Surer Budak, Evrim; Kaplan Kurt, Gulnihal Hale

    2015-01-01

    We report a patient with lung cancer. The first PET/CT imaging revealed hypermetabolic mass in the left aortopulmonary region and hypermetabolic nodule in the anterior segment of the upper lobe of the left lung. After completing chemotherapy and radiotherapy against the primary mass in the left lung, the patient underwent a second PET/CT examination for evaluation of treatment response. This test demonstrated, compared with the first PET/CT, an increase in the size and metabolic activity of the primary mass in the left lung in addition to multiple, pathologic-sized, hypermetabolic metastatic lymph nodes as well as multiple metastatic sclerotic areas in bones. These findings were interpreted as progressive disease. In addition, an asymmetrical FDG uptake was noticed at the level of right vocal cord. During follow-up, a laryngoscopy was performed, which demonstrated left vocal cord paralysis with no apparent mass. Thus, we attributed the paralytic appearance of the left vocal cord to infiltration of the left recurrent laryngeal nerve by the primary mass located in the apical region of the left lung. In conclusion, the knowledge of this pitfall is important to avoid false-positive PET results. PMID:26613056

  2. Laryngeal Paralyses: Theoretical Considerations and Effects on Laryngeal Vibration.

    ERIC Educational Resources Information Center

    Smith, Marshall E.; And Others

    1992-01-01

    A theoretical four-mass model of the larynx was developed to simulate laryngeal biomechanical behavior and used to evaluate states of asymmetric laryngeal vibration. Simulations of laryngeal paralyses were compared with data on glottal vibration in observed laryngeal function. (Author/JDD)

  3. Bilateral diaphragmatic paralysis after kidney surgery.

    PubMed

    Sozzo, S; Carrat, P; Damiani, M F; Falcone, V A; Palumbo, A; Dragonieri, S; Resta, O

    2012-06-01

    A 57-year-old woman underwent an enucleoresection of her right kidney angiomyolipoma. Two weeks later she was admitted to our hospital because of dyspnea at rest with orthopnea. The chest x-ray showed the elevation of both hemidiaphragms and the measurement of the sniff transdiaphragmatic pressure confirmed the diagnosis of bilateral diaphragmatic paralysis. A diaphragm paralysis can be ascribed to several causes, i.e. trauma, compressive events, inflammations, neuropathies, or it can be idiopathic. In this case, it was very likely that the patient suffered from post-surgery neuralgic amyotrophy. To our knowledge, there are only a few reported cases of neuralgic amyotrophy, also known as Parsonage-Turner Syndrome, which affects only the phrenic nerve as a consequence of a surgery in an anatomically distant site. PMID:23193847

  4. Thyrotoxic periodic paralysis

    SciTech Connect

    Ferreiro, J.E.; Arguelles, D.J.; Rams, H. Jr.

    1986-01-01

    A case of thyrotoxic periodic paralysis is reported in a Hispanic man with an unusual recurrence six weeks after radioactive iodine treatment. Thyrotoxic periodic paralysis has now been well characterized in the literature: it occurs primarily in Orientals with an overwhelming male preponderance and a higher association of specific HLA antigens. Clinical manifestations include onset after high carbohydrate ingestion or heavy exertion, with progressive symmetric weakness leading to flaccid paralysis of the extremities and other muscle groups, lasting several hours. If hypokalemia is present, potassium administration may help abort the attack. Although propranolol can be efficacious in preventing further episodes, the only definitive treatment is establishing a euthyroid state. The pathophysiology is still controversial, but reflects altered potassium and calcium dynamics as well as certain morphologic characteristics within the muscle unit itself.

  5. [Rapid prototyping of the larynx for laryngeal frame work surgery].

    PubMed

    Hiramatsu, Hiroyuki; Yamaguchi, Hiroya; Nimi, Seiji; Ono, Hidenori

    2004-10-01

    A detailed understanding of the three-dimensional (3D) structure of the larynx is important for determining appropriate methods and approaches for laryngeal frame work surgery. In this study, a 3D laryngeal model was constructed based on postoperative helical CT data obtained after lateral cricoarytenoid muscle (LCA) pull surgery (Iwamura) for the treatment of unilateral vocal fold paralysis. The anatomical configurations of the arytenoid cartilages and the optimal approaches for laryngeal frame work surgery were then examined. A 3D model of the human larynx was prototyped using a selective laser sintering method. A compound powder of plastic nylon and an inorganic substance (glass beads) was used as the raw material. The cricoid cartilage and the arytenoid cartilages were prototyped, and the configurations of the arytenoid cartilages were evaluated. The results were similar to those of previous reports. The arytenoid cartilage of the unaffected side moved downward while adducting, and the vocal process moved inwards and downwards. On the other hand, the paralyzed arytenoid cartilage moved neither inward nor downward, and the vocal process was fixed at an outer and upper position. Next, the thyroid cartilage was added to the model to determine the optimal location of the window in the thyroid cartilage for the LCA pull surgery. The window after the first surgery was largened using a surgical drill. The 3D prototype model was useful for understanding the complex configurations of the laryngeal anatomy, and to determine the optimal approaches for laryngeal frame work surgery, etc. PMID:15559298

  6. Hypokalemic periodic paralysis

    PubMed Central

    Abbas, Haider; Kothari, Nikhil; Bogra, Jaishri

    2012-01-01

    Hypokalemic periodic paralysis is a rare genetic disorder characterized by recurrent attacks of skeletal muscle weakness with associated hypokalemia which is precipitated by stress, cold, carbohydrate load, infection, glucose infusion, hypothermia, metabolic alkalosis, anesthesia, and steroids. We encountered one such incidence of prolonged recovery after general anesthesia, which on further evaluation revealed a case of hypokalemic paralysis. The key to successful management of such a patient was vigilant pre-operative evaluation, perioperative monitoring, and aggressive treatment of hypokalemia when it occurs. PMID:23833504

  7. Hyperkalemic periodic paralysis.

    PubMed

    Naylor, J M

    1997-04-01

    Hyperkalemic periodic paralysis is an autosomal codominant genetic disease of horses who are descendants of the quarter horse sire Impressive. It produces a muscular phenotype that has been selected by show judges, which has resulted in the rapid dissemination of this disease. Clinical attacks are characterized by muscle fasciculation and spasm, and they respond to treatments for the concurrent hyperkalemia. PMID:9106348

  8. Vocal cord paralysis associated with Ramsay Hunt syndrome: looking back 50?years

    PubMed Central

    Rasmussen, Eva Rye; Mey, Kristianna

    2014-01-01

    Ramsay Hunt syndrome is defined by herpes zoster oticus and peripheral facial nerve palsy which is often associated with otalgia. The syndrome is, in rare cases, associated with other cranial nerve paralyses including the vagal nerve causing unilateral vocal cord paralysis. Vocal cord paralysis is more often seen as a symptom of various other diseases, that is, malignant tumours, neurodegenerative illness, cerebrovascular assaults, inflammatory processes or as a result of intubation or surgical procedures. The symptoms of unilateral vocal cord paralysis are mainly hoarseness, dyspnoea and dysphagia. We present a case of Ramsay Hunt syndrome combined with unilateral hearing loss and left vocal cord paralysis. The patient underwent MRI, CT and a lumbar puncture causing anxiety in the patient and delaying the initiation of antiviral and anti-inflammatory treatment, which is only efficient when initiated within 72?h. We hope to raise the awareness of this disease. PMID:24503657

  9. Stages of Laryngeal Cancer

    MedlinePLUS

    ... and symptoms of laryngeal cancer include a sore throat and ear pain. These and other signs and ... hoarseness in the voice. Tests that examine the throat and neck are used to help detect (find), ...

  10. [Paraglottic laryngeal abscesses].

    PubMed

    Fernndez Prez, A; Fernndez-Nogueras Jimnez, F; Moreno Len, J A

    2002-01-01

    We present 2 cases of laryngeal abscesses in the paraglottic space. We revise the existing literature in relation with this nowadays rare entity that requires a quick diagnosis and treatment as it is a fast life threatening disease. PMID:12402494

  11. Imaging in laryngeal cancers

    PubMed Central

    Joshi, Varsha M; Wadhwa, Vineet; Mukherji, Suresh K

    2012-01-01

    Imaging plays an important complementary role to clinical examination and endoscopic biopsy in the evaluation of laryngeal cancers. A vast majority of these cancers are squamous cell carcinomas (SCC). Cross-sectional imaging with contrast-enhanced computed tomography (CT) and magnetic resonance (MR) imaging allows excellent depiction of the intricate anatomy of the larynx and the characteristic patterns of submucosal tumor extension. CT, MRI and more recently PET-CT, also provide vital information about the status of cervical nodal disease, systemic metastases and any synchronous malignancies. Additionally, certain imaging-based parameters like tumor volume and cartilaginous abnormalities have been used to predict the success of primary radiotherapy or surgery in these patients. Integration of radiological findings with endoscopic evaluation greatly improves the pretherapeutic staging accuracy of laryngeal cancers, and significantly impacts the choice of management strategies in these patients. Imaging studies also help in the post-therapeutic surveillance and follow-up of patients with laryngeal cancers. In this article, we review the currently used laryngeal imaging techniques and protocols, the key anatomic structures relevant to tumor spread and the characteristic patterns of submucosal extension and invasion of laryngeal cancer. The role of CT, MRI and PET-CT in the evaluation of patients with laryngeal SCC and the impact of imaging findings on prognosis and clinical management is also discussed. PMID:23599569

  12. Bioengineered nerve regeneration and muscle reinnervation

    PubMed Central

    Kingham, Paul J; Terenghi, Giorgio

    2006-01-01

    The peripheral nervous system has the intrinsic capacity to regenerate but the reinnervation of muscles is often suboptimal and results in limited recovery of function. Injuries to nerves that innervate complex organs such as the larynx are particularly difficult to treat. The many functions of the larynx have evolved through the intricate neural regulation of highly specialized laryngeal muscles. In this review, we examine the responses of nerves and muscles to injury, focusing on changes in the expression of neurotrophic factors, and highlight differences between the skeletal limb and laryngeal muscle systems. We also describe how artificial nerve conduits have become a useful tool for delivery of neurotrophic factors as therapeutic agents to promote peripheral nerve repair and might eventually be useful in the treatment of laryngeal nerve injury. PMID:17005023

  13. Determinants of diaphragm motion in unilateral diaphragmatic paralysis.

    PubMed

    Scillia, Pierre; Cappello, Matteo; De Troyer, Andr

    2004-01-01

    Cranial displacement of a hemidiaphragm during sniffs is a cardinal sign of unilateral diaphragmatic paralysis in clinical practice. However, we have recently observed that isolated stimulation of one phrenic nerve in dogs causes the contralateral (inactive) hemidiaphragm to move caudally. In the present study, therefore, we tested the idea that, in unilateral diaphragmatic paralysis, the pattern of inspiratory muscle contraction plays a major role in determining the motion of the inactive hemidiaphragm. We induced a hemidiaphragmatic paralysis in six anesthetized dogs and assessed the contour of the diaphragm during isolated unilateral phrenic nerve stimulation and during spontaneous inspiratory efforts. Whereas the inactive hemidiaphragm moved caudally in the first instance, it moved cranially in the second. The parasternal intercostal muscles were then severed to reduce the contribution of the rib cage muscles to inspiratory efforts and to enhance the force generated by the intact hemidiaphragm. Although the change in pleural pressure (DeltaPpl) was unaltered, the cranial displacement of the paralyzed hemidiaphragm was consistently reduced. A pneumothorax was finally induced to eliminate DeltaPpl during unilateral phrenic nerve stimulation, and this enhanced the caudal displacement of the inactive hemidiaphragm. These observations indicate that, in unilateral diaphragmatic paralysis, the motion of the inactive hemidiaphragm is largely determined by the balance between the force related to DeltaPpl and the force generated by the intact hemidiaphragm. PMID:12949010

  14. Bilateral laryngeal paralysis in a dog secondary to laryngeal osseous metaplasia.

    PubMed

    Skelding, Alicia Marie; Kisiel, Agatha; Essman, Stephanie; Rutland, Bronwyn E

    2016-02-01

    A 7-year-old spayed female Lurcher was evaluated for a chronic history of increased upper respiratory noise. Advanced imaging including digital radiography and pre- and post-contrast computed tomography (CT) scan confirmed the presence of an ill-defined soft tissue mineralized mass of the ventral larynx. Histopathology demonstrated pleocellular myositis and fasciitis with osseous metaplasia. PMID:26834266

  15. Visual Experiences during Paralysis

    PubMed Central

    Whitham, Emma M.; Fitzgibbon, Sean P.; Lewis, Trent W.; Pope, Kenneth J.; DeLosAngeles, Dylan; Clark, C. Richard; Lillie, Peter; Hardy, Andrew; Gandevia, Simon C.; Willoughby, John O.

    2011-01-01

    Rationale: Paralyzed human volunteers (n = 6) participated in several studies the primary one of which required full neuromuscular paralysis while awake. After the primary experiment, while still paralyzed and awake, subjects undertook studies of humor and of attempted eye-movement. The attempted eye-movements tested a central, intentional component to one’s internal visual model and are the subject of this report. Methods: Subjects reclined in a supportive chair and were ventilated after paralysis (cisatracurium, 20 mg intravenously). In illumination, subjects were requested to focus alternately on the faces of investigators standing on the left and the right within peripheral vision. In darkness, subjects were instructed to look away from a point source of light. Subjects were to report their experiences after reversal of paralysis. Results: During attempted eye-movement in illumination, one subject had an illusion of environmental movement but four subjects perceived faces as clearly as if they were in central vision. In darkness, four subjects reported movement of the target light in the direction of attempted eye-movements and three could control the movement of the light at will. Conclusion: The hypothesis that internal visual models receive intended ocular-movement-information directly from oculomotor centers is strengthened by this evidence. PMID:22162967

  16. Muscle paralysis in thyrotoxicosis.

    PubMed

    Siddiqui, Fraz Anwar; Sheikh, Aisha

    2015-01-01

    Thyrotoxic periodic paralysis (TPP) is a condition characterised by muscle paralysis due to hypokalaemia usually secondary to thyrotoxicosis. We report a case of a 31-year-old man with no known comorbidities who presented to a tertiary healthcare unit with a 1-month history of difficulty in breathing, palpitations, weight loss and hoarseness of voice. On examination, his thyroid gland was palpable and fine hand tremors were present. An initial provisional diagnosis of hyperthyroidism was made. Three months after initial presentation, the patient presented in emergency with severe muscle pain and inability to stand. Laboratory results revealed hypokalaemia. All the symptoms reverted over the next few hours on administration of intravenous potassium. A diagnosis of TTP was established. After initial presentation, the patient was treated with carbimazole and propranolol. Once he was euthyroid, radioactive iodine ablation therapy (15?mCi) was carried out as definitive therapy, after which the patient's symptoms resolved; he is currently doing fine on levothyroxine replacement and there has been no recurrence of muscle paralysis. PMID:26025973

  17. Sudden flaccid paralysis.

    PubMed

    Tariq, Mohammad; Peshin, Rohit; Ellis, Oliver; Grover, Karan

    2015-01-01

    Periodic thyrotoxic paralysis is a genetic condition, rare in the West and in Caucasians. Thyrotoxicosis, especially in western hospitals, is an easily overlooked cause of sudden-onset paralysis. We present a case of a 40-year-old man who awoke one morning unable to stand. He had bilateral lower limb flaccid weakness of 0/5 with reduced reflexes and equivocal plantars; upper limbs were 3/5 with reduced tone and reflexes. ECG sinus rhythm was at a rate of 88/min. PR interval was decreased and QT interval increased. Bloods showed potassium of 1.8?mEq/L (normal range 3.5-5), free T4 of 29.2?pmol/L (normal range 6.5-17) and thyroid-stimulating hormone (TSH) of <0.01?mIU/L (normal range 0.35-4.94). Random urinary potassium was 8.8?mEq/L (normal range 12.5-62.5). The patient was admitted initially to intensive therapy unit and given intravenous potassium. His symptoms resolved within 24?h. He was diagnosed with thyrotoxic periodic paralysis. He was discharged on carbimazole and propanolol, and follow-up was arranged in the endocrinology clinic. PMID:25566931

  18. SURGICAL MANAGEMENT OF VOCAL CORD PARALYSIS: THE NEED FOR CAREFUL PATIENT SELECTION

    PubMed Central

    Kokong, DD; Adoga, AA; Bakari, A; Okundia, PO; Onakoya, PA; Nwaorgu, OGB

    2015-01-01

    Background Vocal cord paralysis is one of the challenging laryngeal clinical entities confronting the Laryngologist and indeed, the Phono-surgeon. The ability to maintain an effective balance between voice and airway function to ensure good quality of life requires expertise. This study is therefore designed to highlight our experience on surgical management of vocal cord paralysis. Method Clinical notes of all patients that met the inclusion criteria for this study on vocal cord paralysis over a ten-year period were analysed. Data was generated from patients case files retrieved using standard codes according to the International Classification of Diseases (ICD-10). Results From the 7,941 new ENT cases seen, 26 patients had vocal cord paralysis (VCP) giving a prevalence of 0.3%. The male to female ratio was 1: 4.2 with a mean age of 45.7years 6.3. Their ages ranged from 2180 years. Thyroidectomy was the main causal factor in 46.2% while idiopathic causes was documented in 23.1%. Twenty-three patients (88.5%) had unilateral VCP from which 21(91.3%) were abductor paralysis. The ratio of Left: Right VCP was 3:1. All the 3 bilateral cases were abductor paralysis. Neurotropic agents only, were effective in cases of unilateral VCP. However, in those with bilateral paralysis, two had tracheostomy only, while the third had a laryngo-fissure, arytenoidoplasty and endo-laryngeal stenting in addition. All were successfully decannulated with good voice quality. Conclusion With these observations, we suggest the choice of appropriate surgical technique, timing and careful patient selection in order to preserve voice, curtail operative sequelae and achieve good quality of life (QoL) which is the overall management strategy, be borne in mind.

  19. Laryngeal schwannoma: excision via a laryngofissure approach

    PubMed Central

    Tse, Antonia; Anwar, Bilal

    2015-01-01

    Schwannomas are peripheral nerve neurogenic tumours and although not common, laryngeal schwannomas can provide a unique challenge in diagnostic and treatment management. There are limited reports in the literature on approaches to management. A 73-year-old lady presented to the otolaryngology department after a MRI scan demonstrated an incidental right supraglottic mass. Further investigations included CT scanning and microlaryngoscopy, which only confirmed the presence of the mass with no histology diagnosis. Excision was undertaken by a laryngofissure approach and tracheostomy. Histology confirmed a benign ancient schwannoma. PMID:26034238

  20. Genetics Home Reference: Hyperkalemic periodic paralysis

    MedlinePLUS

    ... literature OMIM Genetic disorder catalog Conditions > Hyperkalemic periodic paralysis On this page: Description Genetic changes Inheritance Diagnosis ... definitions Reviewed August 2013 What is hyperkalemic periodic paralysis? Hyperkalemic periodic paralysis is a condition that causes ...

  1. Genetics Home Reference: Hypokalemic periodic paralysis

    MedlinePLUS

    ... literature OMIM Genetic disorder catalog Conditions > Hypokalemic periodic paralysis On this page: Description Genetic changes Inheritance Diagnosis ... definitions Reviewed April 2007 What is hypokalemic periodic paralysis? Hypokalemic periodic paralysis is a condition that causes ...

  2. [Rehabilitation of facial paralysis].

    PubMed

    Martin, F

    2015-10-01

    Rehabilitation takes an important part in the treatment of facial paralysis, especially when these are severe. It aims to lead the recovery of motor activity and prevent or reduce sequelae like synkinesis or spasms. It is preferable that it be proposed early in order to set up a treatment plan based on the results of the assessment, sometimes coupled with an electromyography. In case of surgery, preoperative work is recommended, especially in case of hypoglossofacial anastomosis or lengthening temporalis myoplasty (LTM). Our proposal is to present an original technique to enhance the sensorimotor loop and the cortical control of movement, especially when using botulinum toxin and after surgery. PMID:26195012

  3. Human laryngeal ganglia contain both sympathetic and parasympathetic cell types.

    PubMed

    Ibanez, Marta; Valderrama-Canales, Francisco J; Maranillo, Eva; Vazquez, Teresa; Pascual-Font, Arn; McHanwell, Stephen; Sanudo, Jose

    2010-09-01

    The presence of ganglia associated with the laryngeal nerves is well documented. In man, these ganglia have been less well studied than in other species and, in particular, the cell types within these ganglia are less well characterized. Using a panel of antibodies to a variety of markers found in the paraganglion cells of other species, we were able to show the existence of at least two populations of cells within human laryngeal paraganglia. One population contained chromogranin and tyrosine hydroxylase representing a neurosecretory population possibly secreting dopamine. A second population of choline acetyltransferase positive cells would appear to have a putative parasympathetic function. Further work is needed to characterize these cell populations more fully before it will be possible to assign functions to these cell types but our results are consistent with the postulated functions of these ganglia as chemoreceptors, neurosecretory cells, and regulators of laryngeal mucus secretion. PMID:20821402

  4. [Laryngeal cancer risk factors].

    PubMed

    Jurkiewicz, Dariusz; Dzaman, Karolina; Rapiejko, Piotr

    2006-07-01

    Laryngeal cancer is the most common of head and neck cancers. Neoplasm used to develop basing on DNA mutation which leads to uncontrolled growth and cells' division. It is due to spontaneous mutations or influence of chemical, biological and physical factors. Laryngeal cancer generation is conditioned by many synergic factors. Some of them certainly participate in cancer genesis and this thesis is accepted by medical environment and other of them have been discussed giving different information. Definition of the risk factors role in laryngeal cancer etiology is very difficult especially regarding their contemporary occurrence in one person. Most common risk factors are environmental factors, gastroesophageal reflux, viral infections, diet, radiation, individual predisposition. Some of them, such as cigarette smoking and abuse alcohol are significantly oftener confirmed in patients with neoplasm diagnosis and others' role in developing of illness has been still researched. Thus the purpose of the study was to present so far achievements in laryngeal cancer etiology and to emphasize controversies relating to some factors' role in cancer genesis. PMID:17007303

  5. A computational study of the role of the aortic arch in idiopathic unilateral vocal-fold paralysis.

    PubMed

    Williams, Megan J; Ayylasomayajula, Avinash; Behkam, Reza; Bierhals, Andrew J; Jacobs, M Eileen; Edgar, Julia D; Paniello, Randal C; Barkmeier-Kraemer, Julie M; Vande Geest, Jonathan P

    2015-02-15

    Unilateral vocal-fold paralysis (UVP) occurs when one of the vocal folds becomes paralyzed due to damage to the recurrent laryngeal nerve (RLN). Individuals with UVP experience problems with speaking, swallowing, and breathing. Nearly two-thirds of all cases of UVP is associated with impaired function of the left RLN, which branches from the vagus nerve within the thoracic cavity and loops around the aorta before ascending to the larynx within the neck. We hypothesize that this path predisposes the left RLN to a supraphysiological, biomechanical environment, contributing to onset of UVP. Specifically, this research focuses on the identification of the contribution of the aorta to onset of left-sided UVP. Important to this goal is determining the relative influence of the material properties of the RLN and the aorta in controlling the biomechanical environment of the RLN. Finite element analysis was used to estimate the stress and strain imposed on the left RLN as a function of the material properties and loading conditions. The peak stress and strain in the RLN were quantified as a function of RLN and aortic material properties and aortic blood pressure using Spearman rank correlation coefficients. The material properties of the aortic arch showed the strongest correlation with peak stress [? = -0.63, 95% confidence interval (CI), -1.00 to -0.25] and strain (? = -0.62, 95% CI, -0.99 to -0.24) in the RLN. Our results suggest an important role for the aorta in controlling the biomechanical environment of the RLN and potentially in the onset of left-sided UVP that is idiopathic. PMID:25477351

  6. A computational study of the role of the aortic arch in idiopathic unilateral vocal-fold paralysis

    PubMed Central

    Williams, Megan J.; Ayylasomayajula, Avinash; Behkam, Reza; Bierhals, Andrew J.; Jacobs, M. Eileen; Edgar, Julia D.; Paniello, Randal C.; Barkmeier-Kraemer, Julie M.

    2014-01-01

    Unilateral vocal-fold paralysis (UVP) occurs when one of the vocal folds becomes paralyzed due to damage to the recurrent laryngeal nerve (RLN). Individuals with UVP experience problems with speaking, swallowing, and breathing. Nearly two-thirds of all cases of UVP is associated with impaired function of the left RLN, which branches from the vagus nerve within the thoracic cavity and loops around the aorta before ascending to the larynx within the neck. We hypothesize that this path predisposes the left RLN to a supraphysiological, biomechanical environment, contributing to onset of UVP. Specifically, this research focuses on the identification of the contribution of the aorta to onset of left-sided UVP. Important to this goal is determining the relative influence of the material properties of the RLN and the aorta in controlling the biomechanical environment of the RLN. Finite element analysis was used to estimate the stress and strain imposed on the left RLN as a function of the material properties and loading conditions. The peak stress and strain in the RLN were quantified as a function of RLN and aortic material properties and aortic blood pressure using Spearman rank correlation coefficients. The material properties of the aortic arch showed the strongest correlation with peak stress [? = ?0.63, 95% confidence interval (CI), ?1.00 to ?0.25] and strain (? = ?0.62, 95% CI, ?0.99 to ?0.24) in the RLN. Our results suggest an important role for the aorta in controlling the biomechanical environment of the RLN and potentially in the onset of left-sided UVP that is idiopathic. PMID:25477351

  7. [Vocal cord paralysis associated with tracheal intubation: incidence, risk analysis, and classification of severity].

    PubMed

    Kikura, Mutsuhito; Suzuki, Yuji; Itagaki, Taiga; Sato, Tsunehisa; Nishino, Junko

    2015-01-01

    Vocal cord paralysis after tracheal intubation is rare. It causes severe hoarseness and aspiration, and delays recovery and discharge. Arytenoid cartilage dislocation and recurrent nerve paralysis are main causes of vocal cord paralysis. Physical stimulation of the tracheal tube as well as patient and surgical characteristics also contribute. Vocal cord paralysis occurs in 1 (0.07%) of 1,500 general surgery patients and on the left side in 70% of cases. It is associated with surgery/anesthesia time (two-fold, 3-6 hours; 15-fold, over 6 hours), age (three-fold, over 50 years), and diabetes mellitus or hypertension (two-fold). Symptoms resolve in 2-3 months. In adult cardiovascular surgery, vocal cord paralysis occurs in 1 (0.7-2%) of 50-100 cardiac surgery patients and 1 (8.6-32%) of 3-10 thoracic aortic surgery patients. In pediatric cardiac surgery, vocal cord paralysis occurs in 1 (0.1-0.5%) of 200-1,000 patients. We classified the severity of vocal cord paralysis as I, severe hoarseness; II, aspiration or dysphagia; and III, bilateral vocal cord paralysis, aspiration pneumonia, or the need for tracheal re-intubation or tracheotomy. We discuss the importance of informed consent for the patient and family. PMID:25993750

  8. Facial paralysis and the role of free muscle transplantation.

    PubMed

    Zuker, R M

    2015-10-01

    Facial paralysis can have significant functional, psychological and aesthetic concerns that alter the lives of our patients. These effects can be functional, affecting the eye, nose and mouth, or aesthetic, affecting the symmetry of the face and particularly the mimetic function of smile. Several reanimation procedures have been described to address this. In this chapter, we will outline our technique for reanimation utilizing segmental gracilis muscle transplants to the face. These are innervated either by the contralateral normal 7thnerve via a cross face nerve graft, or a different ipsilateral motor where no 7thnerve is available or would not produce the required result. The other ipsilateral motor that we have found extremely effective is the motor nerve to masseter. This can power a segmental gracilis muscle transplant and lead to excursion that is near normal. These techniques will be described in detail. PMID:26143046

  9. Sleep paralysis as spiritual experience.

    PubMed

    Hufford, David J

    2005-03-01

    This article presents an overview of the sleep paralysis experience from both a cultural and a historical perspective. The robust, complex phenomenological pattern that represents the subjective experience of sleep paralysis is documented and illustrated. Examples are given showing that, for a majority of subjects, sleep paralysis is taken to be a kind of spiritual experience. This is, in part, because of the very common perception of a non-physical 'threatening presence' that is part of the event. Examples from various cultures, including mainstream contemporary America which has no widely known tradition about sleep paralysis, are used to show that the complex pattern and spiritual interpretation are not dependent on cultural models or prior learning. This is dramatically contrary to conventional explanations of apparently 'direct' spiritual experiences, explanations that are summed up as the 'Cultural Source Hypothesis.' This aspect of sleep paralysis was not recognized through most of the twentieth century. The article examines the way that conventional modern views of spiritual experience, combined with medical ideas that labeled 'direct' spiritual experiences as psychopathological, and mainstream religious views of such experiences as heretical if not pathological, suppressed the report and discussion of these experiences in modern society. These views have resulted in confusion in the scientific literature on sleep paralysis with regard to its prevalence and core features. The article also places sleep paralysis in the context of other 'direct' spiritual experiences and offers an 'Experiential Theory' of cross-culturally distributed spiritual experiences. PMID:15881267

  10. Laryngeal hypersensitivity in chronic cough.

    PubMed

    Hull, J H; Menon, A

    2015-12-01

    Patients with chronic cough often report symptoms arising in the throat, in response to non-specific stimuli. Accordingly, the concept of a 'hypersensitivity' of the larynx in chronic cough has evolved over the past ten years. Patients with cough and laryngeal hypersensitivity frequently report features that overlap other laryngeal dysfunction syndromes, including a tendency for the vocal cords to inappropriately adduct. The mechanisms underlying laryngeal hypersensitivity in chronic cough are currently unclear, however recent studies provide new clinical and physiological techniques to aid detection and monitoring of laryngeal hypersensitivity. This review provides an overview of the current state of knowledge in this field. PMID:26325433

  11. Children and Teens with Paralysis

    MedlinePLUS

    ... Center Ask Our Experts Newly Paralyzed Emergency Management Spinal Cord Injury Types Secondary Issues Rehabilitation Centers Health Insurance Social ... Sclerosis Muscular Dystrophy Post-Polio Syndrome Spina Bifida Spinal Cord Injury Syringomyelia / Tethered Cord Transverse Myelitis Paralysis and Its ...

  12. Nerve Agent Toxicity and Treatment.

    PubMed

    Holstege, Christopher P; Dobmeier, Stephen G

    2005-03-01

    The clinical syndrome of nerve agent toxicity varies widely, ranging from the classic cholinergic syndrome to flaccid paralysis and status epilepticus. All nerve agents are capable of producing marked neuropathology. Seizure control is strongly associated with protection against acute lethality and brain pathology. The mainstays of therapy of nerve agent poisoned patients are atropine, pralidoxime, and benzodiazepines. Fosphenytoin provides little therapeutic anticonvulsant effectiveness for nerve agent-induced status epilepticus. Tachycardia is not a contraindication to treatment with atropine in nerve agent toxicity. Atropine should be administered to alleviate respiratory distress, symptomatic bradycardia, and as an adjunct to benzodiazepines and pralidoxime to alleviate seizure activity. In significant nerve agent toxicity, a continuous pralidoxime infusion may be considered. PMID:15676112

  13. [Intraluminal surgical procedures for glottic enlargement in bilateral vocal fold paralysis in adduction].

    PubMed

    Pfeiffer, J; Laszig, R; Maier, W

    2011-02-01

    Bilateral vocal fold paralysis with paramedian position of the vocal chords can result from iatrogenic or traumatic nerve injuries, neurologic disorders and extralaryngeal malignancies and usually causes significant shortness of breath while the voice is only slightly affected. Only about 10% of the affected patients tolerate the narrowed airway caused by bilateral vocal fold paralysis in adduction, so most patients are candidates for a surgical intervention. Today, a range of intraluminal surgical procedures for enlargement of the glottis in bilateral vocal fold paralysis have been described which intend to avoid or supersede tracheostomy and which have replaced time-consuming external approaches to the glottis. This report provides an overview of the most important intraluminal surgical procedures for bilateral vocal fold paralysis in adduction and comments in detail on indications, surgical techniques, advantages and potential complications of the presented procedures for temporary or definitive enlargement of the glottis. PMID:21170510

  14. [Late ulnar paralysis. Study of a series of 17 cases].

    PubMed

    Mansat, M; Bonnevialle, P; Fine, X; Guiraud, B; Testut, M F

    1984-02-16

    Seventeen cases of late ulnar paralysis treated by neurolysis-transposition are reported. The clinical characteristics of these paralyses are emphasized: very prolonged symptom free interval, rapid onset and severe involvement. Ulnar transposition was most often done subcutaneously. Cubitus valgus and definite nerve compression proximal to the arcade of the flexor carpi ulnaris muscle are almost always present. The results as regards the neuropathy are undependable: no patient is completely cured and only half are improved. An anatomical study of the nerve path shows the essential role, in the compression of the nerve, of the muscular arcade of the flexor carpi ulnaris muscle which acts in a way similar to the bridge of a violin. Hence, opening it longitudinally is the principal step of neurolysis. This should be routine before the first signs of neuropathy occur in an elbow whose axis is out of alignment as a sequela of a childhood injury. PMID:6322339

  15. Artifacts produced during electrical stimulation of the vestibular nerve in cats. [autonomic nervous system components of motion sickness

    NASA Technical Reports Server (NTRS)

    Tang, P. C.

    1973-01-01

    Evidence is presented to indicate that evoked potentials in the recurrent laryngeal, the cervical sympathetic, and the phrenic nerve, commonly reported as being elicited by vestibular nerve stimulation, may be due to stimulation of structures other than the vestibular nerve. Experiments carried out in decerebrated cats indicated that stimulation of the petrous bone and not that of the vestibular nerve is responsible for the genesis of evoked potentials in the recurrent laryngeal and the cervical sympathetic nerves. The phrenic response to electrical stimulation applied through bipolar straight electrodes appears to be the result of stimulation of the facial nerve in the facial canal by current spread along the petrous bone, since stimulation of the suspended facial nerve evoked potentials only in the phrenic nerve and not in the recurrent laryngeal nerve. These findings indicate that autonomic components of motion sickness represent the secondary reactions and not the primary responses to vestibular stimulation.

  16. Clinically isolated laryngeal sarcoidosis.

    PubMed

    Plaschke, Christina Caroline; Owen, Hanne Hoejris; Rasmussen, Niels

    2011-04-01

    Laryngeal sarcoidosis is rare (0.5% of patients with sarcoidosis), the pathogenesis is unknown and the optimal treatment remains a matter of debate. We undertook this study to elucidate possible pathogenic factors in clinically isolated laryngeal sarcoidosis and to describe results of supraglottoplastic surgery. From 1995 to 2009, we identified six patients with histologically proven sarcoidosis of the larynx treated at Rigshospitalet. All patients were subjected to a panel of blood tests and MR scan of the head and neck. All patients had dyspnoea at admission, and five were subjected to a combination of CO(2)-laser excision of supraglottic tissue and closure of the incision with sutures. All serological tests were negative or normal, including angiotensin 1 converting enzyme. The clinical expression was uniform with pale, smooth swellings of the supraglottic structures. Surgery proved successful to maintain normal breathing. None of the many parameters examined--some previously having been found to be abnormal in sarcoidosis--were abnormal in the present cohort. We are therefore unable to elucidate the pathogenesis. The combined surgical approach re-established normal airway function for all five patients and complete remission without further swellings was seen in two patients. PMID:21132317

  17. Intraoperative identification of the human communicating nerve during thyroidectomy

    PubMed Central

    Hodnett, Benjamin L.; Schmitt, Nicole C.; Thirumala, Parthasarathy D.; Duvvuri, Umamaheswar

    2015-01-01

    The human communicating nerve (HCN) is a connection between the superior and recurrent laryngeal nerves that has been described in cadaveric studies. We report a case of an extralaryngeal variant of the HCN that was identified and stimulated intraoperatively during thyroidectomy. This appears to be the first case of intraoperative identification of this anatomic variant, of which the functional significance remains unclear. PMID:26666834

  18. Intraoperative identification of the human communicating nerve during thyroidectomy.

    PubMed

    Hodnett, Benjamin L; Schmitt, Nicole C; Thirumala, Parthasarathy D; Duvvuri, Umamaheswar

    2015-01-01

    The human communicating nerve (HCN) is a connection between the superior and recurrent laryngeal nerves that has been described in cadaveric studies. We report a case of an extralaryngeal variant of the HCN that was identified and stimulated intraoperatively during thyroidectomy. This appears to be the first case of intraoperative identification of this anatomic variant, of which the functional significance remains unclear. PMID:26666834

  19. Respiratory stridor associated with polymyopathy suspected to be hyperkalemic periodic paralysis in four quarter horse foals.

    PubMed

    Traub-Dargatz, J L; Ingram, J T; Stashak, T S; Kiper, M L; Tarr, S; Child, G; MacAllister, C G

    1992-07-01

    Four Quarter Horse foals ranging in age from 6 days to 2 months were determined to have upper airway stridor secondary to polymyopathy suspected to be hyperkalemic periodic paralysis. Electromyography revealed spontaneous muscle activity in all muscles examined. Electromyographic findings were similar in the dams of 3 foals (No. 1, 3 and 4). Hyperkalemia was found in foals 1 and 4. Endoscopically, the upper airway stridor in foals 1 and 3 was confirmed to be attributable to laryngeal and pharyngeal collapse or spasm. Foals 1, 2, and 3 were treated with acetazolamide. Foal 4 was not treated, at the owner's request. Foals 2 and 3 improved with treatment, foal 4's condition was static, and foal 1 required a tracheostomy and laryngeal surgery to manage its upper airway stridor. PMID:1644652

  20. [Laryngeal malignant schwannoma in a 9-year-old boy: report of a clinical case].

    PubMed

    Dvornik, G; Del Piano, A; Segatta, P; Vidi, I; Dalla Palma, P

    1996-12-01

    A case of malignant schwannoma of the larynx in a 9 year old boy is reported. The lesion recurred 29 months later with the same histological pattern. The malignant peripheral nerve sheath tumours of the larynx are rare and are almost exceptional in paediatric age. The Authors discuss the main differential diagnosis of spindle cell paediatric tumors of the laryngeal region. PMID:9206781

  1. Management of Advanced Laryngeal Cancer

    PubMed Central

    Sheahan, Patrick

    2014-01-01

    Squamous cell carcinoma of the larynx continues to be the commonest head and neck cancer in many Western countries. The larynx plays a key role for many essential functions, including breathing, voice production, airway protection, and swallowing. The goals of laryngeal cancer treatment are thus to provide best possible oncologic control, while optimizing functional outcomes. In recent decades, the treatment paradigm for advanced laryngeal cancer has shifted from one of primary surgery (total laryngectomy) as gold standard, toward non-surgical organ-preserving treatment using radiotherapy or chemoradiotherapy. However, concerns have emerged regarding functional outcomes after chemoradiotherapy, as well as possible decreased overall survival in patients with laryngeal cancer. The purpose of the present review is to review surgical and non-surgical options for treatment of advanced laryngeal cancer, as well as the evidence supporting each of these. PMID:24808953

  2. Treatment Option Overview (Laryngeal Cancer)

    MedlinePLUS

    ... and symptoms of laryngeal cancer include a sore throat and ear pain. These and other signs and ... hoarseness in the voice. Tests that examine the throat and neck are used to help detect (find), ...

  3. Evaluation of vocal function in unilateral vocal fold paralysis following thyroplastic surgery.

    PubMed

    Adams, S G; Irish, J C; Durkin, L C; Wong, D L; Brown, D H

    1996-06-01

    Perceptual, acoustic, and aerodynamic measures of vocal function were examined, pre- and post-treatment, in nine patients who had received thyroplastic (type I) surgery for unilateral vocal fold paralysis. Following thyroplasty, the patients showed significant improvements in the following perceptual and acoustic measures of vocal function: perceived breathiness, maximum phonation time, s/z ratio, vocal shimmer, and signal-to-noise ratio. Significant post-treatment changes were also observed in the following aerodynamic measures of phonation: air pressure, average airflow, laryngeal resistance, and breath group duration. These findings suggest that a combination of perceptual, acoustic, and aerodynamic measures of vocal function may be useful for comparing the relative effectiveness of different treatment procedures (i.e., thyroplasty vs. Teflon injection) in unilateral vocal fold paralysis. PMID:8783081

  4. [Laryngeal and pharyngeal actinomycosis].

    PubMed

    Schumann, R; Lorenz, K J; Tisch, M; Maier, H

    2010-08-01

    Cervicofacial actinomycosis is an uncommon infection and in most cases odontogenic in origin. Pharyngeal and/or laryngeal lesions, usually occurring secondary to mucosal trauma, are very rare and may mimic a malignant tumor. In such cases, which represent less than 1% of all cases, the differential diagnosis with upper aerodigestive tract malignancy remains challenging. We report a case of actinomycosis in a 56-year-old male patient who presented with an extensive, centrally necrotic mass in the oropharynx, hypopharynx and larynx region suspected to be a tumor. The lesion was diagnosed 6 months following accidental ingestion of an ear of corn and ultimately proved to be cervicofacial actinomycosis. The clinical and pathological features and current aspects of the diagnosis and treatment of cervicofacial actinomycosis are discussed. PMID:20593159

  5. Laryngeal fracture after coughing.

    PubMed

    Fenig, Mark; Strasberg, Stephen; Cohen, Justin C; Almadi, Rami; Gold, Menachem

    2013-09-01

    Nontraumatic laryngeal fractures are exceedingly rare disease entities. Only 3 prior instances have been described in the medical literature (Br Med J 1950;1:1052; Acta Otorrinolaringol Esp 2007;58:73-4; Otolaryngol Head Neck Surg 2012;147:801-2). We present a case of thyroid cartilage fracture and associated phlegmon formation after a vigorous coughing spell in a 47-year-old man. On presentation, the patient's symptoms included the triad of odynophagia, dysphagia, and dysphonia as well as diffuse swelling and tenderness over the thyroid cartilage. Computed tomography and magnetic resonance imaging revealed a mildly displaced anterior thyroid cartilage fracture as well as a phlegmon in the strap muscle compartment adjacent to the fracture (Figs. 1 and 2). Intravenous dexamethasone and antibiotics were initiated, and the patient was admitted to the medical intensive care unit. On fiberoptic examination with the flexible laryngoscope, the patient was found to have slightto-moderate watery edema of the right aryepiglottic fold and right greater than left arytenoid cartilages. After 48 hours, the patient's neck swelling and pain significantly improved. On hospital day 4, the patient was discharged with a course of oral antibiotics. One week later, the patient reported only mild odynophagia and persistent dysphonia. He otherwise felt well and was tolerating fluids and soft food without difficulty. A preexisting, congenital abnormality resulting in a focal weakness in the thyroid cartilage might predispose patients to nontraumatic fractures (Otolaryngol Head Neck Surg 2012;147:801-2). Patients in prior case reports of nontraumatic laryngeal fractures presented with similar symptoms (Table). The triad of odynophagia, dysphagia, and dysphonia after a severe coughing or sneezing episode should raise the clinician's suspicion of a thyroid cartilage fracture. PMID:23806730

  6. Tuberculous Otitis Media with Facial Paralysis Combined with Labyrinthitis

    PubMed Central

    Hwang, Gyu Ho; Jung, Jong Yoon; Yum, Gunhwee

    2013-01-01

    Tuberculosis otitis media is a very rare cause of otorrhea, so that it is infrequently considered in differential diagnosis because clinical symptoms are nonspecific, and standard microbiological and histological tests for tuberculosis often give false-negative results. We present a rare case presenting as a rapidly progressive facial paralysis with severe dizziness and hearing loss on the ipsilateral side that was managed with facial nerve decompression and anti-tuberculosis therapy. The objective of this article is to create an awareness of ear tuberculosis, and to consider tuberculosis in the differential diagnosis of chronic otitis media with complications. PMID:24653900

  7. Single-stage dynamic reanimation of the smile in irreversible facial paralysis by free functional muscle transfer.

    PubMed

    Thiele, Jan; Bannasch, Holger; Stark, G Bjoern; Eisenhardt, Steffen U

    2015-01-01

    Unilateral facial paralysis is a common disease that is associated with significant functional, aesthetic and psychological issues. Though idiopathic facial paralysis (Bell's palsy) is the most common diagnosis, patients can also present with a history of physical trauma, infectious disease, tumor, or iatrogenic facial paralysis. Early repair within one year of injury can be achieved by direct nerve repair, cross-face nerve grafting or regional nerve transfer. It is due to muscle atrophy that in long lasting facial paralysis complex reconstructive methods have to be applied. Instead of one single procedure, different surgical approaches have to be considered to alleviate the various components of the paralysis. The reconstruction of a spontaneous dynamic smile with a symmetric resting tone is a crucial factor to overcome the functional deficits and the social handicap that are associated with facial paralysis. Although numerous surgical techniques have been described, a two-stage approach with an initial cross-facial nerve grafting followed by a free functional muscle transfer is most frequently applied. In selected patients however, a single-stage reconstruction using the motor nerve to the masseter as donor nerve is superior to a two-stage repair. The gracilis muscle is most commonly used for reconstruction, as it presents with a constant anatomy, a simple dissection and minimal donor site morbidity. Here we demonstrate the pre-operative work-up, the post-operative management, and precisely describe the surgical procedure of single-stage microsurgical reconstruction of the smile by free functional gracilis muscle transfer in a step by step protocol. We further illustrate common pitfalls and provide useful tips which should enable the reader to truly comprehend the procedure. We further discuss indications and limitations of the technique and demonstrate representative results. PMID:25868011

  8. Respiratory sensations, cardiovascular control, kinaesthesia and transcranial stimulation during paralysis in humans.

    PubMed Central

    Gandevia, S C; Killian, K; McKenzie, D K; Crawford, M; Allen, G M; Gorman, R B; Hales, J P

    1993-01-01

    1. To determine whether discomfort associated with breathing (dyspnoea) is related to the chemical drive to breath, three subjects were totally paralysed while fully conscious. Subjective responses to a rising CO2 stimulus were obtained during rebreathing, rebreathing with CO2 added, and breath holding. Dyspnoea was measured with a 10-point Borg scale. 2. Following nasotracheal intubation and ventilation (oxygen saturation, O2,Sat, 98-100% and end-tidal CO2, PET,CO2, 30-40 mmHg), total neuromuscular blockade was induced by a rapid injection of atracurium (> 2.5 mg kg-1) and complete paralysis was maintained with an infusion (5 mg (kg h)-1). Paralysis was confirmed by abolition of the compound muscle action potentials of both the diaphragm and abductor hallucis evoked by supramaximal electrical stimulation of the relevant nerves. Communication via finger movement was preserved for the first 20-30 min following paralysis by inflation of a sphygmomanometer cuff on one arm. 3. Before and during complete paralysis, dyspnoea increased progressively during hypercapnia produced by rebreathing (with or without CO2 added to the circuit at 250 ml min-1). The mean PET,CO2 eliciting 'severe' dyspnoea was 46 mmHg during rebreathing, 42 mmHg during 'breath holding', and 52 mmHg during rebreathing with added CO2. There were no significant differences between the values obtained during paralysis and in the control study immediately before paralysis. The duration of breath holding was not prolonged by paralysis and the PET,CO2 at the 'break point' was not altered by paralysis. 4. Thus, dyspnoea is preserved following total neuromuscular blockade. This suggests that chemoreceptor activity, via the central neuronal activity which it evokes, can lead to discomfort in the absence of any contraction of respiratory muscles. 5. During paralysis, attempted contraction of arm, leg and trunk muscles increased heart rate and blood pressure. For attempted handgrip contractions, the increases in heart rate (range, 7-15 beats min-1) and mean arterial pressure (range, 20-32 mmHg) were similar to those recorded with actual contractions in trials immediately before paralysis. In one subject, graded increases in heart rate and blood pressure occurred for attempted contractions of 45 s duration over a range of intensities (0-100% maximal effort). 6. During complete paralysis, transcranial electromagnetic stimulation of the motor cortex produced illusory twitch-like movements of the wrist and digits. This also occurred in separate studies during complete ischaemic paralysis and anaesthesia of the forearm and hand.(ABSTRACT TRUNCATED AT 400 WORDS) PMID:8308755

  9. The effects of botulinum toxin injections into the cricopharyngeus muscle of patients with cricopharyngeus dysfunction associated with pharyngo-laryngeal weakness.

    PubMed

    Woisard-Bassols, Virginie; Alshehri, Sarah; Simonetta-Moreau, Marion

    2013-03-01

    This prospective, open study was carried out in order to assess changes in the swallowing and dietary status after injection of Botulinum toxin A (BoNT-A) into the upper esophageal sphincter (UES) in a series of patients with cricopharyngeus (CP) muscle dysfunction associated with pharyngo-laryngeal weakness during at least 1 year follow-up after treatment. Patients who had a cricopharyngeus (CP) muscle dysfunction associated with pharyngo-laryngeal weakness and who were at risk for aspiration were included in the study. The upper border of the cricoid cartilage was identified and the CP muscle localized using a standard electromyogram (EMG). The dose of BoNT-A was determined depending on the results of EMG performed just before the injection. Outcomes were assessed by the penetration-aspiration scale (PAS), the level of residue in the pyriform sinus and the National Institute of Health-Swallow Safety Scale (NIH-SSS) on a video fluoroscopic swallowing (VFSS) assessment, the patient's subjective impressions of their ability to swallow by the Deglutition Handicap Index (DHI), and changes in dietary status by the Functional Oral Intake Scale. Eleven patients underwent the complete assessment of swallowing function at 1, 3, 6, and 12 months. After the first set of treatment, seven patients had a good response and four did not respond. A significant decrease in the PAS score (p = 0.03), the amount of residue (p = 0.04) and the NIH-SSS score (p = 0.03) was observed 3 months after the injection in comparison with the first VFSS before the treatment. A relapse of dysphagia occurred in 3 out of the 11 treated patients; at 3 and 4 months for 2 patients with a Wallenberg syndrome, and at 11 months for a patient with cranial nerve paralysis after a surgery for a glomus tumor. Two of them underwent a second injection. One patient had a good response and remained stable for at least 1 year. The second did not respond either to the second injection or to a myotomy of the cricopharyngeal muscle. The third one is waiting for further surgery (myotomy). Therefore, at the end of the study and after a follow-up of at least 12 months, 5 patients out of the 11 enrolled had a good result. Percutaneous injection of BoNT-A into the UES can be a useful solution to improve cricopharyngeal dysfunction, despite the underlying pharyngo-laryngeal weakness. PMID:22865104

  10. Surgical and conservative methods for restoring impaired motor function - facial nerve, spinal accessory nerve, hypoglossal nerve (not including vagal nerve or swallowing)

    PubMed Central

    Laskawi, R.; Rohrbach, S.

    2005-01-01

    The present review gives a survey of rehabilitative measures for disorders of the motor function of the mimetic muscles (facial nerve), and muscles innervated by the spinal accessory and hypoglossal nerves. The dysfunction can present either as paralysis or hyperkinesis (hyperkinesia). Conservative and surgical treatment options aimed at restoring normal motor function and correcting the movement disorders are described. Static reanimation techniques are not dealt with. The final section describes the use of botulinum toxin in the therapy of dysphagia. PMID:22073058

  11. A curious case of paralysis.

    PubMed

    Fox, Caroline

    2016-03-01

    Primary hyperaldosteronism is found in up to 13% of patients with hypertension. This article describes a patient with hypokalemia, hypertension, and periodic paralysis that were caused by primary hyperaldosteronism. Plasma aldosterone concentration to plasma renin activity ratio is a common screening test, and adrenal vein sampling can be performed to determine which gland is overproducing aldosterone. Treatment with mineralocorticoid receptor antagonists or adrenalectomy gives similar reductions in BP. PMID:26914776

  12. Toward A Simulation-Based Tool for the Treatment of Vocal Fold Paralysis

    PubMed Central

    Mittal, Rajat; Zheng, Xudong; Bhardwaj, Rajneesh; Seo, Jung Hee; Xue, Qian; Bielamowicz, Steven

    2011-01-01

    Advances in high-performance computing are enabling a new generation of software tools that employ computational modeling for surgical planning. Surgical management of laryngeal paralysis is one area where such computational tools could have a significant impact. The current paper describes a comprehensive effort to develop a software tool for planning medialization laryngoplasty where a prosthetic implant is inserted into the larynx in order to medialize the paralyzed vocal fold (VF). While this is one of the most common procedures used to restore voice in patients with VF paralysis, it has a relatively high revision rate, and the tool being developed is expected to improve surgical outcomes. This software tool models the biomechanics of airflow-induced vibration in the human larynx and incorporates sophisticated approaches for modeling the turbulent laryngeal flow, the complex dynamics of the VFs, as well as the production of voiced sound. The current paper describes the key elements of the modeling approach, presents computational results that demonstrate the utility of the approach and also describes some of the limitations and challenges. PMID:21556320

  13. Toward a simulation-based tool for the treatment of vocal fold paralysis.

    PubMed

    Mittal, Rajat; Zheng, Xudong; Bhardwaj, Rajneesh; Seo, Jung Hee; Xue, Qian; Bielamowicz, Steven

    2011-01-01

    Advances in high-performance computing are enabling a new generation of software tools that employ computational modeling for surgical planning. Surgical management of laryngeal paralysis is one area where such computational tools could have a significant impact. The current paper describes a comprehensive effort to develop a software tool for planning medialization laryngoplasty where a prosthetic implant is inserted into the larynx in order to medialize the paralyzed vocal fold (VF). While this is one of the most common procedures used to restore voice in patients with VF paralysis, it has a relatively high revision rate, and the tool being developed is expected to improve surgical outcomes. This software tool models the biomechanics of airflow-induced vibration in the human larynx and incorporates sophisticated approaches for modeling the turbulent laryngeal flow, the complex dynamics of the VFs, as well as the production of voiced sound. The current paper describes the key elements of the modeling approach, presents computational results that demonstrate the utility of the approach and also describes some of the limitations and challenges. PMID:21556320

  14. Thyrotoxic periodic paralysis in a white woman.

    PubMed

    Dixon, A N; Jones, R

    2002-11-01

    A 24 year old white woman presented with sudden onset of flaccid quadriparesis and hypokalaemia. She was later found to be thyrotoxic. Paralysis resolved with potassium supplements, and after initiation of antithyroid medication she had no further episodes of hypokalaemic paralysis. To the best of the authors' knowledge, and after a Medline search, thyrotoxic periodic paralysis has not been described previously in a white woman. PMID:12496329

  15. Menthol suppresses laryngeal C-fiber hypersensitivity to cigarette smoke in a rat model of gastroesophageal reflux disease: the role of TRPM8.

    PubMed

    Liu, Bi-Yu; Lin, Yu-Jung; Lee, Hung-Fu; Ho, Ching-Yin; Ruan, Ting; Kou, Yu Ru

    2015-03-01

    Patients with gastroesophageal reflux disease (GERD) display enhanced laryngeal reflex reactivity to stimuli that may be due to sensitization of the laryngeal C-fibers by acid and pepsin. Menthol, a ligand of transient receptor potential melastatin-8 (TRPM8), relieves throat irritation. However, the possibility that GERD induces laryngeal C-fiber hypersensitivity to cigarette smoke (CS) and that menthol suppresses this event has not been investigated. We delivered CS into functionally isolated larynxes of 160 anesthetized rats. Laryngeal pH 5-pepsin treatment, but not pH 5-denatured pepsin, augmented the apneic response to CS, which was blocked by denervation or perineural capsaicin treatment (a procedure that blocks the conduction of C fibers) of the superior laryngeal nerves. This augmented apnea was partially attenuated by capsazepine [an transient receptor potential vanilloid 1 (TRPV1) antagonist], SB-366791 (a TRPV1 antagonist), and HC030031 [a transient receptor potential ankyrin 1 (TRPA1) antagonist] and was completely prevented by a combination of TRPV1 and TRPA1 antagonists. Local application of menthol significantly suppressed the augmented apnea and this effect was reversed by pretreatment with AMTB (a TRPM8 antagonist). Our electrophysiological studies consistently revealed that laryngeal pH 5-pepsin treatment increased the sensitivity of laryngeal C-fibers to CS. Likewise, menthol suppressed this laryngeal C-fiber hypersensitivity and its effect could be reversed by pretreatment with AMTB. Our results suggest that laryngeal pH 5-pepsin treatment increases sensitivity to CS of both TRPV1 and TRPA1, which are presumably located at the terminals of laryngeal C-fibers. This sensory sensitization leads to enhanced laryngeal reflex reactivity and augmentation of the laryngeal C-fiber responses to CS, which can be suppressed by menthol acting via TRPM8. PMID:25539933

  16. Laryngeal metastasis from lung cancer

    PubMed Central

    Kalai, Umasankar; Madan, Karan; Jain, Deepali; Mohan, Anant; Guleria, Randeep

    2015-01-01

    Metastatic tumors of the larynx are rare. The most common tumors metastasizing to the larynx are melanoma and renal cell carcinoma. Bronchogenic carcinoma metastasizing to the larynx has been rarely described. Herein, we report the case of a 49-year-old, chronic smoker, who incidentally had a laryngeal growth detected during flexible bronchoscopy examination for evaluation of suspected lung cancer. Histopathological examination of the laryngeal nodule and the biopsy obtained from the main bronchus growth confirmed the diagnosis of metastatic squamous cell carcinoma to the larynx from primary lung cancer. PMID:25983415

  17. Genetics Home Reference: Infantile-onset ascending hereditary spastic paralysis

    MedlinePLUS

    ... disorder catalog Conditions > Infantile-onset ascending hereditary spastic paralysis On this page: Description Genetic changes Inheritance Diagnosis ... 2007 What is infantile-onset ascending hereditary spastic paralysis? Infantile-onset ascending hereditary spastic paralysis is a ...

  18. [Vocal cord paralysis after thyroid surgery : Current medicolegal aspects of intraoperative neuromonitoring].

    PubMed

    Dralle, H; Schneider, R; Lorenz, K; Phuong, N Thanh; Sekulla, C; Machens, A

    2015-07-01

    Intraoperative neuromonitoring (IONM) has been commercially available for approximately 15 years and is highly predictive in thyroid gland surgery concerning either postoperative vocal fold mobility in the case of an intact signal for muscle action electromyogram (EMG, >?99?% right negative) or vocal fold dysfunction in the case of loss of signal (>?70?% right positive). The use of IONM improves the intraoperative identification of recurrent laryngeal nerve function and due to the high predictive value with respect to the expected vocal cord function the result of IONM has to be integrated into the surgical concept of thyroidectomy. Unilateral loss of function of the recurrent laryngeal nerve cannot be completely avoided despite correct application of IONM; however, bilateral vocal fold palsy can be safely avoided when contralateral surgery is cancelled after a loss of signal occurs during resection of the first side in planned bilateral surgery (alternative strategy). Patients have to be informed preoperatively about the limitations of IONM and potential strategy changes during planned bilateral surgery. Surgeons should apply IONM according to the published current recommendations and by selecting a risk-oriented intraoperative strategy in the case of loss of signal from the recurrent laryngeal nerve. PMID:26099288

  19. Laryngeal dysfunction in Amyotrophic Lateral Sclerosis: a review and case report

    PubMed Central

    Watts, Christopher R; Vanryckeghem, Martine

    2001-01-01

    Background Laryngeal dysfunction can be a salient feature in the clinical symptomatology of speakers diagnosed with Amyotrophic Lateral Sclerosis (ALS). In addition to dysphonia, swallowing function is also disrupted. This paper reviews what is known about laryngeal dysfunction resulting from ALS. Results Presented is a case report of a female, diagnosed with ALS, whose initial symptoms were caused by laryngeal bulbar involvement that was characterized by dysphonia and dysphagia. Conclusions In bulbar forms of ALS, voice and/or swallowing difficulties are often the initial signs of disease. Careful examination of the muscles innervated by bulbar nerves, and tracking the rate of progressive deficit in the affected muscles, will help to solidify an accurate diagnosis. With therapy, the ability to swallow safely may still be maintained even when voice and articulation abilities are such that oral communication is inefficient. PMID:11722802

  20. Tick paralysis cases in Argentina.

    PubMed

    Remondegui, Carlos

    2012-01-01

    Tick paralysis (TP) occurs worldwide and is caused by a neurotoxin secreted by engorged female ticks that affects the peripheral and central nervous system. The clinical manifestations range from mild or nonspecific symptoms to manifestations similar to Guillain-Barré syndrome, bulbar involvement, and death in 10% of the patients. The diagnosis of TP is clinical. To our knowledge, there are no formal reports of TP in humans in South America, although clusters of TP among hunting dogs in Argentina have been identified recently. In this paper, clinical features of two cases of TP occurring during 1994 in Jujuy Province, Argentina, are described. PMID:22930054

  1. NUMERICAL SIMULATION OF LARYNGEAL FLOW

    EPA Science Inventory

    In this study, we have investigated laryngeal air flows by numerically solving the corresponding Navier-Stokes equations expressed in a two-dimensional cylindrical coordinate system. The glottal aperture, defined by the geometry of the vocal folds was allowed to change with the v...

  2. Dosimetric Predictors of Laryngeal Edema

    SciTech Connect

    Sanguineti, Giuseppe . E-mail: gisangui@utmb.edu; Adapala, Prashanth; Endres, Eugene J. C; Brack, Collin; Fiorino, Claudio; Sormani, Maria Pia; Parker, Brent

    2007-07-01

    Purpose: To investigate dosimetric predictors of laryngeal edema after radiotherapy (RT). Methods and Materials: A total of 66 patients were selected who had squamous cell carcinoma of the head and neck with grossly uninvolved larynx at the time of RT, no prior major surgical operation except for neck dissection and tonsillectomy, treatment planning data available for analysis, and at least one fiberoptic examination of the larynx within 2 years from RT performed by a single observer. Both the biologically equivalent mean dose at 2 Gy per fraction and the cumulative biologic dose-volume histogram of the larynx were extracted for each patient. Laryngeal edema was prospectively scored after treatment. Time to endpoint, moderate or worse laryngeal edema (Radiation Therapy Oncology Group Grade 2+), was calculated with log rank test from the date of treatment end. Results: At a median follow-up of 17.1 months (range, 0.4- 50.0 months), the risk of Grade 2+ edema was 58.9% {+-} 7%. Mean dose to the larynx, V30, V40, V50, V60, and V70 were significantly correlated with Grade 2+ edema at univariate analysis. At multivariate analysis, mean laryngeal dose (continuum, hazard ratio, 1.11; 95% confidence interval, 1.06-1.15; p < 0.001), and positive neck stage at RT (N0-x vs. N +, hazard ratio, 3.66; 95% confidence interval, 1.40-9.58; p = 0.008) were the only independent predictors. Further stratification showed that, to minimize the risk of Grade 2+ edema, the mean dose to the larynx has to be kept {<=}43.5 Gy at 2 Gy per fraction. Conclusion: Laryngeal edema is strictly correlated with various dosimetric parameters; mean dose to the larynx should be kept {<=}43.5 Gy.

  3. Tracheobronchial and laryngeal responses to hypercapnia, histamine and capsaicin in dogs.

    PubMed

    Jammes, Y; Davies, A; Widdicombe, J G

    1985-01-01

    In nine greyhound dogs, anaesthetized with chloralose-urethane, total lung resistance, volume of an isolated cervical tracheal segment and resistance of the isolated larynx were simultaneously measured. Three stimuli were tested: inhalation of a CO2-enriched gas mixture; histamine injected intravenously or administered by aerosol to stimulate primarily lung irritant receptors; and intravenous injection of capsaicin to stimulate primarily lung C-fibre receptors. The stimuli were applied in three successive conditions: neurally-intact animals; denervation of the right lung plus cold block of myelinated fibres in the left cervical vagus nerve; and further blockade of non-myelinated fibres in this nerve. Histamine and capsaicin increased lung and laryngeal resistances, and reduced tracheal volume, and the responses after denervation are consistent with the drugs acting by lung vagal reflexes. In neurally-intact animals, hypercapnia increased total lung resistance, decreased tracheal volume and lowered laryngeal resistance. After elimination of conduction in all myelinated fibres, CO2-induced changes in lung resistance and in tracheal volume were still present. However, the dilating effect of hypercapnia on the larynx diminished markedly. Elimination of all vagal pulmonary afferents abolished the residual laryngeal response to hypercapnia, lowered and delayed changes in tracheal volume and greatly reduced the increase in lung resistance. The results indicate that the laryngeal response to hypercapnia depends on vagal integrity, but the tracheobronchial constrictor effect of CO2 is less affected by vagal denervation. PMID:4074957

  4. The ultrastructure of rat laryngeal epithelia.

    PubMed Central

    Lewis, D J; Prentice, D E

    1980-01-01

    The histology and ultrastructure of the rat laryngeal epithelia are described. Five epithelial types were identified. Stratified squamous epithelium was found over most of the epiglottis, arytenoid projections and lateral ventricles. The vocal folds were covered by a low squamoid type of epithelium. Respiratory epithelium, similar to that found elsewhere in the respiratory tract, occupied all the mucosa caudal to the vocal folds, small areas at the base of the epiglottis and along the inner aspects of the arytenoid projections. Two forms of relatively unusual pseudostratified cuboidal epithelium were present in the ventrolateral aspect at the level of the arytenoid projections and within the ventral pouch. Non-myelinated, intro-epithelial nerve fibres were found throughout the larynx, and were abundant in areas at the base of the epiblottis covered by respiratory epithelium and to a lesser extent in the cuboidal epithelium of the ventral pouch. Globule leucocytes were frequently found within respiratory epithelium, less frequently in cuboidal epithelium and only rarely in squamous areas. Images Fig. 2 Fig. 3 Fig. 4 Fig. 5 Fig. 6 Fig. 7 Fig. 8 Fig. 9 Fig. 10 Fig. 11 Fig. 12 Fig. 13 Fig. 14 Fig. 15 Fig. 16 Fig. 17 PMID:7410202

  5. Hypothalamic modulation of laryngeal reflexes in the anaesthetized cat: role of the nucleus tractus solitarii.

    PubMed Central

    Dawid-Milner, M S; Silva-Carvalho, L; Goldsmith, G E; Spyer, K M

    1995-01-01

    1. This investigation was initiated because activation of laryngeal afferents, either by electrical stimulation of the superior laryngeal nerve (SLN) or by natural stimulation of receptors in the laryngeal mucosa, results in a cardiorespiratory response comprising bradycardia, hypotension and apnoea (phrenic nerve activity was suppressed). This pattern of response is qualitatively equivalent to the response that is evoked on activation of the arterial baroreceptors. 2. Preliminary studies indicated that the effects of activating the SLN were suppressed during stimulation in the hypothalamic defence area (HDA) at points that also blocked the effects of baroreceptor stimulation. 3. Recordings were taken from seventy-two neurones localized within the ipsilateral nucleus tractus solitarii (NTS) whose activity was modified by SLN stimulation. Sixty neurones responded with an EPSP on SLN stimulation; nine of these had an inspiratory firing pattern. Five neurones were seen to receive an IPSP on SLN stimulation. 4. Five respiratory SLN-activated neurones were unresponsive to stimulation of the other nerve inputs, whilst four received convergent EPSP inputs on sinus nerve (SN) stimulation. One cell of these four also received inputs from the aortic and the vagus nerves. Sixty-one non-respiratory SLN-activated neurones also received convergent inputs from the sinus nerve. Of these, fifty displayed an EPSP, four an IPSP and seven an EPSP-IPSP. Fifteen neurones also received inputs from the aortic nerve and seventeen from the vagus. 5. From the population of neurones affected by SLN stimulation, twenty-four of seventy were also influenced by HDA stimulation (3 were respiratory cells). Sixteen of these responses consisted of an EPSP (2 respiratory cells), five of an IPSP (1 respiratory cell) and three of an EPSP-IPSP. 6. In neurones receiving an IPSP on HDA stimulation, the SLN-evoked excitatory response was reduced throughout the period of HDA-evoked inhibition. These neurones were all shown to receive excitatory inputs from the arterial baroreceptors and laryngeal mechanoreceptors. 7. Additionally, in the thirty-seven neurones that were excited by SLN stimulation but received no direct synaptic input on HDA stimulation, a conditioning stimulus to the HDA evoked a block of SLN-evoked responses without an accompanying change in membrane potential. Several of these neurones were also affected by both baroreceptor and laryngeal mechanoreceptor stimulation. 8. These observations are discussed in the context of the role of the NTS in cardiorespiratory control. The potential importance of these interactions in respiratory distress are highlighted and the implications for the organization of central pathways for the control of autonomic and respiratory function are discussed. PMID:8544135

  6. Nerve biopsy

    MedlinePLUS

    ... myelin sheath covering the nerve) Inflammatory nerve conditions (neuropathies) Additional conditions under which the test may be performed: Alcoholic neuropathy Axillary nerve dysfunction Brachial plexopathy Charcot-Marie-Tooth ...

  7. Respiratory motor nerve activities during experimental seizures in cats.

    PubMed

    Terndrup, T E; Knuth, S L; Gdovin, M J; Darnall, R; Bartlett, D

    1996-03-01

    We evaluated respiratory motor nerve activities during experimental seizures induced with subcortical penicillin. The activities of the phrenic (PH), nasolabial (NL), and hypoglossal (HG) nerves and the recurrent laryngeal motor branches to the thyroarytenoid (TA) and posterior cricoarytenoid (PCA) muscles were analyzed in 13 anesthetized, vagotomized, paralyzed, and ventilated cats. During ictal and interictal phases of seizures, nerve activities became irregular and peak integrated nerve activities increased, particularly in the case of the PH nerve. The ictal phase of seizures was associated with increased tonic activity and decreased phasic respiratory discharges, particularly in the cases of the HG, NL, and PCA nerves. During some prolonged ictal discharges, entrainment of nerve activities by cortical spiking was associated with irregular uncoordinated activation, particularly in the TA nerve. These studies help explain respiratory impairment during seizures by providing evidence of impaired coordination between activation of muscles that regulate upper airway patency and activation of the diaphragm. PMID:8964758

  8. The functional anatomy of suggested limb paralysis.

    PubMed

    Deeley, Quinton; Oakley, David A; Toone, Brian; Bell, Vaughan; Walsh, Eamonn; Marquand, Andre F; Giampietro, Vincent; Brammer, Michael J; Williams, Steven C R; Mehta, Mitul A; Halligan, Peter W

    2013-02-01

    Suggestions of limb paralysis in highly hypnotically suggestible subjects have been employed to successfully model conversion disorders, revealing similar patterns of brain activation associated with attempted movement of the affected limb. However, previous studies differ with regard to the executive regions involved during involuntary inhibition of the affected limb. This difference may have arisen as previous studies did not control for differences in hypnosis depth between conditions and/or include subjective measures to explore the experience of suggested paralysis. In the current study we employed functional magnetic resonance imaging (fMRI) to examine the functional anatomy of left and right upper limb movements in eight healthy subjects selected for high hypnotic suggestibility during (i) hypnosis (NORMAL) and (ii) attempted movement following additional left upper limb paralysis suggestions (PARALYSIS). Contrast of left upper limb motor function during NORMAL relative to PARALYSIS conditions revealed greater activation of contralateral M1/S1 and ipsilateral cerebellum, consistent with the engagement of these regions in the completion of movements. By contrast, two significant observations were noted in PARALYSIS relative to NORMAL conditions. In conjunction with reports of attempts to move the paralysed limb, greater supplementary motor area (SMA) activation was observed, a finding consistent with the role of SMA in motor intention and planning. The anterior cingulate cortex (ACC, BA 24) was also significantly more active in PARALYSIS relative to NORMAL conditions - suggesting that ACC (BA 24) may be implicated in involuntary, as well as voluntary inhibition of prepotent motor responses. PMID:23351848

  9. [Facial paralysis surgery. Current concepts].

    PubMed

    Robla-Costales, David; Robla-Costales, Javier; Socolovsky, Mariano; di Masi, Gilda; Fernndez, Javier; Campero, lvaro

    2015-01-01

    Facial palsy is a relatively common condition, from which most cases recover spontaneously. However, each year, there are 127,000 new cases of irreversible facial paralysis. This condition causes aesthetic, functional and psychologically devastating effects in the patients who suffer it. Various reconstructive techniques have been described, but there is no consensus regarding their indication. While these techniques provide results that are not perfect, many of them give a very good aesthetic and functional result, promoting the psychological, social and labour reintegration of these patients. The aim of this article is to describe the indications for which each technique is used, their results and the ideal time when each one should be applied. PMID:25498528

  10. Different navigation of the hypoglossal nerve in the same patient: in the light of the literature.

    PubMed

    Ulu, Sahin; Bucak, Abdulkadir; Gonul, Ycel; Guzel, Hilal; Tekin, Mustafa S

    2013-07-01

    The hypoglossal nerve appears typically between the internal carotid artery and internal jugular vein and down in the lateral groove between these 2 anatomical structures on to the right common carotid artery bifurcation. In this case report, we presented a patient that was operated on for laryngeal carcinoma, and abnormal navigation of hypoglossal nerve was observed during the neck dissection. PMID:23851881

  11. Hyperkalemic periodic paralysis in horses.

    PubMed

    Spier, S J; Carlson, G P; Holliday, T A; Cardinet, G H; Pickar, J G

    1990-10-15

    Eleven horses (3 mares, 7 stallions, 1 gelding) with clinical and biochemical evidence of hyperkalemic periodic paralysis were studied. Each horse had history of episodic weakness, muscular tremors, or collapse, which lasted for periods of a few minutes to hours. Diagnosis was based on hyperkalemia in association with a spontaneous episode of paralysis or by precipitation of an episode by oral administration of potassium chloride. Clinical and biochemical events were documented during spontaneous and induced episodes of muscular weakness. During episodes, electrocardiographic findings were consistent with hyperkalemia. Electromyography performed between episodes revealed fibrillation potentials and positive sharp waves, complex repetitive discharges, and myotonic discharges. Histologic changes in muscle biopsy specimens varied from no overt changes in some horses to vacuolation in type-2B fibers with mild degenerative changes in other horses. Electron microscopy of myofibers revealed dilatations of the sarcoplasmic reticulum. Analysis of blood samples taken serially during induced attacks in 5 horses revealed marked hyperkalemia (5.5 to 9.0 mEq/L), with normal acid-base status, hemoconcentration, and modest changes in muscle-derived enzymes. Close correlation (r2 = 0.882) between total plasma protein and plasma potassium concentrations was observed and indicated a shift of fluid out of the extracellular fluid compartment. Treatment of either spontaneous or induced episodes by IV administration of calcium, glucose, or bicarbonate resulted in rapid recovery. Dietary management or daily administration of acetazolamide effectively controlled episodes. An affected mare was bred to an affected stallion, and 3 affected offspring were produced by embryo transfer. Blood samples from another extended family of affected horses were analyzed for identification of a genetic marker.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2243032

  12. Electrophysiological properties of laryngeal motoneurones in rats submitted to chronic intermittent hypoxia

    PubMed Central

    Moraes, Davi J A; Machado, Benedito H

    2015-01-01

    To keep an appropriate airflow to and from the lungs under physiological conditions a precise neural co-ordination of the upper airway resistance by laryngeal motoneurones in the nucleus ambiguus is essential. Chronic intermittent hypoxia (CIH), an important component of obstructive sleep apnoea, may alter these fine mechanisms. Here, using nerve and whole cell patch clamp recordings in in situ preparations of rats we investigated the effects of CIH on the respiratory control of the upper airway resistance, on the electrophysiological properties of laryngeal motoneurones in the nucleus ambiguus, and the role of carotid body (CB) afferents to the brainstem on the underlying mechanisms of these effects. CIH rats exhibited longer pre-inspiratory and lower post-inspiratory superior laryngeal nerve activities than control rats. These changes produced exaggerated glottal abduction (before inspiration) and decreased glottal adduction during post-inspiration, indicating a reduction of upper airway resistance during these respiratory phases after CIH. CB denervation abolished these changes produced by CIH. Regarding choline acetyltransferase positive-laryngeal motoneurones, CIH increased the firing frequency of inspiratory and decreased the firing frequency of post-inspiratory laryngeal motoneurones, without changes in their intrinsic electrophysiological properties. These data show that the effects of CIH on the upper airway resistance and laryngeal motoneurones activities are driven by the integrity of CB, which afferents induce changes in the central respiratory generators in the brainstem. These neural changes in the respiratory network seem to be an adaptive process required for an appropriated pulmonary ventilation and control of upper airway resistance under intermittent episodes of hypoxia. Key points The respiratory control of the glottis by laryngeal motoneurones is characterized by inspiratory abduction and post-inspiratory adduction causing decreases and increases in upper airway resistance, respectively. Chronic intermittent hypoxia (CIH), an important component of obstructive sleep apnoea, exaggerated glottal abduction (before inspiration), associated with active expiration and decreased glottal adduction during post-inspiration. CIH increased the inspiratory and decreased the post-inspiratory laryngeal motoneurone activities, which is not associated to changes in their intrinsic electrophysiological properties. We conclude that the changes in the respiratory network after CIH seem to be an adaptive process required for an appropriated pulmonary ventilation and control of upper airway resistance under intermittent episodes of hypoxia. PMID:25433075

  13. Multidisciplinary Management of Laryngeal Carcinoma

    SciTech Connect

    Mendenhall, William M. Mancuso, Anthony A.; Hinerman, Russell W.; Malyapa, Robert S.; Werning, John W.; Amdur, Robert J.; Villaret, Douglas B.

    2007-10-01

    The management of head and neck cancer has evolved into a multidisciplinary approach in which patients are evaluated before treatment and decisions depend on prospective multi-institutional trials, as well as retrospective outcome studies. The choice of one or more modalities to use in a given case varies with the tumor site and extent, as exemplified in the treatment of laryngeal squamous cell carcinomas. The goals of treatment include cure, laryngeal voice preservation, voice quality, optimal swallowing, and minimal xerostomia. Treatment options include transoral laser excision, radiotherapy (both definitive and postoperative), open partial laryngectomy, total laryngectomy, and neck dissection. The likelihood of local control and preservation of laryngeal function is related to tumor volume. Patients who have a relatively high risk of local recurrence undergo follow-up computed tomography scans every 3-4 months for the first 2 years after radiotherapy. Patients with suspicious findings on computed tomography might benefit from fluorodeoxyglucose positron emission tomography to differentiate post-radiotherapy changes from tumor.

  14. Bilateral Diaphragmatic Paralysis in a Patient With Critical Illness Polyneuropathy

    PubMed Central

    Chen, Hsuan-Yu; Chen, Hung-Chen; Lin, Meng-Chih; Liaw, Mei-Yun

    2015-01-01

    Abstract Bilateral diaphragmatic paralysis (BDP) manifests as respiratory muscle weakness, and its association with critical illness polyneuropathy (CIP) was rarely reported. Here, we present a patient with BDP related to CIP, who successfully avoided tracheostomy after diagnosis and management. A 71-year-old male presented with acute respiratory failure after sepsis adequately treated. Repeated intubation occurred because of carbon dioxide retention after each extubation. After eliminating possible factors, septic shock-induced respiratory muscle weakness was suspected. Physical examination, a nerve conduction study, and chest ultrasound confirmed our impression. Pulmonary rehabilitation and reconditioning exercises were arranged, and the patient was discharged with a diagnosis of BDP. The diagnosis of BDP is usually delayed, and there are only sporadic reports on its association with polyneuropathy, especially in patients with preserved limb muscle function. Therefore, when physicians encounter patients that are difficult to wean from mechanical ventilation, CIP associated with BDP should be considered in the differential diagnosis. PMID:26252301

  15. Axillary Nerve Reconstruction: Anterior-Posterior Exposure With Sural Nerve Cable Graft Pull-Through Technique.

    PubMed

    Baltzer, Heather L; Spinner, Robert J; Bishop, Allen T; Shin, Alexander Y

    2015-12-01

    Deltoid paralysis after axillary nerve injury results in limitations in shoulder function and stability. In the setting of an isolated axillary nerve injury with no clinical or electromyographic evidence of recovery that is within 6 to 9 months postinjury, the authors' preferred technique to reinnervate the deltoid is to reconstruct the axillary nerve with sural nerve grafting. Intraoperative neuromuscular electrophysiology is critical to determine the continuity of the axillary nerve before proceeding with reconstruction. The majority of the time, both an anterior and posterior incision and dissection of the axillary nerve is required to adequately delineate the zone of injury. This also ensures that both proximally and distally, uninjured axillary nerve is present before graft inset and also facilitates the ability to perform a meticulous microsurgical inset of the nerve graft posteriorly. The nerve graft must be pulled through from posterior to anterior to span the zone of injury and reconstruct the axillary nerve. Careful infraclavicular brachial plexus dissection is necessary to prevent further injury to components of the brachial plexus in the setting of a scarred bed. Patients will require postoperative therapy to prevent limitations in shoulder range of motion secondary to postoperative stiffness. This paper presents a detailed surgical technique for axillary nerve reconstruction by an anterior-posterior approach with a pull-through technique of a sural nerve cable graft. PMID:26524659

  16. [Summery and recommendations for acupuncture for peripheral facial paralysis].

    PubMed

    Wang, Sheng-Qiang; Yu, Su; Wang, Jian-Ping

    2011-12-01

    Articles on acupuncture for peripheral facial paralysis were picked up from CNKI database. The retrieved original studies were evaluated and summarized. The problems of acupuncture for peripheral facial paralysis were analyzed, and concrete solutions were proposed. Problems that differential diagnosis, prognosis, treatment of severe facial paralysis, and identification of sequelae and compliation were not embasized in clinical treatment of facial paralysis. Consequently, the effectiveness of acupuncture for peripheral facial paralysis will be improved by sloving above problems. PMID:22256658

  17. Child Paralysis Cases Spiked During Virus Outbreak

    MedlinePLUS

    ... fullstory_156356.html Child Paralysis Cases Spiked During Virus Outbreak: Study But definitive cause of polio-like ... during a national outbreak of enterovirus D68, a virus in the same family as polio, researchers report ...

  18. Genetics Home Reference: Hypokalemic periodic paralysis

    MedlinePLUS

    ... with understanding hypokalemic periodic paralysis? autosomal ; autosomal dominant ; calcium ; carbohydrate ; cell ; channel ; contraction ; familial ; gene ; hypokalemia ; inherited ; ions ; ion transport ; muscle cells ; potassium ; prevalence ; protein ; sodium You may find ...

  19. Equine hyperkalemic periodic paralysis: review and implications.

    PubMed Central

    Naylor, J M

    1994-01-01

    The purpose of this review is to present an up-to-date summary of the signs, diagnosis, treatment, and implications of equine hyperkalemic periodic paralysis. The review encompasses all original articles published between 1986 and early 1993. Hyperkalemic periodic paralysis is the result of a genetic mutation in the skeletal muscle sodium channel gene. It is inherited as an autosomal dominant trait; most affected horses are heterozygotes. The classical signs are muscle fasciculation, spasm, and weakness associated with hyperkalemia. However, these signs are only rarely observed in affected horses. Potential sequelae to attacks are abrasions and involuntary recumbency; these problems are not specific for hyperkalemic periodic paralysis, but they occur more frequently in hyperkalemic periodic paralysis-affected horses. It is also likely that hyperkalemic periodic paralysis results in greater muscle mass. There are suggestions that homozygotes may be more severely affected and show signs of upper respiratory obstruction as foals. The practitioner needs to be aware of the tests for hyperkalemic periodic paralysis, and their limitations, so that he can properly diagnose this condition. The industry has the difficult problem of deciding whether or not testing should be mandatory and the fate of positive horses. Images Figure 2. PMID:8050073

  20. Equine hyperkalemic periodic paralysis: review and implications.

    PubMed

    Naylor, J M

    1994-05-01

    The purpose of this review is to present an up-to-date summary of the signs, diagnosis, treatment, and implications of equine hyperkalemic periodic paralysis. The review encompasses all original articles published between 1986 and early 1993. Hyperkalemic periodic paralysis is the result of a genetic mutation in the skeletal muscle sodium channel gene. It is inherited as an autosomal dominant trait; most affected horses are heterozygotes. The classical signs are muscle fasciculation, spasm, and weakness associated with hyperkalemia. However, these signs are only rarely observed in affected horses. Potential sequelae to attacks are abrasions and involuntary recumbency; these problems are not specific for hyperkalemic periodic paralysis, but they occur more frequently in hyperkalemic periodic paralysis-affected horses. It is also likely that hyperkalemic periodic paralysis results in greater muscle mass. There are suggestions that homozygotes may be more severely affected and show signs of upper respiratory obstruction as foals. The practitioner needs to be aware of the tests for hyperkalemic periodic paralysis, and their limitations, so that he can properly diagnose this condition. The industry has the difficult problem of deciding whether or not testing should be mandatory and the fate of positive horses. PMID:8050073

  1. Laryngospasm, dysphagia, and emaciation associated with hyperkalemic periodic paralysis in a horse.

    PubMed

    Guglick, M A; MacAllister, C G; Breazile, J E

    1996-07-01

    An 18-month-old Quarter Horse gelding was examined because of weight loss and dysphagia of 1 month's duration. Clinical signs included lethargy, dehydration, ptyalism, and probable aspiration pneumonia. Severe dyspnea and cyanosis were evident after mild exercise. Endoscopy revealed laryngospasm and pharyngospasm. Because clinical signs and endoscopic findings were suggestive of hyperkalemic periodic paralysis (HPP), acetazolamide treatment was instituted. Marked improvement was observed within 48 hours. The horse was determined to be homozygous for HPP. It is likely that this horse's dysphagia, with resultant weight loss and aspiration pneumonia, were clinical manifestations and consequences of HPP. Regardless of age and serum potassium concentration, HPP should be considered as a differential diagnosis for pharyngeal and laryngeal abnormalities and dysphagia in horses with Quarter Horse breeding. PMID:8926191

  2. Dynamic 320-slice CT larynx for detection and management of idiopathic bilateral vocal cord paralysis.

    PubMed

    Ruane, Laurence E; Lau, Kenneth K; Low, Kathy; Crossett, Marcus; Vallance, Neil; Bardin, Philip G

    2014-03-01

    Idiopathic bilateral vocal cord paralysis (VCP) is a rare and difficult condition often undiagnosed and frequently confused with asthma and other respiratory conditions. Accurate diagnosis is crucial since 80% of cases patients require surgical intervention, such as tracheostomy or laser surgery, to relieve symptoms. The "gold standard" for diagnosing VCP has been laryngoscopy. In this case study, we demonstrate for the first time that idiopathic bilateral VCP can be accurately diagnosed by means of a novel noninvasive methodology: dynamic volume 320-slice computed tomography larynx. Three-dimensional reconstruction of laryngeal motion during the breathing cycle permitted functional assessment of the larynx showing absence of vocal cord movements. The new methodology may be valuable for noninvasive diagnosis of vocal cord movement disorders before and for follow-up after surgery. PMID:25473555

  3. Occupational risk for laryngeal cancer.

    PubMed

    Flanders, W D; Rothman, K J

    1982-04-01

    In a case-control analysis, we studied the effects of type of employment on laryngeal cancer risk using the interview data from the Third National Cancer Survey. Effects were measured relative to the risk for those employed in a group of arbitrarily defined industries and occupations with low risk. We excluded females and controlled for age, tobacco use, alcohol use, and race in the analysis. We found ratio estimates above 3.0 for workers in the railroad industry and the lumber industry; and for sheetmetal workers, grinding wheel operators, and automobile mechanics. PMID:7065314

  4. Occupational risk for laryngeal cancer

    SciTech Connect

    Flanders, W.D.; Rothman, K.J.

    1982-04-01

    In a case-control analysis, we studied the effects of type of employment on laryngeal cancer risk using the interview data from the Third National Cancer Survey. Effects were measured relative to the risk for those employed in a group of arbitrarily defined industries and occupations with low risk. We excluded females and controlled for age, tobacco use, alcohol use, and race in the analysis. We found ratio estimates above 3.0 for workers in the railroad industry and the lumber industry; and for sheetmetal workers, grinding wheel operators, and automobile mechanics.

  5. Laryngeal syphilis: a case report.

    PubMed

    Lahav, Gil; Lahav, Yonatan; Ciobotaro, Pnina; Ziv, Nadia; Halperin, Doron

    2011-03-01

    Syphilis is a sexually transmitted disease caused by the spirochete Treponema pallidum. The complexity of the disease gained it the moniker "the great imitator"; it was William Osler who said, "He who knows syphilis, knows medicine." In 1866, Patrick Watson of Edinburgh, Scotland, reported a case of a 36-year-old man in whom syphilis destroyed the larynx.(1) The diagnosis was made postmortem. It was once believed that this was the first reported total laryngectomy, but the credit should actually be given to Christian Albert Theodor Billroth who performed this surgery on a patient with laryngeal carcinoma in 1873. PMID:21422316

  6. Occupational risk for laryngeal cancer.

    PubMed Central

    Flanders, W D; Rothman, K J

    1982-01-01

    In a case-control analysis, we studied the effects of type of employment on laryngeal cancer risk using the interview data from the Third National Cancer Survey. Effects were measured relative to the risk for those employed in a group of arbitrarily defined industries and occupations with low risk. We excluded females and controlled for age, tobacco use, alcohol use, and race in the analysis. We found ratio estimates above 3.0 for workers in the railroad industry and the lumber industry; and for sheetmetal workers, grinding wheel operators, and automobile mechanics. PMID:7065314

  7. A new practical classification of laryngeal view.

    PubMed

    Cook, T M

    2000-03-01

    A new practical classification of laryngeal view at laryngoscopy is presented and evaluated. The best laryngeal view obtained with or without anterior laryngeal pressure is recorded. The laryngeal view is easy (E) when the laryngeal inlet is visible. The view is restricted (R) when the posterior glottic structures (posterior commissure or arytenoids) are visible or the epiglottis is visible and can be lifted; this includes some grade 2 and some grade 3 views as classified by Cormack and Lehane. A difficult (D) view is present when the epiglottis cannot be lifted or when no laryngeal structures are visible. Five hundred patients were studied. Laryngoscopy, with the patient anaesthetised and paralysed, was performed with a Macintosh laryngoscope. If the vocal cords were not visible, a gum elastic bougie was used to aid intubation. Other aids were used only if this did not allow intubation. Each laryngeal view was graded according to the new classification and that of Cormack and Lehane. Intubation was timed and the equipment needed to facilitate intubation was recorded. The new classification stratified increasing difficulty with intubation (time for intubation longer and increasingly complex methods needed) better than the Cormack and Lehane classification. The new classification is as sensitive and more specific than the Cormack and Lehane classification in predicting difficult intubation. It is also more sensitive and more specific in predicting easy intubation. PMID:10671848

  8. Acute Flaccid paralysis in adults: Our experience

    PubMed Central

    Kaushik, Rupesh; Kharbanda, Parampreet S.; Bhalla, Ashish; Rajan, Roopa; Prabhakar, Sudesh

    2014-01-01

    Acute flaccid paralysis (AFP) is a complex clinical syndrome with a broad array of potential etiologies that vary with age. We present our experience of acute onset lower motor neuron paralysis. Materials and Methods: One hundred and thirty-three consecutive adult patients presenting with weakness of duration less than four weeks over 12 months period were enrolled. Detailed history, clinical examination, and relevant investigations according to a pre-defined diagnostic algorithm were carried out. The patients were followed through their hospital stay till discharge or death. Results: The mean age was 33.27 (range 13-89) years with male preponderance (67.7%). The most common etiology was neuroparalytic snake envenomation (51.9%), followed by Guillain Barre syndrome (33.1%), constituting 85% of all patients. Hypokalemic paralysis (7.5%) and acute intermittent porphyria (4.5%) were the other important conditions. We did not encounter any case of acute polio mylitis in adults. In-hospital mortality due to respiratory paralysis was 9%. Conclusion: Neuroparalytic snakebite and Guillain Barre syndrome were the most common causes of acute flaccid paralysis in adults in our study. PMID:25114422

  9. Restoration of prehensile function for motor paralysis in Hopkins syndrome: case report.

    PubMed

    Satbhai, Nilesh G; Doi, Kazuteru; Hattori, Yasunori; Sakamoto, Sotetsu

    2014-02-01

    Hopkins syndrome is a rare cause of poliomyelitis-like paralysis affecting 1 or more extremities after an acute attack of asthma. The exact etiology of Hopkins syndrome is not known. A 4-year-old girl developed acute asthma followed by complete flaccid paralysis of the left upper extremity. She underwent staged reconstruction using the double free muscle transfer technique. Rigorous postoperative physiotherapy was carried out to achieve a good functional outcome. At recent follow-up, 27 months after the first procedure, the patient was able to effectively use the reconstructed hand for most daily activities. She had good control and could perform 2-handed activities. The selection of a suitable operative treatment and suitable donor nerves is critical, and there are no clear guidelines in the literature. The double free muscle transfer can be effectively employed in similar cases to restore grasping function. PMID:24480689

  10. Epiglottic laryngoplasty for complicated laryngeal stenosis.

    PubMed

    Sobol, S M; Levine, H; Wood, B; Tucker, H M

    1981-01-01

    The technique of epiglottic laryngoplasty, previously described for reconstruction following near total laryngectomy for glottic carcinoma, has been used in selected patients with severe glottic and subglottic stenosis. Our experience in four patients suggests that it is useful for 1) laryngeal stenosis in which there is loss or collapse of the external cartilaginous framework, and 2) laryngeal stenosis which is refractory to the usual forms of therapy. The technique is a technically simple, one-stage procedure which provides its own endolaryngeal mucosal lining, as well as autogenous cartilaginous support. It has been successful in restoring adequate airway and preserving voice without interfering with deglutition or laryngeal competence in most patients. PMID:7271159

  11. Adult-onset familial vocal fold paralysis.

    PubMed

    Amir, Ida; Crow, Yanick J; Morar, Pradeep

    2015-09-01

    We describe the cases of 2 brothers in their early 50s, born to consanguineous parents, who presented with acute stridor as a result of adult-onset bilateral abductor vocal fold paralysis. Both patients had a history of adult-onset asthma. No other associated symptoms were evident, and findings on neurologic examination and all other investigations were normal. Both patients required emergency surgical tracheostomy. Another brother with a similar history had died of an airway problem when he was 53 years of age; 2 other younger brothers and 3 younger sisters were currently unaffected. To the best of our knowledge, this is the first report of adult-onset familial bilateral vocal fold paralysis in the absence of associated features. The parents' consanguinity suggested an autosomal recessive basis to this disorder. In addition to describing the features of this case, we review the literature relating to adult-onset familial vocal fold paralysis. PMID:26401672

  12. Lip Forces and Chewing Efficiency in Children with Peripheral Facial Paralysis.

    PubMed

    Ilea, Aranka; Cristea, Alexandru; Dudescu, Cristian M; Hurubeanu, Lucia; Vâjâean, Cosmin; Albu, Silviu; Câmpian, Radu S

    2015-08-01

    Peripheral facial paralysis is accompanied by facial motor disorders and also, by oral dysfunctions. The aim of this study was to evaluate the lip forces and chewing efficiency in a group of children with peripheral facial paralysis. The degree of peripheral facial paralysis in the study group (n 11) was assessed using the House-Brackmann scale. The control group consisted of 21 children without facial nerve impairment. To assess lip forces, acrylic vestibular plates of three sizes were used: large (LVP), medium (MVP) and small (SVP). The lip force was recorded with a force transducer coupled with the data acquisition system. Masticatory efficiency was evaluated by the ability to mix two differently colored chewing gums. The images were processed with Adobe Photoshop CS3 (Delaware Corporation, San Jose, California, United States) and the number of pixels was quantified with the Image J software (DHHS/NIH/NIMH/RSB, Maryland, United States). For statistical analysis, the following statistical analysis were used: Pearson or Spearman correlation coefficient, multiple linear regression analysis, multiple logistic regression analysis, and optimal cutoff values for muscular dysfunction. There were statistically significant differences between lip forces in the following three groups: p=0.01 (LVP), p=0.01 (MVP), and p=0.008 (SVP). The cutoff values of lip forces in the study group were as follows: 7.08 N (LVP), 4.89 N (MVP), and 4.24 N (SVP). There were no statistically significant differences between the masticatory efficiency in the two groups (p=0.25). Lip forces were dependent on the degree of peripheral facial paralysis and age, but not on gender. In peripheral facial paralysis in children, a significant decrease of lip forces, but not masticatory efficiency, occurs. PMID:25974875

  13. [HYPP: hyperkalemic periodic paralysis in the horse].

    PubMed

    Sloet van Oldruitenborgh-Oosterbaan, M M

    1999-03-15

    Hyperkalaemic periodic paralysis(HYPP) is characterized by intermittent episodes of muscular tremor, weakness, and collapse, and is probably caused by abnormal electrolyte transport in the muscle cell membrane. During an episode of HYPP, most animals are severely hyperkalaemic. HYPP is a hereditary disease and occurs only in American Quarter horses or crossbreds. Because these horses are now being imported into the Netherlands, HYPP should be included in the differential diagnosis of horses showing signs of muscle tremor, paresis, or paralysis. The present article reviews the literature on HYPP and describes a case showing typical signs of the disease. PMID:10188180

  14. Treatment Options by Stage (Laryngeal Cancer)

    MedlinePLUS

    ... and symptoms of laryngeal cancer include a sore throat and ear pain. These and other signs and ... hoarseness in the voice. Tests that examine the throat and neck are used to help detect (find), ...

  15. Laryngeal synkinesis following reinnervation in the rat. Neuroanatomic and physiologic study using retrograde fluorescent tracers and electromyography.

    PubMed

    Flint, P W; Downs, D H; Coltrera, M D

    1991-10-01

    The functional organization of laryngeal motoneurons in the nucleus ambiguous (NA) was evaluated in adult male rats before and after recurrent laryngeal nerve section and reinnervation. Using retrograde double labeling techniques with fluorescent probes, we obtained the number and position of labeled neurons by using the Bioquant 3-D imaging system. Reinnervation was documented by electromyography. In nine control animals vector analysis revealed significant (p less than .05) separation of the posterior cricoarytenoid (PCA) muscle motoneurons and the thyroarytenoid and lateral cricoarytenoid (TA/LCA) muscle motoneurons. The PCA motoneurons were positioned ventromedially in the NA, and TA/LCA motoneurons were found dorsolaterally in the NA. Rostral-caudal separation was not significant. Electromyography revealed phasic electrical activity synchronous with respiration in the PCA, and activity synchronous with deglutition in the TA/LCA. In four animals surviving 15 weeks following recurrent laryngeal nerve section and primary neurorrhaphy, functional organization within the NA was lost and phasic motor unit activity synchronous with respiration was seen in the TA/LCA muscle as well as the PCA. Vector analysis revealed the reinnervating motoneurons for both the PCA and TA/LCA to be positioned dorsolaterally, similar to the control group TA/LCA motoneurons. These findings demonstrate a shift in the topographic organization of laryngeal motoneurons within the NA following reinnervation, with random organization occurring at the neurorrhaphy site. PMID:1952645

  16. Factors associated with the improvement of vocal fold movement: an analysis of LEMG and laryngeal CT parameters.

    PubMed

    Mengsteab, Paulos Y; Kwon, Jeong-Yi; Han, Tai Ryoon; Kwon, Tack Kyun; Kim, Deok-Ho; Kim, Sang Jun

    2015-02-01

    The aim of this study is to elucidate the relationship of laryngeal electromyography (LEMG) and computed tomographic (CT) parameters to improve the prognosis of recurrent laryngeal nerve injury. 22 patients clinically suspected of having recurrent laryngeal nerve injury were examined with LEMG and CT studies. Bilateral thyroarytenoid (TA) muscles were examined and findings were interpreted by a single blind technique. Laryngeal CT image analysis of the ventricle dilation symmetry determined TA muscle atrophy. Finally, a follow-up laryngoscopic examination determined improvement of vocal fold movement. Ventricle dilation symmetry and the dichotomized TA muscle atrophy parameter significantly relate to the improvement of vocal fold movement (?(2)=4.029, P=0.039, and ?(2)=3.912, P=0.048, respectively). When the severity of vocal fold impairment was classified as severe TA muscle atrophy or none/discrete MUAP recruitment, it was found to significantly relate with the improvement of vocal fold movement (?(2)=6.712, P=.010). From this study, image analysis of the ventricle dilation symmetry to determine the severity of TA muscle atrophy shows promise for the improved prognosis of vocal fold immobility. PMID:25217204

  17. Danish std: laryngealization or tone.

    PubMed

    Grnnum, Nina; Vazquez-Larruscan, Miguel; Basbll, Hans

    2013-01-01

    In the light of previous acoustic analyses of Danish std and Danish intonation, we discuss two different phonological theories. In one, std is an autonomous laryngeal syllable prosody. In the other, std is the phonetic manifestation of an HL tonal pattern compressed within one syllable. The tonal representation is found to be contradicted by the phonetic reality, and it cannot account for the structurally determined alternation between non-std and std in inflection and derivation, nor for latent std or std in compounds. Furthermore, std patterns are largely constant across regional varieties of Danish, but tonal patterns over the relevant structural domains are highly variable. Thus, std may occur on any kind of tonal configuration, anywhere in the speaker's pitch range, a variability which is hard to reconcile with a fixed HL representation. PMID:24157435

  18. Laryngitis

    MedlinePLUS

    ... BH, Lund LJ, et al, eds. Cummings Otolaryngology: Head & Neck Surgery . 6th ed. Philadelphia, PA: Elsevier Mosby; 2015: ... et al. Clinical practice guideline: hoarseness (dysphonia). Otolaryngol Head Neck Surg . 2009;141(3 Suppl 2):S1-S31. ...

  19. Another Scale for the Assessment of Facial Paralysis? ADS Scale: Our Proposition, How to Use It

    PubMed Central

    2015-01-01

    Introduction Several authors in the years propose different methods to evaluate areas and specific movements disease in patient affected by facial palsy. Despite these efforts the House Brackmann is anyway the most used assessment in medical community. Aim The aims of our study is the proposition and assessing a new rating Arianna Disease Scale (ADS) for the clinical evaluation of facial paralysis. Materials and Methods Sixty patients affected by unilateral facial Bell paralysis were enrolled in a prospective study from 2012 to 2014. Their facial nerve function was evaluated with our assessment analysing facial district divided in upper, middle and lower third. We analysed different facial expressions. Each movement corresponded to the action of different muscles. The action of each muscle was scored from 0 to 1, with 0 corresponding from complete flaccid paralysis to muscles normal function ending with a score of 1. Synkinesis was considered and evaluated also in the scale with a fixed 0.5 score. Our results considered ease and speed of evaluation of the assessment, the accuracy of muscle deficit and the ability to calculate synkinesis using a score. Results All the three observers agreed 100% in the highest degree of deficit. We found some discrepancies in intermediate score with 92% agreement in upper face, 87% in middle and 80% in lower face, where there were more muscles involved in movements. Conclusion Our scale had some limitations linked to the small group of patients evaluated and we had a little difficulty understanding the intermediate score of 0.3 and 0.7. However, this was an accurate tool to quickly evaluate facial nerve function. This has potential as an alternative scale to and to diagnose facial nerve disorders. PMID:26814596

  20. Facial Nerve Schwannoma of Parotid Gland: Difficulties in Diagnosis and Management.

    PubMed

    Damar, Murat; Dinç, Aykut Erdem; Şevik Eliçora, Sultan; Bişkin, Sultan; Erten, Gül; Biz, Serdar

    2016-01-01

    Facial nerve schwannomas (FNS) are encapsulated benign tumors arising from Schwann cells of seventh cranial nerve. Most of the facial nerve schwannomas are localized in intratemporal region; only 9% of cases involve a portion of the extratemporal segment. Preoperative diagnosis is often unclear; diagnosis is often made intraoperatively. Management of intraparotid FNS is troublesome because of the facial nerve paralysis. In this report we presented a case of intraparotid schwannoma in a 55-year-old male patient complaining of a painless mass without peripheral facial nerve palsy in left parotid gland. Clinical features, preoperative and intraoperative diagnosis, and difficulties during management are discussed with the review of the literature. PMID:26904338

  1. Facial Nerve Schwannoma of Parotid Gland: Difficulties in Diagnosis and Management

    PubMed Central

    Damar, Murat; Dinç, Aykut Erdem; Şevik Eliçora, Sultan; Bişkin, Sultan; Erten, Gül; Biz, Serdar

    2016-01-01

    Facial nerve schwannomas (FNS) are encapsulated benign tumors arising from Schwann cells of seventh cranial nerve. Most of the facial nerve schwannomas are localized in intratemporal region; only 9% of cases involve a portion of the extratemporal segment. Preoperative diagnosis is often unclear; diagnosis is often made intraoperatively. Management of intraparotid FNS is troublesome because of the facial nerve paralysis. In this report we presented a case of intraparotid schwannoma in a 55-year-old male patient complaining of a painless mass without peripheral facial nerve palsy in left parotid gland. Clinical features, preoperative and intraoperative diagnosis, and difficulties during management are discussed with the review of the literature. PMID:26904338

  2. Facial nerve identification with fluorescent dye in rats.

    PubMed

    Melo, Giulianno Molina de; Cervantes, Onivaldo; Covolan, Luciene; Baptista, Heloisa Allegro; Ferreira, Elenn Soares; Abrahao, Marcio

    2016-02-01

    PURPOSE The parotidectomy technique still has an elevated paresis and paralysis index, lowering patient life's quality. The correct identification of the facial nerve can prevent nerve damage. Fluorescent dye identifies nerves in experimental studies but only few articles focused its use on facial nerve study in parotidectomies. We aimed to stain the rat facial nerve with fluorescent dye to facilitate visualization and dissection in order to prevent injuries. METHODS Forty adult male Wistar rats were submitted to facial injection of saline solution (Gsf-control group, 10) or fluorescent dye solution (Gdye group, 30) followed by parotidectomy preserving the facial nerve, measuring the time for localization and facility of localization (LocTime and LFN). Nerve function was assessed using the Vibrissae Movements (PMV) and Eyelid Closure Motion (PFP) scores. RESULTS Nerve localization was faster in Gdye group, with 83% Easy LFN rate. The Gdye group presented with low nerve injury degree and better PMV and PFP scores, with high sensitivity and accuracy. CONCLUSIONS This experimental method of facial nerve fluorescence was effective for intraoperative nerve visualization, identification and preservation. The technique may be used in future facial nerve studies, translated to humans, contributing to the optimization of parotid surgery in the near future. PMID:26959618

  3. Attempts to restore abduction of the paralyzed equine arytenoid cartilage. III. Nerve anastomosis.

    PubMed Central

    Ducharme, N G; Viel, L; Partlow, G D; Hulland, T J; Horney, F D

    1989-01-01

    The purpose of this project was to attempt restoration of abduction of a recently denervated left dorsal cricoarytenoid muscle in the horse by anastomosing the first cervical nerve to the abductor branch of the left recurrent laryngeal nerve. Ten horses were used in the study. In six horses the left recurrent laryngeal nerve was transected and ligated while the ventral branch of the left first cervical nerve was anastomosed to the abductor branch of the left recurrent laryngeal nerve. The remaining four horses also had the left recurrent laryngeal nerve transected and ligated but had no nerve anastomosis performed. Each horse was evaluated preoperatively, and at one week, three and six months after surgery, by endoscopy and determination of upper airway resistance. The endoscopy was performed with the horses breathing room air and while breathing 10% carbon dioxide. All ten horses showed endoscopic signs of complete laryngeal hemiplegia immediately postoperatively. Starting at three months postoperatively clonic movements of the left arytenoid cartilage were observed in four of the six reinnervated horses but not in the sham operated horses. At the sixth postoperative month five reinnervated horses had clonic movements of the left arytenoid cartilage. The comparison of upper airway resistance measurements before surgery and at one week, three and six months after surgery showed no significant differences in either control or experimental horses. Following euthanasia at six months postoperatively, the left and right dorsal crioarytenoid muscles were compared for evidence of reinnervation. No significant difference in weight was noted in the reinnervated horses but the left dorsal cricoarytenoid muscle weighed less than the control horses. Images Fig. 2. Fig. 3. Fig. 4. Fig. 5. Fig. 6. Fig. 7. Fig. 8. Fig. 9. PMID:2713787

  4. What's New in Laryngeal and Hypopharyngeal Cancer Research and Treatment?

    MedlinePLUS

    ... Additional resources for laryngeal and hypopharyngeal cancers What’s new in laryngeal and hypopharyngeal cancers research and treatment? ... to better tests for early detection and to new targeted treatments. Chemoprevention Chemoprevention is the use of ...

  5. Pre-clinical evaluation of a minimally invasive laryngeal pacemaker system in mini-pig.

    PubMed

    Foerster, Gerhard; Arnold, Dirk; Bischoff, Sabine; Boltze, Karsten; Scholle, Hans-Christoph; Schubert, Harald; Mueller, Andreas H

    2016-01-01

    Microlaryngoscopic enlargement techniques have been the standard treatment for bilateral vocal fold paralysis (BVFP) for decades. Laryngeal pacing is a promising alternative treatment based on the electrostimulation of the posterior cricoarytenoid (PCA) muscle. This paper reports on the results of a pre-clinical study aiming to evaluate this method. Eight Gttingen mini-pigs were implanted with a laryngeal pacemaker (LP) implant prototype and with two LP electrodes, one in each PCA muscle. The 6-week follow-up included endoscopic stimulation controls in general anaesthesia and radiographic controls of electrode integrity and position stability. Stimulation parameters for optimal glottal opening were evaluated via videolaryngoscopy. Histopathology was performed upon conclusion of the study. 7/8 (87.5%) animals were successfully implanted with the LP implant prototype and two LP electrodes. In general, stimulation was effectively delivered and correlated with the expected PCA muscle activation. 2/14 (14.3%) electrodes dislocated and 1/14 (7.1%) electrode tip broke. The LP system used in this experiment to induce vocal fold abduction by means of selective functional electrical stimulation of the PCA showed promising results. It may be a valid alternative to the current golden standard for BVFP treatment. Clinical studies are needed to confirm the medical relevance of the LP. PMID:26264908

  6. Tumor Volumes and Prognosis in Laryngeal Cancer

    PubMed Central

    Issa, Mohamad R.; Samuels, Stuart E.; Bellile, Emily; Shalabi, Firas L.; Eisbruch, Avraham; Wolf, Gregory

    2015-01-01

    Tumor staging systems for laryngeal cancer (LC) have been developed to assist in estimating prognosis after treatment and comparing treatment results across institutions. While the laryngeal TNM system has been shown to have prognostic information, varying cure rates in the literature have suggested concern about the accuracy and effectiveness of the T-classification in particular. To test the hypothesis that tumor volumes are more useful than T classification, we conducted a retrospective review of 78 patients with laryngeal cancer treated with radiation therapy at our institution. Using multivariable analysis, we demonstrate the significant prognostic value of anatomic volumes in patients with previously untreated laryngeal cancer. In this cohort, primary tumor volume (GTVP), composite nodal volumes (GTVN) and composite total volume (GTVP + GTVN = GTVC) had prognostic value in both univariate and multivariate cox model analysis. Interestingly, when anatomic volumes were measured from CT scans after a single cycle of induction chemotherapy, all significant prognosticating value for measured anatomic volumes was lost. Given the literature findings and the results of this study, the authors advocate the use of tumor anatomic volumes calculated from pretreatment scans to supplement the TNM staging system in subjects with untreated laryngeal cancer. The study found that tumor volume assessment after induction chemotherapy is not of prognostic significance. PMID:26569309

  7. Viscoelastic properties of laryngeal posturing muscles

    NASA Astrophysics Data System (ADS)

    Alipour, Fariborz; Hunter, Eric; Titze, Ingo

    2003-10-01

    Viscoelastic properties of canine laryngeal muscles were measured in a series of in vitro experiments. Laryngeal posturing that controls vocal fold length and adduction/abduction is an essential component of the voice production. The dynamics of posturing depends on the viscoelastic and physiological properties of the laryngeal muscles. The time-dependent and nonlinear behaviors of these tissues are also crucial in the voice production and pitch control theories. The lack of information on some of these muscles such as posterior cricoarytenoid muscle (PCA), lateral cricoarytenoid muscle (LCA), and intraarytenoid muscle (IA) was the major incentive for this study. Samples of PCA and LCA muscles were made from canine larynges and mounted on a dual-servo system (Ergometer) as described in our previous works. Two sets of experiments were conducted on each muscle, a 1-Hz stretch and release experiment that provides stress-strain data and a stress relaxation test. Data from these muscles were fitted to viscoelastic models and Young's modulus and viscoelastic constants are obtained for each muscle. Preliminary data indicates that elastics properties of these muscles are similar to those of thyroarytenoid and cricothyroid muscles. The relaxation response of these muscles also shows some similarity to other laryngeal muscles in terms of time constants.

  8. Diesel exhaust, diesel fumes, and laryngeal cancer.

    PubMed

    Muscat, J E; Wynder, E L

    1995-03-01

    A hospital-based, case-control study of 235 male patients with laryngeal cancer and 205 male control patients was conducted to determine the effects of exposure to diesel engine exhaust and diesel fumes and the risk of laryngeal cancer. All patients were interviewed directly in the hospital with a standardized questionnaire that gathered information on smoking habits, alcohol consumption, employment history, and occupational exposures. Occupations that involve substantial exposure to diesel engine exhaust include mainly truck drivers, as well as mine workers, firefighters, and railroad workers. The odds ratio for laryngeal cancer associated with these occupations was 0.96 (95% confidence interval, 0.5 to 1.8). The odds ratio for self-reported exposure to diesel exhaust was 1.47 (95% confidence interval, 0.5 to 4.1). An elevated risk was found for self-reported exposure to diesel fumes (odds ratio, 6.4; 95% confidence interval, 1.8 to 22.6). No association was observed between jobs that entail exposure to diesel fumes, such as automobile mechanics, and the risk of laryngeal cancer. These results show that diesel engine exhaust is unrelated to laryngeal cancer risk. The different findings for self-reported diesel fumes and occupations that involve exposure to diesel fumes could reflect a recall bias. PMID:7870446

  9. Epigenetic dysregulation in laryngeal squamous cell carcinoma.

    PubMed

    Wong, Thian-Sze; Gao, Wei; Li, Zeng-Hong; Chan, Jimmy Yu-Wai; Ho, Wai-Kuen

    2012-01-01

    Laryngeal carcinoma is a common head and neck cancer with poor prognosis. Patients with laryngeal carcinoma usually present late leading to the reduced treatment efficacy and high rate of recurrence. Despite the advance in the use of molecular markers for monitoring human cancers in the past decades, there are still no reliable markers for use to screen laryngeal carcinoma and follow the patients after treatment. Epigenetics emerged as an important field in understanding the biology of the human malignancies. Epigenetic alterations refer to the dysregulation of gene, which do not involve the alterations of the DNA sequence. Major epigenetic changes including methylation imbalance, histone modification, and small RNA dysregulation could play a role in the development of human malignancies. Global epigenetic change is now regarded as a molecular signature of cancer. The characteristics and behavior of a cancer could be predicted based on the specific epigenetic pattern. We here provide a review on the understanding of epigenetic dysregulation in laryngeal carcinoma. Further knowledge on the initiation and progression of laryngeal carcinoma at epigenetic level could promote the translation of the knowledge to clinical use. PMID:22645613

  10. Goiter and Laryngeal Sensory Neuropathy

    PubMed Central

    Hamdan, Abdul Latif; Jabour, Jad; Azar, Sami T.

    2013-01-01

    Objective. Examining the prevalence of laryngeal sensory neuropathy (LSN) in goiter patients versus a control group. Study Design. Cross-sectional study. Methods. 33 Goiter patients were enrolled versus 25 age-matched controls. TSH levels, size of thyroid gland, and presence or absence of thyroid nodules were reported. Subjects were asked about the presence or absence of any of the following symptoms: cough, globus pharyngeus, and/or throat clearing that persistented for more than 6 weeks. The presence of one or more of these symptoms for at least six weeks in the absence of LPRD, allergy, asthma, ACE inhibitor intake, and psychogenic disorder was defined as LSN. Results. For goitrous patients mean age (years) was (41.73 ± 9.47) versus (37.44 ± 10.89) for controls. 82% goitrous patients had known nodules and 27% carried a simultaneous diagnosis of hypothyroidism. Among those with documented size (61%), mean total thyroid volume was 26.996 ± 14.852 cm3, with a range from 9.430 to 67.022 cm3. The overall prevalence of LSN among goitrous patients was 42% versus 12% among controls (P = 0.0187). There was no correlation between LSN, size of thyroid gland, and TSH level. Conclusion. The prevalence of LSN in goitrous patients is significantly higher than that in a nongoitrous population. PMID:23818901

  11. Palsy of the rear limbs in Mycobacterium lepraemurium-infected mice results from bone damage and not from nerve involvement

    PubMed Central

    Rojas-Espinosa, O; Becerril-Villanueva, E; Wek-Rodrguez, K; Arce-Paredes, P; Reyes-Maldonado, E

    2005-01-01

    A small but relatively constant proportion (35%) of mice chronically infected with Mycobacterium lepraemurium (MLM) develops bilateral paralysis of the rear limbs. The aim of the study was to investigate whether or not the bilateral leg palsy results from nerve involvement. Direct bacterial nerve infection or acute/delayed inflammation might possibly affect the nerves. Therefore, palsied animals were investigated for the presence of: (a) histopathological changes in the leg tissues including nerves, bones and annexes, and (b) serum antibodies to M. lepraemurium and M. leprae lipids, including phenolic glycolipid I from M. leprae. Histopathological study of the palsied legs revealed that the paralysis was not the result of direct involvement of the limb nerves, as neither bacilli nor inflammatory cells were observed in the nerve branches studied. Antibodies to brain lipids and cardiolipin were not detected in the serum of the palsied animals, thus ruling out an immune response to self-lipids as the basis for the paralysis. Although high levels of antibodies to MLM lipids were detected in the serum of palsied animals they were not related to limb paralysis, as the nerves of the palsied legs showed no evidence of inflammatory damage. In fact, nerves showed no evidence of damage. Paralysis resulted from severe damage of the leg bones. Within the bones the bone marrow became replaced by extended bacilli-laden granulomas that frequently eroded the bone wall, altering the normal architecture of the bone and its annexes, namely muscle, tendons and connective tissue. Although this study rules out definitively the infectious or inflammatory damage of nerves in murine leprosy, it opens a new avenue of research into the factors that participate in the involvement or the sparing of nerves in human and murine leprosy, respectively. PMID:15932504

  12. [Gao Yuchun's experience of facial paralysis treatment].

    PubMed

    Wang, Yanjun; Cui, Linhua; Yuan, Jun; He, Li; Xie, Zhanqing; Xue, Weihua; Li, Mei; Zhang, Zhenwei; Gao, Yuchun; Kang, Suobin

    2015-05-01

    To introduce professor Gao Yuchun's clinical experience and treating characteristics of facial paralysis treated with acupuncture and moxibustion. Professor Gao pays attention to yangming when he selects acupoints for clinical syndrome, and directs acupoints selection based on syndrome differentiation in different levels of jingjin, meridians and zangfu; he praises opposing needling technique and reinforcing the deficiency and reducing the excess highly; the acupuncture manipulation is gentle,shallow and slow for reducing the healthy side and reinforcing the affected side, and through losing its excess to complement its deficiency; besides, he stresses needle retaining time and distinguishes reinforcing and reducing. Facial paralysis is treated with key factors such as acupoints selecting based on yangming, acupuncture manipulation, needle retaining time, etc. And the spleen and stomach is fine and good at transportation and transformation; the meridians is harmonious; the qi and blood is smooth. The clinical efficacy is enhanced finally. PMID:26255524

  13. Diagnosing limb paresis and paralysis in sheep

    PubMed Central

    Crilly, James Patrick; Rzechorzek, Nina; Scott, Philip

    2015-01-01

    Paresis and paralysis are uncommon problems in sheep but are likely to prompt farmers to seek veterinary advice. A thorough and logical approach can aid in determining the cause of the problem and highlighting the benefit of veterinary involvement. While this may not necessarily alter the prognosis for an individual animal, it can help in formulating preventive measures and avoid the costs – both in economic and in welfare terms – of misdirected treatment. Distinguishing between central and peripheral lesions is most important, as the relative prognoses are markedly different, and this can often be achieved with minimal equipment. This article describes an approach to performing a neurological examination of the ovine trunk and limbs, the ancillary tests available and the common and important causes of paresis and paralysis in sheep. PMID:26752801

  14. Laryngeal paraganglioma: an updated critical review.

    PubMed

    Myssiorek, David; Rinaldo, Alessandra; Barnes, Leon; Ferlito, Alfio

    2004-11-01

    Laryngeal paragangliomas are rare submucosal lesions that arise from paraganglion cells located in the false vocal fold and subglottic larynx. To date, 76 recognized cases have been reported in the world literature. Symptoms arise when the lesions become large enough to impair function. Supraglottic paragangliomas cause hoarseness and deglutition disorders, whereas subglottic tumors become symptomatic when they obstruct the airway. Evaluation of these tumors includes obtaining a complete history. Familial paragangliomas and hypertension should be sought but are rarely, if ever, associated with laryngeal paragangliomas. MRI can detect these lesions and permit characterization of the vascularity of the lesion. Adding 111In pentetreotide scanning can distinguish neuroendocrine tumors from other submucosal laryngeal lesions, making the preoperative diagnosis clearer and obviating the need for biopsy. The biggest dilemma regarding laryngeal paragangliomas is making the correct pathologic distinction between paraganglioma, typical carcinoid, atypical carcinoid and medullary thyroid cancer. Immunohistochemical markers, supplementing standard histopathologic evaluation, can distinguish paragangliomas from the aforementioned tumors. This distinction is critical as the prognosis for treated paragangliomas is excellent compared to that for other neuroendocrine neoplasms. Almost all alleged malignant paragangliomas of the larynx are in reality atypical carcinoid tumors that have been misdiagnosed. Treatment should always comprise excision. Thyrotomy has the best chance of achieving a sustained cure without damaging phonation or deglutition. Laser excision has been used successfully but there is no great experience with this modality. Surgery is preferable to radiation for paragangliomas in all locations but especially so in the larynx, due to issues such as swelling, airway protection and destruction of cartilage. With increased clinical suspicion and the use of modern imaging techniques, laryngeal paragangliomas should be routinely diagnosed and treated without loss of laryngeal functions. PMID:15513540

  15. Short- and long-term effects of paralysis on the motor innervation of two different neonatal mouse muscles

    PubMed Central

    Brown, M. C.; Hopkins, W. G.; Keynes, R. J.

    1982-01-01

    1. A study was made of short- and long-term effects of paralysis induced by type A botulinum toxin on the development of innervation of mouse muscles. The toxin was injected locally over the tensor fasciae latae (t.f.l.) and gluteus muscles at various times after birth, and the innervation was later examined by intracellular recording and by a histological technique using a reduced silver stain for axons. 2. Paralysis induced at 0-4 days of age delayed but did not prevent the eventual elimination of nearly all focal multiple innervation in gluteus muscle fibres, whereas in t.f.l. up to 50% of the fibres remained focally innervated by more than one axon for at least 120 days. There was an associated reduction in the number of muscle fibres in t.f.l. of between 50 and 70%. The biggest reduction in the number of gluteus fibres was under 40%. 3. In the t.f.l., paralysis begun at 6-9 days caused the extent of single-site polyneuronal innervation to increase above the level existing at the time of paralysis. Histologically this increase was seen to be due at least in part to the stimulation of nodal sprout growth from a limited number of nodes. 4. Motor nerve terminal sprouts were evoked by paralysis at all ages. In mice injected before 4 days of age recovery from the toxin occurred rapidly and without the formation of ectopic synapses by sprouted motor terminals; however, intrafusal motor nerves also sprouted and established a permanent ectopic innervation on surrounding extrafusal muscle fibres. 5. The following conclusions are drawn. (a) In some but not all muscles, neonatally induced paralysis can not only temporarily halt elimination of polyneuronal innervation but actually lead to an increase; it is suggested tentatively that this occurs only during the neonatal period because of the availability at that time of endoneurial pathways associated with normal polyneuronal innervation, rather than because of any special neuronal growth potential then. (b) Permanent establishment of focal polyneuronal innervation is due not to stability of presynaptic elements maintained past a critical developmental stage but is associated with substantial losses of muscle fibres, leading to a high ratio of nerve fibres to muscle fibres. ImagesPlate 1Plate 2 PMID:6216335

  16. [Diagnosis and therapy of laryngitis gastrica].

    PubMed

    Pahn, J; Schlottmann, A; Witt, G; Wilke, W

    2000-07-01

    We treated 64 patients with the diagnosis of laryngitis gastrica with Antra (Omeprazol) in doses of 10, 20, and 40 mg. To determine the success of the therapy, pH monitoring of the esophagus and hypopharynx, the voice status and measurement of vocal penetrating capacity were used. The results prove that a 20-mg dose of Antra is suitable for the therapy of laryngitis gastrica with a high rate of success. Problems which arose during the investigation, consequent changes of the original concept of the project as well as new aspects and questions which resulted from this are discussed with respect to further investigation. PMID:10955230

  17. Facial Nerve Trauma: Evaluation and Considerations in Management

    PubMed Central

    Gordin, Eli; Lee, Thomas S.; Ducic, Yadranko; Arnaoutakis, Demetri

    2014-01-01

    The management of facial paralysis continues to evolve. Understanding the facial nerve anatomy and the different methods of evaluating the degree of facial nerve injury are crucial for successful management. When the facial nerve is transected, direct coaptation leads to the best outcome, followed by interpositional nerve grafting. In cases where motor end plates are still intact but a primary repair or graft is not feasible, a nerve transfer should be employed. When complete muscle atrophy has occurred, regional muscle transfer or free flap reconstruction is an option. When dynamic reanimation cannot be undertaken, static procedures offer some benefit. Adjunctive tools such as botulinum toxin injection and biofeedback can be helpful. Several new treatment modalities lie on the horizon which hold potential to alter the current treatment algorithm. PMID:25709748

  18. Comparison of soft tissue response in rabbits following laryngeal implantation with hydroxylapatite, silicone rubber, and Teflon.

    PubMed

    Flint, P W; Corio, R L; Cummings, C W

    1997-05-01

    This study evaluates the soft tissue response in rabbits following laryngeal implantation for medialization using hydroxylapatite prostheses, carved silicone rubber prostheses, and injectable Teflon. Sixteen rabbits underwent left recurrent laryngeal nerve section for denervation and laryngeal implantation with hydroxylapatite. At 1, 3, 6, and 12 months, 4 animals were painlessly sacrificed and processed for histology. Similarly, animals were implanted with carved silicone rubber prostheses or with Teflon injected through a flap in the thyroid lamina for comparison at 1, 3, and 6 months. In animals implanted with hydroxylapatite, histologic findings include limited acute inflammatory response, thin fibrous encapsulation, and osteogenesis in the region of the fenestra, with lamellar bone bridging the space between the implant and thyroid lamina. With silicone rubber prostheses, there is a limited inflammatory response and fibrous encapsulation of the implant without evidence of osteogenesis. Animals implanted with Teflon demonstrated a classic foreign body reaction with multinucleated giant cells, granuloma formation, and migration of Teflon into surrounding muscle. With respect to soft tissue response, both hydroxylapatite and silicone rubber are less reactive than Teflon. The osteogenesis observed in the presence of hydroxylapatite increases implant stability and minimizes the risk of migration. Conversely, the presence of bone growth may limit the reversibility of medialization procedures performed with hydroxylapatite. PMID:9153105

  19. Nerve Blocks

    MedlinePLUS

    ... Sometimes the needle has to be inserted fairly deep to reach the nerve causing your problem. This ... understanding of the possible charges you will incur. Web page review process: This Web page is reviewed ...

  20. Vocal Cord Paralysis and its Etiologies: A Prospective Study

    PubMed Central

    Seyed Toutounchi, Seyed Javad; Eydi, Mahmood; Golzari, Samad EJ; Ghaffari, Mohammad Reza; Parvizian, Nashmil

    2014-01-01

    Introduction: Vocal cord paralysis is a common symptom of numerous diseases and it may be due to neurogenic or mechanical fixation of the cords. Paralysis of the vocal cords is just a symptom of underlying disease in some cases; so, clinical diagnosis of the underlying cause leading to paralysis of the vocal cords is important. This study evaluates the causes of vocal cord paralysis. Methods: In a prospective study, 45 patients with paralyzed vocal cord diagnosis were examined by tests such as examination of the pharynx, larynx, esophagus, thyroid, cervical, lung, and mediastinum, brain and heart by diagnostic imaging to investigate the cause vocal cord paralysis. The study was ended by diagnosing the reason of vocal cord paralysis at each stage of the examination and the clinical studies. Results: The mean duration of symptoms was 18.956.50 months. The reason for referral was phonation changes (97.8%) and aspiration (37.8%) in the subjects. There was bilateral paralysis in 6.82%, left paralysis in 56.82% and right in 63.36% of subjects. The type of vocal cord placement was midline in 52.8%, paramedian in 44.4% and lateral in 2.8% of the subjects. The causes of vocal cords paralysis were idiopathic paralysis (31.11%), tumors (31.11%), surgery (28.89%), trauma, brain problems, systemic disease and other causes (2.2%). Conclusion: An integrated diagnostic and treatment program is necessary for patients with vocal cord paralysis. Possibility of malignancy should be excluded before marking idiopathic reason to vocal cord paralysis. PMID:24753832

  1. Hyperthyroid hypokalemic periodic paralysis in a Hispanic male.

    PubMed Central

    Baumgartner, F. J.; Lee, E. T.

    1990-01-01

    A case of hyperthyroid periodic paralysis in a Hispanic male is reported, the disorder in this race being described only once before. He presented with complete paralysis below the neck, and his admission potassium of 1.3 mEq/L is the lowest reported in the literature. Correction of the hypokalemia resolved his symptoms. Radionuclide imaging and thyroid function tests revealed the presence of hyperthyroidism which was managed medically. The pathophysiology of hyperthyroid hypokalemic periodic paralysis is discussed. PMID:2304102

  2. Thyrotoxic hypokalemic periodic paralysis in a Hispanic male.

    PubMed Central

    Zumo, Lawrence A.; Terzian, Christian; Brannan, Timothy

    2002-01-01

    We report a case of a Hispanic male presenting with acute onset of bilateral lower extremity weakness, without any antecedent viral or bacterial illness, dietary changes, infiltrative orbitopathy, diffuse goiter, infiltrative dermopathy, and family history of periodic paralysis, who was later found to have Graves' disease. This demonstrates a rare case of periodic paralysis as the initial presentation of hyperthyroidism. Thyrotoxic hypokalemic periodic paralysis is common in Asian and Hispanic individuals and uncommon in whites and African Americans. PMID:12069220

  3. Monolimb Paralysis after Laparoscopic Appendectomy Due to Conversion Disorder

    PubMed Central

    Song, Sung Hyuk; Lee, Kyeong Hwan

    2014-01-01

    Limb paralysis can develop for various reasons. We found a 13-year-old patient who became paralyzed in her lower extremities after laparoscopic appendectomy. Some tests, including electrodiagnostic studies and magnetic resonance imaging, were performed to evaluate the cause of lower limb paralysis. None of the tests yielded definite abnormal findings. We subsequently decided to explore the possibility of psychological problems. The patient was treated with simultaneous rehabilitation and psychological counseling. Paralysis of the patient's lower extremity improved gradually and the patient returned to normal life. Our findings indicate that psychological problems can be related to limb paralysis without organ damage in patients who have undergone laparoscopic surgical procedures. PMID:25426280

  4. Tick paralysis in Australia caused by Ixodes holocyclus Neumann

    PubMed Central

    Hall-Mendelin, S; Craig, S B; Hall, R A; O’Donoghue, P; Atwell, R B; Tulsiani, S M; Graham, G C

    2011-01-01

    Ticks are obligate haematophagous ectoparasites of various animals, including humans, and are abundant in temperate and tropical zones around the world. They are the most important vectors for the pathogens causing disease in livestock and second only to mosquitoes as vectors of pathogens causing human disease. Ticks are formidable arachnids, capable of not only transmitting the pathogens involved in some infectious diseases but also of inducing allergies and causing toxicoses and paralysis, with possible fatal outcomes for the host. This review focuses on tick paralysis, the role of the Australian paralysis tick Ixodes holocyclus, and the role of toxin molecules from this species in causing paralysis in the host. PMID:21396246

  5. Facial-paralysis diagnostic system based on 3D reconstruction

    NASA Astrophysics Data System (ADS)

    Khairunnisaa, Aida; Basah, Shafriza Nisha; Yazid, Haniza; Basri, Hassrizal Hassan; Yaacob, Sazali; Chin, Lim Chee

    2015-05-01

    The diagnostic process of facial paralysis requires qualitative assessment for the classification and treatment planning. This result is inconsistent assessment that potential affect treatment planning. We developed a facial-paralysis diagnostic system based on 3D reconstruction of RGB and depth data using a standard structured-light camera - Kinect 360 - and implementation of Active Appearance Models (AAM). We also proposed a quantitative assessment for facial paralysis based on triangular model. In this paper, we report on the design and development process, including preliminary experimental results. Our preliminary experimental results demonstrate the feasibility of our quantitative assessment system to diagnose facial paralysis.

  6. Hysterical conversion paralysis in an adolescent boy with lumbar spondylolysis.

    PubMed

    Higuchi, Tadahiro; Tonogai, Ichiro; Sakai, Toshinori; Takata, Yoichiro; Goda, Yuichiro; Abe, Mitsunobu; Jha, Subash C; Fukuta, Shoji; Higashino, Kosaku; Nagamachi, Akihiro; Sairyo, Koichi

    2016-05-01

    We describe a case of recurrent hysterical paralysis triggered by low back pain because of lumbar spondylolysis. A 16-year-old male soccer player was referred to our institution with five previous episodes of acute paralysis triggered by severe low back pain. We performed direct surgical repair of the terminal-stage bilateral spondylolysis at L4 using a hook-rod system. His chronic low back pain was completely resolved, and no further episodes of hysterical paralysis have occurred after surgery. Spine surgeons should be aware of possible hysterical conversion paralysis when there is discrepancy between radiological and neurological findings. PMID:26049966

  7. Tick paralysis in Australia caused by Ixodes holocyclus Neumann.

    PubMed

    Hall-Mendelin, S; Craig, S B; Hall, R A; O'Donoghue, P; Atwell, R B; Tulsiani, S M; Graham, G C

    2011-03-01

    Ticks are obligate haematophagous ectoparasites of various animals, including humans, and are abundant in temperate and tropical zones around the world. They are the most important vectors for the pathogens causing disease in livestock and second only to mosquitoes as vectors of pathogens causing human disease. Ticks are formidable arachnids, capable of not only transmitting the pathogens involved in some infectious diseases but also of inducing allergies and causing toxicoses and paralysis, with possible fatal outcomes for the host. This review focuses on tick paralysis, the role of the Australian paralysis tick Ixodes holocyclus, and the role of toxin molecules from this species in causing paralysis in the host. PMID:21396246

  8. Selective activation of the human tibial and common peroneal nerves with a flat interface nerve electrode

    NASA Astrophysics Data System (ADS)

    Schiefer, M. A.; Freeberg, M.; Pinault, G. J. C.; Anderson, J.; Hoyen, H.; Tyler, D. J.; Triolo, R. J.

    2013-10-01

    Objective. Electrical stimulation has been shown effective in restoring basic lower extremity motor function in individuals with paralysis. We tested the hypothesis that a flat interface nerve electrode (FINE) placed around the human tibial or common peroneal nerve above the knee can selectively activate each of the most important muscles these nerves innervate for use in a neuroprosthesis to control ankle motion. Approach. During intraoperative trials involving three subjects, an eight-contact FINE was placed around the tibial and/or common peroneal nerve, proximal to the popliteal fossa. The FINE's ability to selectively recruit muscles innervated by these nerves was assessed. Data were used to estimate the potential to restore active plantarflexion or dorsiflexion while balancing inversion and eversion using a biomechanical simulation. Main results. With minimal spillover to non-targets, at least three of the four targets in the tibial nerve, including two of the three muscles constituting the triceps surae, were independently and selectively recruited in all subjects. As acceptable levels of spillover increased, recruitment of the target muscles increased. Selective activation of muscles innervated by the peroneal nerve was more challenging. Significance. Estimated joint moments suggest that plantarflexion sufficient for propulsion during stance phase of gait and dorsiflexion sufficient to prevent foot drop during swing can be achieved, accompanied by a small but tolerable inversion or eversion moment.

  9. Use of Lasers in Laryngeal Surgery

    PubMed Central

    Yan, Yan; Olszewski, Aleksandra E.; Hoffman, Matthew R.; Zhuang, Peiyun; Ford, Charles N.; Dailey, Seth H.; Jiang, Jack J.

    2012-01-01

    Lasers are a relatively recent addition to laryngeal surgery. Since their invention, laser use and applications have expanded rapidly. In this paper, we discuss the benefits and disadvantages of lasers for different procedures, as well as ways to overcome commonly faced clinical problems. The use of lasers in surgery has offered a time- and cost-efficient alternative to cold surgical techniques, and has been employed in the treatment of numerous laryngeal pathologies, including stenoses, recurrent respiratory papillomatosis, leukoplakia, nodules, malignant laryngeal disease, and polypoid degeneration (Reinke’s edema). However, lasers can incur adjacent tissue damage and vocal fold scarring. These problems can be minimized through understanding the mechanisms by which lasers function and correctly manipulating the parameters under a surgeon’s control. By varying fluence, power density, and pulsation, tissue damage can be decreased and lasers can be used with greater confidence. The various types of lasers and their applications to the treatment of specific pathologies are reviewed with the intention of helping surgeons select the best tool for a given procedure. Recent applications of lasers to treat benign laryngeal lesions and severe laryngomalacia demonstrate that additional research must be conducted in order to realize the full potential of this surgical tool. PMID:19487102

  10. Atraumatic laser treatment for laryngeal papillomatosis

    NASA Astrophysics Data System (ADS)

    McMillan, Kathleen; Pankratov, Michail M.; Wang, Zhi; Bottrill, Ian; Rebeiz, Elie E.; Shapshay, Stanley M.

    1994-09-01

    Ten to fifteen thousand new cases of recurrent respiratory papillomatosis (RRP) are diagnosed each year in the United States. RRP is caused by the human papillomavirus (HPV) and is characterized by recurrent, non-malignant, proliferative lesions of the larynx. Patients with RRP undergo numerous microsurgical procedures to remove laryngeal papilloma threatening airway patency and interfering with phonation. The standard surgical technique involves CO2 laser vaporization of laryngeal epithelium affected by the lesions, and requires general anesthesia. The pulsed dye laser operating at 585 nm has previously been demonstrated to be effective in clearing HPV lesions of the skin (verrucae). For treatment of RRP, the fiber- compatible pulsed dye laser radiation may be delivered under local anesthesia using a flexible intranasal laryngoscope. Potential advantages of the pulsed dye laser treatment over CO2 laser surgery include (1) reduced morbidity, especially a lower risk of laryngeal scarring; (2) lower cost; (3) reduced technical difficulty; and (4) reduced risk of viral dissemination or transmission. In vivo studies are underway to determine the effect of pulsed dye laser radiation on normal canine laryngeal tissue.

  11. Current role of stroboscopy in laryngeal imaging

    PubMed Central

    Mehta, Daryush D.; Hillman, Robert E.

    2013-01-01

    Purpose of review This paper summarizes recent technological advancements and insight into the role of stroboscopy in laryngeal imaging. Recent findings Videostroboscopic technology Although stroboscopy has not undergone major technological improvements, recent clarifications have been made to the application of stroboscopic principles to video-based laryngeal imaging. Also recent advances in coupling stroboscopy with high-definition video cameras provide higher spatial resolution of phonatory function. Visual stroboscopic assessment Studies indicate that interrater reliability of visual stroboscopic assessment varies depending on the laryngeal feature being rated and that only a subset of features may be needed to represent an entire assessment. High-speed videoendoscopy (HSV) judgments have been shown to be more sensitive than stroboscopy for evaluating vocal fold phase asymmetry, pointing to the potential of complementing stroboscopy with alternative imaging modalities in hybrid systems. Clinical role Stroboscopic imaging continues to play a central role in voice clinics. Although HSV may provide more detailed information about phonatory function, its eventual clinical adoption depends on how remaining practical, technical, and methodological challenges will be met. Summary Laryngeal videostroboscopy continues to be the modality of choice for imaging vocal fold vibration, but technological advancements and HSV research findings are driving increased interest in the clinical adoption of HSV to complement videostroboscopic assessment. PMID:22931908

  12. Laryngeal leiomyosarcoma with coexistent tuberculous mediastinal lymphadenopathy.

    PubMed

    Yksel Asl?er, Nesibe Gl; Do?an, Ersoy; Sar?o?lu, Slen; ?kiz, Ahmet mer

    2015-01-01

    Laryngeal leiomyosarcoma is an extremely rare malignancy originating from the smooth muscles of blood vessels. Herein, we present the first case of leiomyosarcoma arising from the glottic area of the larynx with coexistent tuberculous mediastinal lymphadenopathy. The patient was treated with vertical laryngectomy and anti-tuberculous medication. He has been disease-free for 24 months since initial treatment. PMID:25935064

  13. Ventricular pressures in phonating excised larynges

    PubMed Central

    Alipour, Fariborz; Scherer, Ronald C.

    2012-01-01

    Pressure in the laryngeal ventricle was measured with a beveled needle connected to a pressure transducer in excised canine larynges. Air pressures within the ventricle were obtained for different adduction levels of the true vocal folds (TVFs), false vocal folds (FVFs), and subglottal pressures (Ps). Results indicated that the air pressures in the ventricle appear to be strongly related to the motion of the FVFs rather than to the effects of TVF vibration. Both dc and ac pressures depend on FVF adduction, amplitude of motion of the FVFs, and whether the FVFs touch each other during the vibratory cycle. Mean and peak-to-peak pressures in the ventricle were as high as 65% of the mean and peak-to-peak Ps, respectively, when the FVFs vibrated with large amplitude and contact each cycle. If the glottis was not closed, a medial movement of the FVFs appeared to create a positive pressure pulse on the Ps signal due to an increase in the laryngeal flow resistance. The electroglottograph signal showed evidence of tissue contact for both the TVFs and the FVFs. The study suggests that the laryngeal ventricle acts as a relatively independent aero-acoustic chamber that depends primarily upon the motion of the FVFs. PMID:22894222

  14. Preoperative clinical prediction of difficult laryngeal exposure in suspension laryngoscopy.

    PubMed

    Pinar, Ercan; Calli, Caglar; Oncel, Semih; Selek, Burcu; Tatar, Bekir

    2009-05-01

    We investigated general and physical predictors of difficult laryngeal exposure in patients undergoing suspension laryngoscopy; 93 patients were included in this prospective study. The patients were classified as difficult laryngeal exposure group or non-difficult laryngeal exposure group based on the laryngeal view in suspension laryngoscopy. Twelve parameters (age, sex, body mass index, neck circumference, full mouth opening, modified mallampati index, hyoid-mental, thyroid-mental, horizontal thyroid-mental, vertical thyroid-mental, sternum-mental distance) that could predict difficult laryngeal exposure were evaluated. Of 93 patients, 22 had difficult laryngeal exposure. Cormack-Lehane score, neck circumference, body mass index, modified mallampati index, hyoid-mental, thyroid-mental, vertical thyroid-mental, and sternum-mental distance showed significant correlation with difficult laryngeal exposure. Based on the multivariate analysis, neck circumference superior to 40 cm, hyoid-mental and sternum-mental distance with respectively a value less than 6.05 and 13.9 cm were independently associated with difficult laryngeal exposure. Muscular neck, hyoid-mental and sterno-mental distance should be considered clinical predictors of difficult laryngeal exposure. Measurements of physical variables at full extension position of the neck are more useful and reliable predictors than neutral position for the risk of difficult laryngeal exposure. PMID:18985370

  15. Development and validation of the Newcastle laryngeal hypersensitivity questionnaire

    PubMed Central

    2014-01-01

    Background Laryngeal hypersensitivity may be an important component of the common disorders of laryngeal motor dysfunction including chronic refractory cough, pdoxical vocal fold movement (vocal cord dysfunction), muscle tension dysphonia, and globus pharyngeus. Patients with these conditions frequently report sensory disturbances, and an emerging concept of the irritable larynx suggests common features of a sensory neuropathic dysfunction as a part of these disorders. The aim of this study was to develop a Laryngeal Hypersensitivity Questionnaire for patients with laryngeal dysfunction syndromes in order to measure the laryngeal sensory disturbance occurring in these conditions. Methods The 97 participants included 82 patients referred to speech pathology for behavioural management of laryngeal dysfunction and 15 healthy controls. The participants completed a 21 item self administered questionnaire regarding symptoms of abnormal laryngeal sensation. Factor analysis was conducted to examine correlations between items. Discriminant analysis and responsiveness to change were evaluated. Results The final questionnaire comprised 14 items across three domains: obstruction, pain/thermal, and irritation. The questionnaire demonstrated significant discriminant validity with a mean difference between the patients with laryngeal disorders and healthy controls of 5.5. The clinical groups with laryngeal hypersensitivity had similar abnormal scores. Furthermore the Newcastle Laryngeal Hypersensitivity Questionnaire (LHQ) showed improvement following behavioural speech pathology intervention with a mean reduction in LHQ score of 2.3. Conclusion The Newcastle Laryngeal Hypersensitivity Questionnaire is a simple, non-invasive tool to measure laryngeal pesthesia in patients with laryngeal conditions such as chronic cough, pdoxical vocal fold movement (vocal cord dysfunction), muscle tension dysphonia, and globus pharyngeus. It can successfully differentiate patients from healthy controls and measure change following intervention. It is a promising tool for use in clinical research and practice. PMID:24552215

  16. Epidemiological review of laryngeal cancer: An Indian perspective

    PubMed Central

    Bobdey, Saurabh; Jain, Aanchal; Balasubramanium, Ganesh

    2015-01-01

    Background: Laryngeal cancer is one of the 10 leading causes of cancer in Indian men. The association of laryngeal cancer and tobacco smoking is well-established, but the peculiarities such as wide variation of disease distribution and survival, role of tobacco chewing, indoor air pollution, and dietary factors in laryngeal cancer causation needs to be understood. In this study, we review the descriptive and observational epidemiology of laryngeal cancer in India. Materials and Methods: MEDLINE and Web of science electronic database was searched from January 1995 to December 2013, using the using keywords laryngeal cancer, laryngeal cancer outcome, epidemiology, etiological factor and their corresponding Mesh terms were used in combination like OR, AND. Two authors independently selected studies published in English and conducted in India. A total of 15 studies were found to be relevant and eligible for this review. Results: In India, laryngeal cancer contributes to approximately 3-6% of all cancers in men. The age-adjusted incidence rate of cancer larynx in males varies widely among registries, highest is 8.18 per 100,000 in Kamprup Urban District and the lowest is 1.26 per 100,000 in Nagaland. The 5-year survival for laryngeal cancer in India is approximately 28%. Indian studies show tobacco, alcohol, long-term exposure to indoor air pollution, spicy food, and nonvegetarian diet as risk factors for laryngeal cancer. Conclusion: There is wide regional variation in the incidence of laryngeal cancer in India. Survival rates of laryngeal carcinoma are much lower as compared to other Asian countries. Studies conducted in India to identify important risk factors of laryngeal cancer are very limited, especially on diet and indoor air pollution. Hence, more research is required for identifying the etiological factors and development of scientifically sound laryngeal cancer prevention programs.

  17. How do I manage an acute injury to the facial nerve?

    PubMed

    Colbert, Serryth; Coombes, Daryl; Godden, Daryl; Cascarini, Luke; Kerawala, Cyrus; Brennan, Peter A

    2014-01-01

    Paralysis of the facial nerve is a cause of considerable functional and aesthetic disfigurement. Damage to the upper trunk can result in eye complications with the risk of exposure keratitis. Numerous factors influence the therapeutic strategy: the cause of the injury, the time elapsed since injury, functional impairment, and the likelihood of recovery. We discuss the management of an acute injury to the facial nerve and focus on the surgical options. PMID:24090764

  18. Laryngeal preservation in managing advanced tracheal adenoid cystic carcinoma.

    PubMed

    Subramaniam, Thavakumar; Lennon, Paul; Kinsella, John; O'Neill, James Paul

    2015-01-01

    A 37-year-old male athlete was diagnosed with primary tracheal adenoid cystic carcinoma following investigation for dyspnea, wheeze, and eventual stridor. Preoperative bronchoscopy revealed a highly vascular tumor 4?cm distal to the cricoid with no gross disease extending to the carina. Imaging revealed circumferential tracheal irregularity immediately inferior to the cricoid, with no definite cricoid invasion. Locoregional extension of disease was noted invading the thyroid and abutment of the carotid approximately 180. Intraoperative findings identified tracheal mucosal disease extending distal to the carina and proximally at the cricothyroid joints where bilateral functional recurrent nerves were preserved. A decision made to preserve the larynx given the inability to fully resect distal tracheal disease. A 5?cm sleeve resection of the trachea was made with a cricotracheal anastomosis following suprahyoidal muscle release and laryngeal drop-down. The patient was treated with adjuvant radiotherapy including platinum based chemotherapy in an effort to maximise local control. PET scanning three months after therapy revealed no FDG uptake locally or distally. PMID:25878915

  19. Laryngeal Preservation in Managing Advanced Tracheal Adenoid Cystic Carcinoma

    PubMed Central

    Subramaniam, Thavakumar; Lennon, Paul; Kinsella, John; O'Neill, James Paul

    2015-01-01

    A 37-year-old male athlete was diagnosed with primary tracheal adenoid cystic carcinoma following investigation for dyspnea, wheeze, and eventual stridor. Preoperative bronchoscopy revealed a highly vascular tumor 4?cm distal to the cricoid with no gross disease extending to the carina. Imaging revealed circumferential tracheal irregularity immediately inferior to the cricoid, with no definite cricoid invasion. Locoregional extension of disease was noted invading the thyroid and abutment of the carotid approximately 180. Intraoperative findings identified tracheal mucosal disease extending distal to the carina and proximally at the cricothyroid joints where bilateral functional recurrent nerves were preserved. A decision made to preserve the larynx given the inability to fully resect distal tracheal disease. A 5?cm sleeve resection of the trachea was made with a cricotracheal anastomosis following suprahyoidal muscle release and laryngeal drop-down. The patient was treated with adjuvant radiotherapy including platinum based chemotherapy in an effort to maximise local control. PET scanning three months after therapy revealed no FDG uptake locally or distally. PMID:25878915

  20. Like a Deer in the Headlights: The Paralysis of Stuckness

    ERIC Educational Resources Information Center

    Anderson-Nathe, Ben

    2008-01-01

    When describing how they experience moments of not-knowing, youth workers often talk about a sense of paralysis, as though their uncertainty becomes physically constraining. This chapter describes the first of five themes associated with youth workers' experiences of not knowing what to do: the paralysis of stuckness. In addition to describing and

  1. Anthracosis: An unusual cause of vocal fold paralysis.

    PubMed

    Aydin, Sedat; Celebi, Ozlem; Kiroglu, Merve; Demir, Mehmet Gökhan

    2015-07-01

    Anthracotic pigmentation in the bronchial mucosa is a bronchoscopic finding of pneumoconiosis, or evidence of heavy atmospheric soot. This pigmentation in the tracheobronchial mucosa is surrounded by calcified or noncalcified lymph nodes. Anthracosis is not a previously known cause of left vocal fold paralysis. We present what we believe to be the first reported case of anthracosis-caused vocal fold paralysis. PMID:26214668

  2. Thyrotoxic periodic paralysis triggered by ?2-adrenergic bronchodilators.

    PubMed

    Yeh, Fu-Chiang; Chiang, Wen-Fang; Wang, Chih-Chiang; Lin, Shih-Hua

    2014-05-01

    Hypokalemic periodic paralysis is the most common form of periodic paralysis and is characterized by attacks of muscle paralysis associated with a low serum potassium (K+) level due to an acute intracellular shifting. Thyrotoxic periodic paralysis (TPP), characterized by the triad of muscle paralysis, acute hypokalemia, and hyperthyroidism, is one cause of hypokalemic periodic paralysis. The triggering of an attack of undiagnosed TPP by ?2-adrenergic bronchodilators has, to our knowledge, not been reported previously. We describe two young men who presented to the emergency department with the sudden onset of muscle paralysis after administration of inhaled ?2-adrenergic bronchodilators for asthma. In both cases, the physical examination revealed an enlarged thyroid gland and symmetrical flaccid paralysis with areflexia of lower extremities. Hypokalemia with low urine K+ excretion and normal blood acid-base status was found on laboratory testing, suggestive of an intracellular shift of K+, and the patients' muscle strength recovered at serum K+ concentrations of 3.0 and 3.3 mmol/L. One patient developed hyperkalemia after a total potassium chloride supplementation of 110 mmol. Thyroid function testing was diagnostic of primary hyperthyroidism due to Graves disease in both cases. These cases illustrate that ?2-adrenergic bronchodilators should be considered a potential precipitant of TPP. PMID:24852589

  3. Thyrotoxic Periodic Paralysis: An Underdiagnosed and Under-recognized Condition.

    PubMed

    Tella, Sri Harsha; Kommalapati, Anuhya

    2015-01-01

    Thyrotoxic hypokalemic periodic paralysis (TPP) is a condition characterized by the triad of acute hypokalemia without total body potassium deficit, episodic muscle paralysis, and thyrotoxicosis. We describe two cases of thyrotoxic periodic paralysis who presented to our hospital with potassium values of 1.3 MeQ/l and 1.2 MeQ/l, respectively. Surprisingly, the two patients had no documented past medical history. Based on the clinical features of high heart rate, palpitations (seen in both the patients), and exophthalmos (seen in one patient), thyrotoxic periodic paralysis was suspected. A thorough laboratory workup confirmed the diagnosis of thyrotoxicosis. Beta blockers were initiated promptly, along with intravenous potassium chloride, and the patients eventually improved symptomatically. These patients were eventually diagnosed with Graves' disease and were placed on methimazole, which prevented further attacks. Thyroid periodic paralysis (TPP) is a rare clinical manifestation of hyperthyroidism. Patients present with sudden onset paralysis associated with severe hypokalemia. The presence of paralysis and hypokalemia in a patient who has a history of hyperthyroidism should prompt the physician about thyrotoxic periodic paralysis. Ahigh index of suspicion, prompt diagnosis, and management of the condition can prevent severe complications, such as cardiac arrhythmias. PMID:26623197

  4. Peripheral Nerve Disorders

    MedlinePLUS

    ... spinal cord. Like static on a telephone line, peripheral nerve disorders distort or interrupt the messages between the brain ... body. There are more than 100 kinds of peripheral nerve disorders. They can affect one nerve or many nerves. ...

  5. Medial Plantar Nerve Entrapment

    MedlinePLUS

    ... Fibromatosis Medial and lateral plantar nerve entrapment is compression of nerve branches at the inner heel (the ... nerve or surgery to free the nerve from compression may help relieve pain. Foot Problems Overview of ...

  6. Severe Acute Orthopnea: Ipilimumab-Induced Bilateral Phrenic Nerve Neuropathy.

    PubMed

    Jinnur, Praveen; Lim, Kaiser G

    2015-08-01

    Ipilimumab is a monoclonal antibody used in the treatment of unresectable or metastatic melanoma. Several immune-related adverse events including potential fatal events have been reported following its use. We report a case of a 66-year-old man who presented with severe acute exertional dyspnea and orthopnea following administration of ipilimumab for metastatic melanoma. Although various peripheral neuropathy syndromes associated with ipilimumab have been reported, bilateral phrenic nerve paralysis has not been previously reported. This case also highlights the clinical features of bilateral phrenic nerve neuropathy. Pulmonologists have to be aware of these unusual immune-related respiratory adverse events in patients being treated with monoclonal antibodies. PMID:25956728

  7. [Surveillance of acute flaccid paralysis in Belarus].

    PubMed

    Samo?lovich, E O; Ermolovich, M A; Kotova, I F; Svirchevskaia, E Iu; Shimanovich, V P; Kozhemiakin, A K; Protas, I I; Fel'dman, E V

    2007-01-01

    The ten-years experience of acute flaccid paralysis (AFP) surveillance in Belarus has been summarized. Among 456 AFP cases reported from 1996 to 2005, 11 were classified as vaccine-associated paralytic poliomyelitis (VAPP), 445--as non-polio AFP. The risk of VAPP for the period 1996-2001 was 1 case per 745,000 used doses of oral poliovaccine (OPV). For the recipients of OPV the risk was 1 case per 911,700 doses and for the first-dose recipients--1 case per 96,000 doses. The high incidence of VAPP was a reason for implementation of sequential polio vaccination schedule in 2000. Guillain-Barre syndrome dominated among non-polio AFP (39.3% of cases); more rare were traumatic neuritis (27.9% of cases), transient monoparalysis (12.1%), myelitis (7.6%). Non-polio AFP differed from VAPP by following epidemiological and virological characteristics: predominance of previously repeatedly vaccinated against poliomyelitis; development of paralysis in long-term period after vaccination; isolation of non-polio viruses belonged to three serotypes of Coxsackie B viruses (B1, B4, B6) and six serotypes of Echo viruses (6, 7, 11, 14, 24, 25) in 8.1% of cases; absence of typical for polio residual paralyses in patients who excreted vaccine polioviruses. PMID:17523475

  8. Isolated sleep paralysis elicited by sleep interruption.

    PubMed

    Takeuchi, T; Miyasita, A; Sasaki, Y; Inugami, M; Fukuda, K

    1992-06-01

    We elicited isolated sleep paralysis (ISP) from normal subjects by a nocturnal sleep interruption schedule. On four experimental nights, 16 subjects had their sleep interrupted for 60 minutes by forced awakening at the time when 40 minutes of nonrapid eye movement (NREM) sleep had elapsed from the termination of rapid eye movement (REM) sleep in the first or third sleep cycle. This schedule produced a sleep onset REM period (SOREMP) after the interruption at a high rate of 71.9%. We succeeded in eliciting six episodes of ISP in the sleep interruptions performed (9.4%). All episodes of ISP except one occurred from SOREMP, indicating a close correlation between ISP and SOREMP. We recorded verbal reports about ISP experiences and recorded the polysomnogram (PSG) during ISP. All of the subjects with ISP experienced inability to move and were simultaneously aware of lying in the laboratory. All but one reported auditory/visual hallucinations and unpleasant emotions. PSG recordings during ISP were characterized by a REM/W stage dissociated state, i.e. abundant alpha electroencephalographs and persistence of muscle atonia shown by the tonic electromyogram. Judging from the PSG recordings, ISP differs from other dissociated states such as lucid dreaming, nocturnal panic attacks and REM sleep behavior disorders. We compare some of the sleep variables between ISP and non-ISP nights. We also discuss the similarities and differences between ISP and sleep paralysis in narcolepsy. PMID:1621022

  9. Parkinson Disease Affects Peripheral Sensory Nerves in the Pharynx

    PubMed Central

    Mu, Liancai; Sobotka, Stanislaw; Chen, Jingming; Su, Hungxi; Sanders, Ira; Nyirenda, Themba; Adler, Charles H.; Shill, Holly A.; Caviness, John N.; Samanta, Johan E.; Sue, Lucia I.; Beach, Thomas G.

    2013-01-01

    Dysphagia is very common in patients with Parkinsons disease (PD) and often leads to aspiration pneumonia, the most common cause of death in PD. Unfortunately, current therapies are largely ineffective for dysphagia. As pharyngeal sensation normally triggers the swallowing reflex, we examined pharyngeal sensory nerves in PD for Lewy pathology. Sensory nerves supplying the pharynx were excised from autopsied pharynges obtained from patients with clinically diagnosed and neuropathologically confirmed PD (n = 10) and healthy age-matched controls (n = 4). We examined: the glossopharyngeal nerve (IX); the pharyngeal sensory branch of the vagus nerve (PSB-X); and the internal superior laryngeal nerve (ISLN) innervating the laryngopharynx. Immunohistochemistry for phosphorylated ?-synuclein was used to detect potential Lewy pathology. Axonal ?-synuclein aggregates in the pharyngeal sensory nerves were identified in all of the PD subjects but not in the controls. The density of ?-synuclein-positive lesions was significantly greater in PD subjects with documented dysphagia compared to those without dysphagia. In addition, ?-synuclein-immunoreactive nerve fibers in the ISLN were much more abundant than those in the IX and PSBX. These findings suggest that pharyngeal sensory nerves are directly affected by the pathologic process of PD. This anatomic pathology may decrease pharyngeal sensation impairing swallowing and airway protective reflexes, thereby contributing to dysphagia and aspiration. PMID:23771215

  10. Bilateral Facial Nerve Palsy: A Diagnostic Dilemma

    PubMed Central

    Pothiawala, Sohil; Lateef, Fatimah

    2012-01-01

    Introduction. Bilateral facial nerve palsy (FNP) is a rare condition, representing less than 2% of all cases of FNP. Majority of these patients have underlying medical conditions, ranging from neurologic, infectious, neoplastic, traumatic, or metabolic disorders. Objective. The differential diagnosis of its causes is extensive and hence can present as a diagnostic challenge. Emergency physicians should be aware of these various diagnostic possibilities, some of which are potentially fatal. Case Report. We report a case of a 43-year-old female who presented to the emergency department with sequential bilateral facial nerve paralysis which could not be attributed to any particular etiology and, hence, presented a diagnostic dilemma. Conclusion. We reinforce the importance of considering the range of differential diagnosis in all cases presenting with bilateral FNP. These patients warrant admission and prompt laboratory and radiological investigation for evaluation of the underlying cause and specific further management as relevant. PMID:23326715

  11. Assessment of laryngeal dysfunctions of dysarthric speakers.

    PubMed

    Surabhi, V; Vijayalakshmi, P; Steffina, Lily; Jayanthan, Ra V

    2009-01-01

    Dysarthria is a neuromotor impairment of speech that affects one or more of the speech sub-systems. It is reflected in the acoustic characteristics of the phonemes as deviations from their healthy counterparts. In the current work, the deviations associated with laryngeal dysfunctions are analysed in order to assess and quantify parameters that will help evaluate dysarthria. Perturbation measures, pitch period statistics and Pitch Variation Index (PVI) are computed for the assessment of laryngeal dysfunctions of dysarthric speakers. The assessments were performed on the Nemours database of dysarthric speech and compared with normal speakers available in the TIMIT speech corpus. The results were correlated with Frenchay Dysarthria Assessment (FDA) scores. The analysis resulted in a technique to predict the degree of severity of dysarthria and illustrate the multi-causal nature of the disorder. PMID:19965223

  12. Capsaicin receptor expression in rat laryngeal innervation.

    PubMed

    Uno, Toshiyuki; Koike, Shinobu; Bamba, Hitoshi; Hirota, Ryuichi; Hisa, Yasuo

    2004-05-01

    Capsaicin elicits a sensation of burning pain by selectively activating sensory neurons that convey information about noxious stimuli to the central nervous system. Vanilloid receptor subtype 1 (VRI) and the vanilloid receptor-like protein 1 (VRL-1) are activated, not only by capsaicin, but also by noxious heat and protons, and it has been suggested that they are polymodal nociceptors. We investigated the expression of VR1 and VRL-1 in the rat larynx and nodose ganglion using VR1 and VRL-1 immunohistochemical analysis with visualization by diaminobenzidine reaction. Fibers positive for VRL-1 were detected in the laryngeal epithelium and lamina propria. Cells positive for VRL-1 were distributed in the intralaryngeal ganglia. Half of the neurons in the nodose ganglion had VR-1 immunoreactivity, and almost 10% of the nodose ganglion neurons were positive for VRL-1. These findings suggest that these capsaicin receptors play an important role in the nociception of the laryngeal innervation. PMID:15174761

  13. Organ preservation surgery for laryngeal cancer

    PubMed Central

    Chawla, Sharad; Carney, Andrew Simon

    2009-01-01

    The principles of management of the laryngeal cancer have evolved over the recent past with emphasis on organ preservation. These developments have paralleled technological advancements as well as refinement in the surgical technique. The surgeons are able to maintain physiological functions of larynx namely speech, respiration and swallowing without compromising the loco-regional control of cancer in comparison to the more radical treatment modalities. A large number of organ preservation surgeries are available to the surgeon; however, careful assessment of the stage of the cancer and selection of the patient is paramount to a successful outcome. A comprehensive review of various organ preservation techniques in vogue for the management of laryngeal cancer is presented. PMID:19442314

  14. Management of laryngeal foreign bodies in children.

    PubMed Central

    Sharma, H S; Sharma, S

    1999-01-01

    Foreign body aspiration is one of the leading causes of accidental death in children. Food items are the most common items aspirated in infants and toddlers, whereas older children are more likely to aspirate non-food items. Laryngeal impaction of a foreign body is very rare as most aspirated foreign bodies pass through the laryngeal inlet and get lodged lower down in the airway. Two rare cases of foreign body aspiration with subglottic impaction in very young children (under 2 years of age) are described. In both the cases subglottic impaction occurred consequent to attempted removal of foreign body by blind finger sweeping. The clinical presentation, investigations, and management of these rare cases are discussed. Images Figure 1 Figure 2 PMID:10191459

  15. Laryngeal biomechanics of the singing voice.

    PubMed

    Koufman, J A; Radomski, T A; Joharji, G M; Russell, G B; Pillsbury, D C

    1996-12-01

    By transnasal fiberoptic laryngoscopy, patients with functional voice often demonstrate abnormal laryngeal biomechanics, commonly supraglottic contraction. Appropriately, such conditions are sometimes termed muscle tension dysphonias. Singers working at the limits of their voice may also transiently demonstrate comparable tension patterns. However, the biomechanics of normal singing, particularly for different singing styles, have not been previously well characterized. We used transnasal fiberoptic laryngoscopy to study 100 healthy singers to assess patterns of laryngeal tension during normal singing and to determine whether factors such as sex, occupation, and style of singing influence laryngeal muscle tension. Thirty-nine male and 61 female singers were studied; 48 were professional singers, and 52 were amateurs. Examinations of study subjects performing standardized and nonstandardized singing tasks were recorded on a laser disk and subsequently analyzed in a frame-by-frame fashion by a blinded otolaryngologist. Each vocal task was graded for muscle tension by previously established criteria, and objective muscle tension scores were computed. The muscle tension score was expressed as a percentage of frames for each task with one of the laryngeal muscle tension patterns shown. The lowest muscle tension scores were seen in female professional singers, and the highest muscle tension scores were seen in amateur female singers. Male singers (professional and amateur) had intermediate muscle tension scores. Classical singers had lower muscle tension scores than nonclassical singers, with the lowest muscle tension scores being seen in those singing choral music (41%), art song (47%), and opera (57%), and the highest being seen in those singing jazz/pop (65%), musical theater (74%), bluegrass/country and western (86%), and rock/gospel (94%). Analyzed also were the influences of vocal nodules, prior vocal training, number of performance and practice hours per week, warm-up before singing, race, smoking, and alcohol consumption. PMID:8969758

  16. Diaphragm and Laryngeal FDG Uptake With Hiccups.

    PubMed

    Srivastava, Madhur K; Jain, Avani S; Panneer, Venkat; Muthukrishnan, Indirani; Simon, Shelley

    2015-11-01

    F-FDG PET/CT study is a well-established investigation in diagnosis, treatment evaluation, and follow-up of malignant tumors. It is very important to know the normal biodistribution and physiologic uptake of F-FDG to prevent it from confusing as malignant disease. This article describes unusual but physiological uptake in the laryngeal and diaphragmatic muscles in a patient presenting as metastatic adenocarcinoma with unknown primary having hiccups. PMID:26204217

  17. Arnold's nerve cough reflex: evidence for chronic cough as a sensory vagal neuropathy.

    PubMed

    Ryan, Nicole M; Gibson, Peter G; Birring, Surinder S

    2014-10-01

    Arnold's nerve ear-cough reflex is recognised to occur uncommonly in patients with chronic cough. In these patients, mechanical stimulation of the external auditory meatus can activate the auricular branch of the vagus nerve (Arnold's nerve) and evoke reflex cough. This is an example of hypersensitivity of vagal afferent nerves, and there is now an increasing recognition that many cases of refractory or idiopathic cough may be due to a sensory neuropathy of the vagus nerve. We present two cases where the cause of refractory chronic cough was due to sensory neuropathy associated with ear-cough reflex hypersensitivity. In both cases, the cough as well as the Arnold's nerve reflex hypersensitivity were successfully treated with gabapentin, a treatment that has previously been shown to be effective in the treatment of cough due to sensory laryngeal neuropathy (SLN). PMID:25383210

  18. Comparative study of thyrotoxic periodic paralysis from idiopathic hypokalemic periodic paralysis: An experience from India

    PubMed Central

    Kalita, J.; Goyal, G.; Bhoi, S. K.; Chandra, S.; Misra, U. K.

    2012-01-01

    Objective: There is paucity of reports on thyrotoxic periodic paralysis (TPP) from India. We report the patients with TPP and compare them with idiopathic hypokalemic periodic paralysis (IHPP). Materials and Methods: Patients with hypokalemic periodic paralysis (HPP) treated during the past 11 years were evaluated retrospectively. Their demographic parameters, family history, clinical features, precipitating factors, severity of weakness, laboratory parameters and rapidity of recovery were recorded. The demographic, clinical and laboratory parameters of TPP and IHPP were compared. Results: During the study period, we managed 52 patients with HPP; nine (17.3%) of whom had TPP and 27 (52%) had IHPP. The demographic, precipitating factors, number of attacks and severity of limb weakness were similar between the TPP and IHPP groups, except in the IHPP group, bulbar weakness was present in four and respiratory paralysis in six, needing artificial ventilation in two patients. Serum potassium was significantly lower in TPP (2.21 0.49) compared with IHPP (2.67 0.59, P = 0.04). Four patients with TPP had subclinical thyrotoxicosis and two had subclinical hyperthyroidism. Rebound hyperkalemia occurred in both TPP and IHPP (three versus eight patients). The recovery was faster in IHPP (26.7 15.4 h) compared with TPP (34.0 14.0 h), but was statistically insignificant. Conclusion: TPP constitutes 17.3% of HPP, and absence of clinical features of thyrotoxicosis and subclinical hyperthyroidism in TPP is not uncommon. Clinical features, demographic profile and rebound hyperkalemia are similar in both TPP and IHPP. The serum potassium level is significantly low in the TPP compared with the IHPP group. PMID:22919190

  19. A comparison between Laryngeal Tube Suction II Airway and Proseal Laryngeal Mask Airway in laparascopic surgery.

    PubMed

    Esa, K; Azarinah, I; Muhammad, M; Helmi, M A; Jaafar, M Z

    2011-08-01

    This was a prospective randomized study comparing the ease of insertion, haemodynamic changes, quality of airway seal, oxygenation and ventilation parameters and complications between Laryngeal Tube Suction II (LTS II) with Proseal Laryngeal Mask Airway (PLMA), both are supraglottic airway incorporated with gastric passage. Fifty-four ASA I and II patients were randomly allocated to receive either LTS II or PLMA. Both devices provided a secure airway even under conditions of elevated intra-abdominal pressure up to 17 mmHg. In this study, there were no differences concerning ease of insertion, haemodynamic changes, quality of airway seal, oxygenation and ventilation parameters and complications between LTS II and PLMA. PMID:22111436

  20. High-resolution measurement of electrically-evoked vagus nerve activity in the anesthetized dog

    NASA Astrophysics Data System (ADS)

    Yoo, Paul B.; Lubock, Nathan B.; Hincapie, Juan G.; Ruble, Stephen B.; Hamann, Jason J.; Grill, Warren M.

    2013-04-01

    Objective. Not fully understanding the type of axons activated during vagus nerve stimulation (VNS) is one of several factors that limit the clinical efficacy of VNS therapies. The main goal of this study was to characterize the electrical recruitment of both myelinated and unmyelinated fibers within the cervical vagus nerve. Approach. In anesthetized dogs, recording nerve cuff electrodes were implanted on the vagus nerve following surgical excision of the epineurium. Both the vagal electroneurogram (ENG) and laryngeal muscle activity were recorded in response to stimulation of the right vagus nerve. Main results. Desheathing the nerve significantly increased the signal-to-noise ratio of the ENG by 1.2 to 9.9 dB, depending on the nerve fiber type. Repeated VNS following nerve transection or neuromuscular block (1) enabled the characterization of A-fibers, two sub-types of B-fibers, and unmyelinated C-fibers, (2) confirmed the absence of stimulation-evoked reflex compound nerve action potentials in both the ipsilateral and contralateral vagus nerves, and (3) provided evidence of stimulus spillover into muscle tissue surrounding the stimulating electrode. Significance. Given the anatomical similarities between the canine and human vagus nerves, the results of this study provide a template for better understanding the nerve fiber recruitment patterns associated with VNS therapies.

  1. Paralysis recovery in humans and model systems

    NASA Technical Reports Server (NTRS)

    Edgerton, V. Reggie; Roy, Roland R.

    2002-01-01

    Considerable evidence now demonstrates that extensive functional and anatomical reorganization following spinal cord injury occurs in centers of the brain that have some input into spinal motor pools. This is very encouraging, given the accumulating evidence that new connections formed across spinal lesions may not be initially functionally useful. The second area of advancement in the field of paralysis recovery is in the development of effective interventions to counter axonal growth inhibition. A third area of significant progress is the development of robotic devices to quantify the performance level of motor tasks following spinal cord injury and to 'teach' the spinal cord to step and stand. Advances are being made with robotic devices for mice, rats and humans.

  2. [HYPP--hyperkalemic periodic paralysis in horses].

    PubMed

    Zeilmann, M

    1993-12-01

    A literature review of the clinical syndrome HYPP (Hyperkalemic periodic paralysis) affecting Quarter Horses is given. HYPP is characterized by sporadic attacks of muscle tremors, weakness and/or collapse, lasting for variable periods of time. Diagnosis is based on physical findings in association with hyperkalemia. In horses with HYPP, the regulation of ion transport through the sodium channels in the muscle cells occasionally fails, causing uncontrollable muscle twitching. Further investigations into molecular genetics reveals a mutation in the gene responsible for sodium and potassium regulation. The identification of this gene mutation is the basis for the blood test used to diagnose HYPP. HYPP is inherited as an autosomal dominant trait. Treatment of HYPP attacks by intravenous application of calcium gluconate, bicarbonate and glucose results in rapid recovery. Consequent dietary management and daily administration of acetazolamide effectively controls the disease. PMID:8122239

  3. Isolated Sleep Paralysis: Fear, Prevention, and Disruption.

    PubMed

    Sharpless, Brian Andrew; Grom, Jessica Lynn

    2014-10-14

    Objectives: Relatively little is known about isolated sleep paralysis (ISP), and no empirically supported treatments are available. This study aims to determine: the clinical impact of ISP, the techniques used to prevent or disrupt ISP, and the effectiveness of these techniques. Method: 156 undergraduates were assessed with lifetime ISP using a clinical interview. Results: 75.64% experienced fear during ISP, and 15.38% experienced clinically significant distress/interference, while 19.23% attempted to prevent ISP, and 79.31% of these believed their methods were successful. Regarding disruption, 69.29% made attempts, but only 54.12% reported them effective. Conclusions: Disruption was more common than prevention, but several techniques were useful. Encouraging individuals to utilize these techniques and better monitor their symptoms may be an effective way to manage problematic ISP. PMID:25315810

  4. Thyrotoxic periodic paralysis: clinical and molecular aspects.

    PubMed

    Falhammar, Henrik; Thorn, Marja; Calissendorff, Jan

    2013-04-01

    Thyrotoxic periodic paralysis (TPP) is a rare complication of hyperthyroidism that most often affects young East Asian males but increasingly also in other ethnic groups. The typical presentation is acute attacks varying from mild weakness to total paralysis starting at night or in the early morning a few hours after a heavy meal, alcohol abuse or strenuous exercise with complete recovery within 72h. Signs and symptoms of hyperthyroidism may not be obvious. The hallmark is hypokalemia from increased cellular sodium/potassium-ATPase pump activity with transport of potassium from the extracellular to the intracellular space in combination with reduced potassium output. Recently, KCNJ18 gene mutations which alter the function of an inwardly rectifying potassium channel named Kir2.6 have been detected in 0-33% of cases. Hence, the pathophysiology in TPP includes a genetic predisposition, thyrotoxicosis and environmental influences and the relative impact from each of these factors may vary. The initial treatment, which is potassium supplementation, should be given with caution due to a high risk of hyperkalemia. Propranolol is an alternative first-line therapeutic option based on the assumption that hyperadrenergic activity is involved in the pathogenesis. If thyroid function tests are unobtainable in the acute situation the diagnosis is supported by the findings of hypokalemia, low spot urine potassium excretion, hypophosphatemia with hypophosphaturia, high spot urine calcium/phosphate ratio, and electrocardiographic abnormalities as tachycardia, atrial fibrillation, high QRS voltage, and atrioventricular block. Definitive treatment is cure of the hyperthyroidism. The underlying mechanisms of TPP remain, however, incompletely understood awaiting further studies. PMID:22918841

  5. Botox induced muscle paralysis rapidly degrades bone

    PubMed Central

    Warner, Sarah E.; Sanford, David A.; Becker, Blair A.; Bain, Steven D.; Srinivasan, Sundar; Gross, Ted S.

    2006-01-01

    The means by which muscle function modulates bone homeostasis is poorly understood. To begin to address this issue, we have developed a novel murine model of unilateral transient hindlimb muscle paralysis using botulinum toxin A (Botox). Female C57BL/6 mice (16 weeks) received IM injections of either saline or Botox (n = 10 each) in both the quadriceps and calf muscles of the right hindleg. Gait dysfunction was assessed by multi-observer inventory, muscle alterations were determined by wet mass, and bone alterations were assessed by micro-CT imaging at the distal femur, proximal tibia, and tibia mid-diaphysis. Profound degradation of both muscle and bone was observed within 21 days despite significant restoration of weight bearing function by 14 days. The muscle mass of the injected quadriceps and calf muscles was diminished ?47.3% and ?59.7%, respectively, vs. saline mice (both P < 0.001). The ratio of bone volume to tissue volume (BV/TV) within the distal femoral epiphysis and proximal tibial metaphysis of Botox injected limbs was reduced ?43.2% and ?54.3%, respectively, while tibia cortical bone volume was reduced ?14.6% (all P < 0.001). Comparison of the contralateral non-injected limbs indicated the presence of moderate systemic effects in the model that were most probably associated with diminished activity following muscle paralysis. Taken as a whole, the micro-CT data implied that trabecular and cortical bone loss was primarily achieved by bone resorption. These data confirm the decisive role of neuromuscular function in mediating bone homeostasis and establish a model with unique potential to explore the mechanisms underlying this relation. Given the rapidly expanding use of neuromuscular inhibitors for indications such as pain reduction, these data also raise the critical need to monitor bone loss in these patients. PMID:16185943

  6. [Deviation index of eye and mouth on peripheral facial paralysis].

    PubMed

    Li, Xue; Liao, Pin-Dong; Luo, Min; Zhu, Bin-Ye

    2011-09-01

    Differences of some points, levels and angles of the healthy and affected sides of patients with peripheral facial paralysis were picked out according to photographs. Through analysis of the index between the healthy and affected side of the patients and the difference between healthy people and patients, it is approved that those special points, levels and angles, which are called as deviation index of eye and mouth, can evaluate peripheral facial paralysis objectively and judge the degree of deviation. Therefore, it provides references for the diagnosis of facial paralysis and its degree judgement. PMID:21972641

  7. Scorpion toxins for the reversal of BoNT-induced paralysis

    PubMed Central

    Lowery, Colin A.; Adler, Michael; Borrell, Andrew; Janda, Kim D.

    2013-01-01

    The botulinum neurotoxins, characterized by their neuromuscular paralytic effects, are the most toxic proteins known to man. Due to their extreme potency, ease of production, and duration of activity, the BoNT proteins have been classified by the Centers for Disease Control as high threat agents for bioterrorism. In an attempt to discover effective BoNT therapeutics, we have pursued a strategy in which we leverage the blockade of K+ channels that ultimately results in the reversal of neuromuscular paralysis. Towards this end, we utilized peptides derived from scorpion venom that are highly potent K+ channel blockers. Herein, we report the synthesis of charybdotoxin, a 37 amino acid peptide, and detail its activity, along with iberiotoxin and margatoxin, in a mouse phrenic nerve hemidiaphragm assay in the absence and the presence of BoNT/A. PMID:24252544

  8. Thyrotoxic periodic paralysis: a peculiar case with unusual dystonic behavior and variable relations of paralysis to serum potassium levels.

    PubMed

    Kusakabe, T; Yoshida, M; Nishikawa, M

    1976-10-01

    This report describes a male patient, aged 49, with tyrotoxic periodic paralysis. The patient had had episodes of main d'accoucheur for eight years. Since thyrotoxicosis had affected the patient last year, he had had attacks of flaccid paralysis of the limbs associated with main d'accoucheur. While the spontaneous attack was normokalemic and responded favorably to potassium, attacks similar to the spontaneous one were provoked not only by glucose infusion, carbohydrate feeding, and NaCl infusion, but also by oral KCl administration. Transition from hypokalemic to hyperkalemic type of paralysis occurred during potassium treatment of a sodium-induced attack, and that from hyperkalemic to hypokalemic type of paralysis occurred after glucose infusion given during a potassium-induced attack. Intra-arterial epinephrine injection caused prompt paralysis of the perfused hand. A main d'accoucheur was induced in one hand by cooling it in chilled water. The spontaneous attacks of flaccid paralysis disappeared after the patient returned to the euthyroid state, but reappeared when he was treated with high doses of desiccated thyroid. Even when the patient was relieved from thyrotoxicosis, he still experienced stiffness in his hands. The administration of glucose, insulin, and KCl also provoked attacks of paralysis with main d'accoucheur or main d'accoucheur. The disease could be of the normokalemic variety of periodic paralysis with fluctations in the potassium levels depending on the provocative tests employed. It seems that the unusual dystonic behavior of this patient is due not to myotonia, but to muscle spasm resulting from metabolic abnormalities. It could also be suggested that excess thyroid hormones have adverse effects on the development and syndrome of periodic paralysis by abetting a latent hereditary abnormality. PMID:977720

  9. Laryngeal Structure and Function in the Pediatric Larynx: Clinical Applications

    ERIC Educational Resources Information Center

    Sapienza, Christine M.; Ruddy, Bari Hoffman; Baker, Susan

    2004-01-01

    This article presents an overview of the normal anatomy and physiology of the pediatric larynx, followed by some examples of pediatric voice disorders that were chosen to exemplify the alterations to the laryngeal anatomy and the subsequent modifications to laryngeal function. Vocal fold nodules are primarily reviewed due to their high incidence…

  10. Laryngeal Structure and Function in the Pediatric Larynx: Clinical Applications

    ERIC Educational Resources Information Center

    Sapienza, Christine M.; Ruddy, Bari Hoffman; Baker, Susan

    2004-01-01

    This article presents an overview of the normal anatomy and physiology of the pediatric larynx, followed by some examples of pediatric voice disorders that were chosen to exemplify the alterations to the laryngeal anatomy and the subsequent modifications to laryngeal function. Vocal fold nodules are primarily reviewed due to their high incidence

  11. 21 CFR 874.3730 - Laryngeal prosthesis (Taub design).

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Laryngeal prosthesis (Taub design). 874.3730 Section 874.3730 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES EAR, NOSE, AND THROAT DEVICES Prosthetic Devices § 874.3730 Laryngeal...

  12. 21 CFR 874.3730 - Laryngeal prosthesis (Taub design).

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Laryngeal prosthesis (Taub design). 874.3730 Section 874.3730 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES EAR, NOSE, AND THROAT DEVICES Prosthetic Devices § 874.3730 Laryngeal...

  13. 21 CFR 874.3730 - Laryngeal prosthesis (Taub design).

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Laryngeal prosthesis (Taub design). 874.3730 Section 874.3730 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES EAR, NOSE, AND THROAT DEVICES Prosthetic Devices § 874.3730 Laryngeal...

  14. 21 CFR 874.3730 - Laryngeal prosthesis (Taub design).

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Laryngeal prosthesis (Taub design). 874.3730 Section 874.3730 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES EAR, NOSE, AND THROAT DEVICES Prosthetic Devices § 874.3730 Laryngeal...

  15. 21 CFR 874.3730 - Laryngeal prosthesis (Taub design).

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Laryngeal prosthesis (Taub design). 874.3730 Section 874.3730 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES EAR, NOSE, AND THROAT DEVICES Prosthetic Devices § 874.3730 Laryngeal...

  16. Does primary brachial plexus surgery alter palliative tendon transfer surgery outcomes in children with obstetric paralysis?

    PubMed Central

    2011-01-01

    Background The surgical management of obstetrical brachial plexus palsy can generally be divided into two groups; early reconstructions in which the plexus or affected nerves are addressed and late or palliative reconstructions in which the residual deformities are addressed. Tendon transfers are the mainstay of palliative surgery. Occasionally, surgeons are required to utilise already denervated and subsequently reinnervated muscles as motors. This study aimed to compare the outcomes of tendon transfers for residual shoulder dysfunction in patients who had undergone early nerve surgery to the outcomes in patients who had not. Methods A total of 91 patients with obstetric paralysis-related shoulder abduction and external rotation deficits who underwent a modified Hoffer transfer of the latissimus dorsi/teres major to the greater tubercle of the humerus tendon between 2002 and 2009 were retrospectively analysed. The patients who had undergone neural surgery during infancy were compared to those who had not in terms of their preoperative and postoperative shoulder abduction and external rotation active ranges of motion. Results In the early surgery groups, only the postoperative external rotation angles showed statistically significant differences (25 degrees and 75 degrees for total and upper type palsies, respectively). Within the palliative surgery-only groups, there were no significant differences between the preoperative and postoperative abduction and external rotation angles. The significant differences between the early surgery groups and the palliative surgery groups with total palsy during the preoperative period diminished postoperatively (p < 0.05 and p > 0.05, respectively) for abduction but not for external rotation. Within the upper type palsy groups, there were no significant differences between the preoperative and postoperative abduction and external rotation angles. Conclusions In this study, it was found that in patients with total paralysis, satisfactory shoulder abduction values can be achieved with tendon transfers regardless of a previous history of neural surgery even if the preoperative values differ. PMID:21489264

  17. Central nervous system control of the laryngeal muscles in humans

    PubMed Central

    Ludlow, Christy L.

    2005-01-01

    Laryngeal muscle control may vary for different functions such as: voice for speech communication, emotional expression during laughter and cry, breathing, swallowing, and cough. This review discusses the control of the human laryngeal muscles for some of these different functions. Sensori-motor aspects of laryngeal control have been studied by eliciting various laryngeal reflexes. The role of audition in learning and monitoring ongoing voice production for speech is well known; while the role of somatosensory feedback is less well understood. Reflexive control systems involving central pattern generators may contribute to swallowing, breathing and cough with greater cortical control during volitional tasks such as voice production for speech. Volitional control is much less well understood for each of these functions and likely involves the integration of cortical and subcortical circuits. The new frontier is the study of the central control of the laryngeal musculature for voice, swallowing and breathing and how volitional and reflexive control systems may interact in humans. PMID:15927543

  18. Syndrome of fascial incarceration of the long thoracic nerve: winged scapula?

    PubMed Central

    Silva, Jefferson Braga; Gerhardt, Samanta; Pacheco, Ivan

    2015-01-01

    Objective To analyze the results from early intervention surgery in patients with the syndrome of fascial incarceration of the long thoracic nerve and consequent winged scapula. Methods Six patients with a syndrome of nerve trapping without specific nerve strain limitations were followed up. Results The patients achieved improvement of their symptoms 620 months after the procedure. The motor symptoms completely disappeared, without any persistent pain. The medial deformity of the winged scapula improved in all cases, without any residual esthetic disorders. Conclusion The approach of early surgical release seems to be a better predictor for recovery from non-traumatic paralysis of the anterior serratus muscle. PMID:26535205

  19. Non-traumatic Occulomotor Nerve Palsy: A Rare Case Report and Discussion on Etiopathogenesis.

    PubMed

    Dubey, Prajesh; Bansal, Vishal; Arun Kumar, K V; Mowar, Apoorva; Khare, Gagan; Singh, Sukumar

    2015-03-01

    The ghost of the past has emerged as the horror of today. The fear of weakness/loss of eyesight following extraction is a common thinking amongst the orthodox people of Indian subcontinent. Occulomotor nerve paralysis following dental extraction is a rare complication. Although these ophthalmic complications in routine practice are rare, some time they do occur and pose difficulty to explain. Occulomotor nerve palsy is amongst the rare reported cases of ocular complication. Here we report a case of spontaneous recovery of occulomotor nerve palsy in an elderly diabetic patient and brief discussion on its etiopathogenesis. PMID:25838716

  20. A Technique for Preoperative Identification of the Facial Nerve Mandibular Branch Using a Nerve Stimulator.

    PubMed

    Ijichi, Kei; Adachi, Makoto; Hamajima, Yuki; Murakami, Shingo

    2015-07-01

    We established the method of preoperative identification to facial nerve marginal mandibular branch (FNMB) identification using a nerve stimulator with bipolar probe for upper-neck surgery. The bipolar electrode is placed on the region while patients were awake; the patient should be in the same position and posture as during the surgery, with the neck skin stretched. A nerve course is confirmed by observing the movement of the lower lip. In this study, 5 upper-neck surgeries were conducted. Preoperative analysis revealed that 4 of the 5 cases had 2 branches of FNMB, and 1 with 3 branches. All FNMB immediately confirmed preoperatively were identified during surgery. We performed this method in much surgery including the surgery of the upper neck. It was easy to identify the facial nerve by this method and came to be able to do it precisely, and an operative time was shortened. We concluded that the preoperative FNMB identification using a nerve stimulator is most useful and benefit for upper-neck surgery patients and lead to avoid lower lip paralysis. PMID:26079125

  1. Transient Delayed Facial Nerve Palsy After Inferior Alveolar Nerve Block Anesthesia

    PubMed Central

    Tzermpos, Fotios H.; Cocos, Alina; Kleftogiannis, Matthaios; Zarakas, Marissa; Iatrou, Ioannis

    2012-01-01

    Facial nerve palsy, as a complication of an inferior alveolar nerve block anesthesia, is a rarely reported incident. Based on the time elapsed, from the moment of the injection to the onset of the symptoms, the paralysis could be either immediate or delayed. The purpose of this article is to report a case of delayed facial palsy as a result of inferior alveolar nerve block, which occurred 24hours after the anesthetic administration and subsided in about 8weeks. The pathogenesis, treatment, and results of an 8-week follow-up for a 20-year-old patient referred to a private maxillofacial clinic are presented and discussed. The patient's previous medical history was unremarkable. On clinical examination the patient exhibited generalized weakness of the left side of her face with a flat and expressionless appearance, and she was unable to close her left eye. One day before the onset of the symptoms, the patient had visited her dentist for a routine restorative procedure on the lower left first molar and an inferior alveolar block anesthesia was administered. The patient's medical history, clinical appearance, and complete examinations led to the diagnosis of delayed facial nerve palsy. Although neurologic occurrences are rare, dentists should keep in mind that certain dental procedures, such as inferior alveolar block anesthesia, could initiate facial nerve palsy. Attention should be paid during the administration of the anesthetic solution. PMID:22428971

  2. An fMRI investigation of racial paralysis.

    PubMed

    Norton, Michael I; Mason, Malia F; Vandello, Joseph A; Biga, Andrew; Dyer, Rebecca

    2013-04-01

    We explore the existence and underlying neural mechanism of a new norm endorsed by both black and white Americans for managing interracial interactions: "racial paralysis', the tendency to opt out of decisions involving members of different races. We show that people are more willing to make choices--such as who is more intelligent, or who is more polite-between two white individuals (same-race decisions) than between a white and a black individual (cross-race decisions), a tendency which was evident more when judgments involved traits related to black stereotypes. We use functional magnetic resonance imaging to examine the mechanisms underlying racial paralysis, to examine the mechanisms underlying racial paralysis, revealing greater recruitment of brain regions implicated in socially appropriate behavior (ventromedial prefrontal cortex), conflict detection (anterior cingulate cortex), deliberative processing (dorsolateral prefrontal cortex), and inhibition (ventrolateral prefrontal cortex). We also discuss the impact of racial paralysis on the quality of interracial relations. PMID:22267521

  3. A young man presenting with paralysis after vigorous exercise

    PubMed Central

    Gubran, Christopher; Narain, Rajay; Malik, Luqmaan; Saeed, Saad Aldeen

    2012-01-01

    Thyrotoxic periodic paralysis (TPP) is a rare metabolic disorder characterised by muscular weakness and paralysis in predisposed thyrotoxic patients. Although patients with TPP are almost uniformly men of Asian descent, cases have been reported in Caucasian and other ethnic populations. The rapid increase in ethnic diversity in Western and European nations has led to increase in TPP reports, where it was once considered exceedingly rare. Correcting the hypokalaemic and hyperthyroid state tends to reverse the paralysis. However, failure to recognise the condition may lead to delay in diagnosis and serious consequences including respiratory failure and death. We describe a young man who was diagnosed with hyperthyroidism who presented with acute paralysis. The clinical characteristics, pathophysiology and management of TTP are reviewed. PMID:22927268

  4. Zika Virus Tied to Rare Disorder That Can Cause Paralysis

    MedlinePLUS

    ... nlm.nih.gov/medlineplus/news/fullstory_157521.html Zika Virus Tied to Rare Disorder That Can Cause Paralysis ... 2016 MONDAY, Feb. 29, 2016 (HealthDay News) -- The Zika virus may cause Guillain-Barre syndrome, a disorder in ...

  5. 9 CFR 310.15 - Disposition of thyroid glands and laryngeal muscle tissue.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... laryngeal muscle tissue. 310.15 Section 310.15 Animals and Animal Products FOOD SAFETY AND INSPECTION... of thyroid glands and laryngeal muscle tissue. (a) Livestock thyroid glands and laryngeal muscle tissue shall not be used for human food. (b) Livestock thyroid glands and laryngeal muscle tissue may...

  6. 9 CFR 310.15 - Disposition of thyroid glands and laryngeal muscle tissue.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... laryngeal muscle tissue. 310.15 Section 310.15 Animals and Animal Products FOOD SAFETY AND INSPECTION... of thyroid glands and laryngeal muscle tissue. (a) Livestock thyroid glands and laryngeal muscle tissue shall not be used for human food. (b) Livestock thyroid glands and laryngeal muscle tissue may...

  7. 9 CFR 310.15 - Disposition of thyroid glands and laryngeal muscle tissue.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... laryngeal muscle tissue. 310.15 Section 310.15 Animals and Animal Products FOOD SAFETY AND INSPECTION... of thyroid glands and laryngeal muscle tissue. (a) Livestock thyroid glands and laryngeal muscle tissue shall not be used for human food. (b) Livestock thyroid glands and laryngeal muscle tissue may...

  8. 9 CFR 310.15 - Disposition of thyroid glands and laryngeal muscle tissue.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... laryngeal muscle tissue. 310.15 Section 310.15 Animals and Animal Products FOOD SAFETY AND INSPECTION... of thyroid glands and laryngeal muscle tissue. (a) Livestock thyroid glands and laryngeal muscle tissue shall not be used for human food. (b) Livestock thyroid glands and laryngeal muscle tissue may...

  9. 9 CFR 310.15 - Disposition of thyroid glands and laryngeal muscle tissue.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... laryngeal muscle tissue. 310.15 Section 310.15 Animals and Animal Products FOOD SAFETY AND INSPECTION... of thyroid glands and laryngeal muscle tissue. (a) Livestock thyroid glands and laryngeal muscle tissue shall not be used for human food. (b) Livestock thyroid glands and laryngeal muscle tissue may...

  10. Modulation of heart rate by temporally patterned vagus nerve stimulation in the anesthetized dog.

    PubMed

    Yoo, Paul B; Liu, Haoran; Hincapie, Juan G; Ruble, Stephen B; Hamann, Jason J; Grill, Warren M

    2016-02-01

    Despite current knowledge of the myriad physiological effects of vagus nerve stimulation (VNS) in various mammalian species (including humans), the impact of varying stimulation parameters on nerve recruitment and physiological responses is not well understood. We investigated nerve recruitment, cardiovascular responses, and skeletal muscle responses to different temporal patterns of VNS across 39 combinations of stimulation amplitude, frequency, and number of pulses per burst. Anesthetized dogs were implanted with stimulating and recording cuff electrodes around the cervical vagus nerve, whereas laryngeal electromyogram (EMG) and heart rate were recorded. In seven of eight dogs, VNS-evoked bradycardia (defined as ?10% decrease in heart rate) was achieved by applying stimuli at amplitudes equal to or greater than the threshold for activating slow B-fibers. Temporally patterned VNS (minimum 5 pulses per burst) was sufficient to elicit bradycardia while reducing the concomitant activation of laryngeal muscles by more than 50%. Temporal patterns of VNS can be used to modulate heart rate while minimizing laryngeal motor fiber activation, and this is a novel approach to reduce the side effects produced by VNS. PMID:26811057

  11. Arytenoid Cartilage Dislocation from External Blunt Laryngeal Trauma: Evaluation and Therapy without Laryngeal Electromyography

    PubMed Central

    Teng, Yaoshu; Wang, Hui-e; Lin, Zhihong

    2014-01-01

    Background Intubation trauma is the most common cause of arytenoid dislocation. The aim of this study was to investigate the diagnosis and treatment of arytenoid cartilage dislocation from external blunt laryngeal trauma in the absence of laryngeal electromyography (LEMG) and to explore the role of early attempted closed reduction in arytenoids cartilage reposition. Material/Methods This 15-year retrospective study recruited 12 patients with suspected arytenoid dislocation from external blunt laryngeal trauma, who were evaluated through 7 approaches: detailed personal history, voice handicap index (VHI) test, indirect laryngoscope, flexible fiberoptic laryngoscope, video strobolaryngoscope, and/or high-resolution computed tomography (CT), and, most importantly, the outcomes after attempted closed reduction under local anesthesia. They were divided into satisfied group (n=9) and dissatisfied group (n=3) based on their satisfied with voice qualities at 1 week after the last closed reduction manipulation. Results Each patient was diagnosed with arytenoid dislocation caused by external blunt laryngeal trauma. In the satisfied group, VHI scores and maximum phonation time (MPT) at 1 week after the last reduction were significantly improved compared with those before the procedure (P<0.05). Normal or improved mobility and length of the affected vocal fold were also noted immediately after the end of the last closed reduction. The median time interval between injury and clinical intervention in satisfied group was 43.4434.13 days, much shorter than the median time of 157.6776.07 days in the dissatisfied group (P<0.05). Conclusions Multimodality assessment protocols are essential for suspected arytenoid dislocation after external blunt laryngeal trauma. Early attempted closed reduction should be widely recommended, especially in health facilities without LEMG, mainly, because it could be helpful for early diagnosis and treatment of this disease. In addition, early closed reduction could also improve the success of arytenoid reduction. PMID:25150338

  12. Unexpected radiation laryngeal necrosis after carbon ion therapy using conventional dose fractionation for laryngeal cancer.

    PubMed

    Demizu, Yusuke; Fujii, Osamu; Nagano, Fumiko; Terashima, Kazuki; Jin, Dongcun; Mima, Masayuki; Oda, Naoharu; Takeuchi, Kaoru; Takeda, Makiko; Ito, Kazuyuki; Fuwa, Nobukazu; Okimoto, Tomoaki

    2015-11-01

    Carbon ion therapy is a type of radiotherapy that can deliver high-dose radiation to a tumor while minimizing the dose delivered to organs at risk. Moreover, carbon ions are classified as high linear energy transfer radiation and are expected to be effective for even photon-resistant tumors. A 73-year-old man with glottic squamous cell carcinoma, T3N0M0, refused laryngectomy and received carbon ion therapy of 70 Gy (relative biological effectiveness) in 35 fractions. Three months after the therapy, the patient had an upper airway inflammation, and then laryngeal edema and pain occurred. Five months after the therapy, the airway stenosis was severe and computed tomography showed lack of the left arytenoid cartilage and exacerbation of laryngeal necrosis. Despite the treatment, 5 and a half months after the therapy, the laryngeal edema and necrosis had become even worse and the surrounding mucosa was edematous and pale. Six months after the therapy, pharyngolaryngoesophagectomy and reconstruction with free jejunal autograft were performed. The surgical specimen pathologically showed massive necrosis and no residual tumor. Three years after the carbon ion therapy, he is alive without recurrence. The first reported laryngeal squamous cell carcinoma case treated with carbon ion therapy resulted in an unexpected radiation laryngeal necrosis. Tissue damage caused by carbon ion therapy may be difficult to repair even for radioresistant cartilage; therefore, hollow organs reinforced by cartilage, such as the larynx, may be vulnerable to carbon ion therapy. Caution should be exercised when treating tumors in or adjacent to such organs with carbon ion therapy. PMID:26355161

  13. Possible normokalemic variant of hyperkalemic periodic paralysis in two horses.

    PubMed

    Stewart, R H; Bertone, J J; Yvorchuk-St Jean, K; Reed, S M; Neil, W H

    1993-08-01

    Hyperkalemic periodic paralysis (HPP), characterized by intermittent episodes of muscle fasciculations, profound muscle weakness, and hyperkalemia, has been described in Quarter Horses, Appaloosas, and Paints. In previous reports, the hallmark of this syndrome has been the development of hyperkalemia during each episode. Two affected horses had episodes of paralysis without associated hyperkalemia, demonstrating that normokalemia during an episode otherwise consistent with HPP does not eliminate HPP as a diagnosis. This clinical presentation appeared to be a variant of HPP. PMID:8226220

  14. Neonatal peripheral facial paralysis' evaluation with photogrammetry: A case report.

    PubMed

    da Fonseca Filho, Gentil Gomes; de Medeiros Cirne, Gabriele Natane; Cacho, Roberta Oliveira; de Souza, Jane Carla; Nagem, Danilo; Cacho, Enio Walker Azevedo; Moran, Cristiane Aparecida; Abreu, Bruna; Pereira, Silvana Alves

    2015-12-01

    Facial paralysis in newborns can leave functional sequelae. Determining the evolution and amount of functional losses requires consistent evaluation methods that measure, quantitatively, the evolution of clinical functionality. This paper reports an innovative method of facial assessment for the case of a child 28 days of age with unilateral facial paralysis. The child had difficulty breast feeding, and quickly responded to the physical therapy treatment. PMID:26607566

  15. Absorbable gelatin powder injection for transient vocal cord paralysis.

    PubMed

    Miller, M A; Saltvoll, B

    1995-05-01

    In the early 1900s, glottic insufficiency in patients with vocal cord paralysis was corrected by injecting paraffin intralaryngeally. Since then, injecting absorbable gelatin powder into the vocal cord has become an acceptable short-term solution for transient paralysis of a single vocal cord. Although relatively uncommon, this procedure has few complications and is an option for patients when vocal cord function is expected to return within one year. PMID:7611738

  16. Exchanging digital video of laryngeal examinations.

    PubMed

    Crump, John M; Deutsch, Thomas

    2004-03-01

    Laryngeal examinations, especially stroboscopic examinations, are increasingly recorded using digital video formats on computer media, rather than using analog formats on videotape. It would be useful to share these examinations with other medical professionals in formats that would facilitate reliable and high-quality playback on a personal computer by the recipients. Unfortunately, a personal computer is not well designed for reliable presentation of artifact-free video. It is particularly important that laryngeal video play without artifacts of motion or color because these are often the characteristics of greatest clinical interest. With proper tools and procedures, and with reasonable compromises in image resolution and the duration of the examination, digital video of laryngeal examinations can be reliably exchanged. However, the tools, procedures, and formats for recording, converting to another digital format ("transcoding"), communicating, copying, and playing digital video with a personal computer are not familiar to most medical professionals. Some understanding of digital video and the tools available is required of those wanting to exchange digital video. Best results are achieved by recording to a digital format best suited for recording (such as MJPEG or DV),judiciously selecting a segment of the recording for sharing, and converting to a format suited to distribution (such as MPEG1 or MPEG2) using a medium suited to the situation (such as e-mail attachment, CD-ROM, a "clip" within a Microsoft PowerPoint presentation, or DVD-Video). If digital video is sent to a colleague, some guidance on playing files and using a PC media player is helpful. PMID:15070220

  17. [Laryngeal tube II : alternative airway for children?].

    PubMed

    Schalk, R; Scheller, B; Peter, N; Rosskopf, W; Byhahn, C; Zacharowski, K; Meininger, D

    2011-06-01

    Difficult airway situations both expected and unexpected, present major challenges to every anesthesiologist, especially in pediatric anesthesia. However, the integration of extraglottic airway devices, such as the laryngeal mask, into the algorithm of difficult airways has improved the handling of difficult airway situations. A device for establishing a supraglottic airway, the laryngeal tube (LT), was introduced in 1999. The LT is an extraglottic airway designed to secure a patent airway during either spontaneous breathing or controlled ventilation. The design of the device has been revised several times and a further development is the LTS II/LTS-D, which provides an additional channel for the insertion of a gastric drain tube. This article reports on the successful use of the LTS II in 12 children aged from 2 days to 6 years when endotracheal intubation, alternative mask or laryngeal mask ventilation failed. Use of the LTS II was associated with a high level of success, securing the airway when other techniques had failed. The potential advantage of the LTS II over the standard LT is an additional suction port, which allows gastric tube placement and can be used as an indirect indicator of correct placement. With a modified insertion technique using an Esmarch manoeuvre, placement was simple and fast to perform. In emergency situations when direct laryngoscopy fails or is too time-consuming the LTS II tube is recommended as an alternative device to secure the airway. As with all extraglottic airway devices, familiarity and clinical experience with the respective device and the corresponding insertion technique are essential for safe and successful use, especially in emergency situations. PMID:21246182

  18. Laryngeal cancer mortality trends in European countries.

    PubMed

    Chatenoud, Liliane; Garavello, Werner; Pagan, Eleonora; Bertuccio, Paola; Gallus, Silvano; La Vecchia, Carlo; Negri, Eva; Bosetti, Cristina

    2016-02-15

    After a steady increase between the 1950s and the 1970s, laryngeal cancer mortality has been levelling off since the early 1980s in men from most western and southern European countries and since the early 1990s in central and eastern Europe. To update trends in laryngeal cancer mortality, we analyzed data provided by the World Health Organization over the last two decades for 34 European countries and the European Union (EU) as a whole. For major European countries, we also identified significant changes in trends between 1980 and 2012 using joinpoint regression analysis. Male mortality in the EU was approximately constant between 1980 and 1991 (annual percent change, APC=-0.5%) and declined by 3.3% per year in 1991-2012. EU age-standardized (world population) rates were 4.7/100,000 in 1990-91 and 2.5/100,000 in 2010-2011. Rates declined in most European countries, particularly over the last two decades. In 2010-11, the highest male rates were in Hungary, the Republic of Moldova, and Romania (over 6/100,000), and the lowest ones in Finland, Norway, Sweden, and Switzerland (below 1/100,000). In EU women, mortality was stable around 0.29/100,000 between 1980 and 1994 and slightly decreased thereafter (APC=-1.3%; 0.23/100,000 in 2000-01). We also considered male incidence trends for nine European countries or cancer registration areas. In most of them, declines were observed over recent decades. Laryngeal cancer mortality thus showed favourable trends over the last few decades in most Europe, following favourable changes in tobacco and, mostly for Mediterranean countries, alcohol consumption. PMID:26335030

  19. Hypokalemic periodic paralysis as first sign of thyrotoxicosis

    PubMed Central

    Trifanescu, RA; Danciulescu Miulescu, R; Carsote, M; Poiana, C

    2013-01-01

    Background: periodic paralysis related to hypokalemia is seldom reported in thyrotoxicosis, and it usually occurs in Asian males. Patients and methods: Two Romanian (Caucasian) young patients presented with hypokalemic paralysis. TSH, FT4, TT3 was measured by immunochemiluminescence. Case report 1. Patient O.R, aged 19, presented marked asthenia and lower limbs paralysis, following high carbohydrate meal. He declared 10 kg weight loss on hypocaloric diet and mild sweating. Biochemical data revealed moderate hypokalemia (K+=2.6 mmol/L) and thyrotoxicosis (TSH<0.03 mIU/L, FT4=30 pmol/L, TT3=315 ng/dL). Case report 2. Patient T.A., aged 18, presented 2 episodes of weakness and flaccid paralysis, with hypokalemia, precipitated by effort, without any sign of thyrotoxicosis. Biochemical data revealed severe hypokalemia (K+=1.8 mmol/L) and thyrotoxicosis (TSH<0.03 mIU/L, FT4=24 pmol/L, TT3=190 ng/dL). Treatment with intravenous potassium, thereafter methimazole and propranolol were administered in both cases, with the maintenance of normal kalemia and thyrotoxicosis control. Conclusion: these 2 cases of hypokalemic periodic paralysis occurring in young Caucasian teenagers with mild thyrotoxicosis underlined the importance of thyroid screening in patients with symptomatic hypokalemia, even in the absence of symptoms and signs of thyrotoxicosis. Abbreviations: THPP=Thyrotoxic periodic paralysis, BMI=body mass index, TRAb=TSH receptor antibody, ECG=electrocardiogram. PMID:23599824

  20. Laryngeal paraganglioma: report of an unusual entity.

    PubMed

    Kaytaz, Asim; Karaman, Emin; Edizer, Deniz Tuna; Haciyev, Yusuf; Oz, Buge

    2010-11-01

    Paragangliomas are rare in the larynx. When they do occur there, the most common subsite is the supraglottic compartment. Unlike other neuroendocrine tumors of the larynx, laryngeal paragangliomas are three times as common in women as in men. Although a preoperative biopsy is often performed to establish the diagnosis, this procedure carries a considerable risk of bleeding, which may necessitate a tracheotomy to secure the airway. Immunohistochemical staining is useful in the differential diagnosis to distinguish a paraganglioma from other neuroendocrine tumors. Computed tomography and/or magnetic resonance imaging with preoperative angiography and possible embolization are important to obtain prior to treatment. Surgical excision is the treatment of choice. PMID:21086280

  1. Response of laryngeal motoneurons to hyperventilation induced apnea in the rat.

    PubMed

    Sun, Qi-Jian; Berkowitz, Robert G; Pilowsky, Paul M

    2005-04-15

    Central apnea is common in the premature newborn. To explain the upper airway findings in different clinical conditions characterized by central apnea, we made single unit recordings from laryngeal motoneurons during normal and hyperventilation. Posterior cricoarytenoid (n = 4) and cricothyroid (n = 4) motoneurons displayed an inspiratory pattern during normal ventilation and remained synchronous with phrenic nerve discharge (PND) during hyperventilation. Laryngeal constrictor motoneurons (LCon) displayed a post-inspiratory pattern during normal ventilation, but lost phasic activity during early hyperventilation (the period after the onset of hyperventilation but before cessation of PND; n = 12). There was a nearly linear relationship between the post-inspiratory activity and strength of PND. Six LCon motoneurons remained silent throughout hyperventilation, while the other six developed a tonic activity during cessation of PND. Further analysis suggested that the silent and tonic LCon motoneurons are likely to share a similar mechanism in their post-inspiratory pattern generation, but differ from each other in their responses to CO2 inputs. In addition, strong inhibition of the LCon tonic activity by the early return of PND could be an important factor in recovery following a period of apnea. Failure of this inspiratory inhibition to occur might explain certain clinical situations, where obstructive apnea supervenes following a period of central apnea. PMID:15766904

  2. Nerve conduction velocity

    MedlinePLUS

    Nerve conduction velocity (NCV) is a test to see how fast electrical signals move through a nerve. ... normal body temperature. Being too cold slows nerve conduction. Tell your doctor if you have a cardiac ...

  3. Electroacupuncture at Zusanli Prevents Severe Scalds-Induced Gut Ischemia and Paralysis by Activating the Cholinergic Pathway

    PubMed Central

    Wang, Huan; Wang, Lei; Shi, Xian; Qi, Song; Hu, Sen; Tong, Zhangqi; Ma, Zhuhong; Qian, Yan; Litscher, Daniela; Litscher, Gerhard

    2015-01-01

    Severe burn injuries may result in gastrointestinal paralysis, and barrier dysfunction due to gut ischemia and lowered vagus excitability. In this study we investigate whether electroacupuncture (EA) at Zusanli (ST36) could prevent severe scalds-induced gut ischemia, paralysis, and barrier dysfunction and whether the protective role of EA at ST36 is related to the vagus nerve. 35% burn area rats were divided into six groups: (a) EAN: EA nonchannel acupoints followed by scald injury; (b) EA: EA at ST36 after scald injury; (c) VGX/EA: vagotomy (VGX) before EA at ST36 and scald injury; (d) VGX/EAN: VGX before EAN and scald injury; (e) atropine/EA: applying atropine before scald injury and then EA at ST36; (f) atropine/EAN: applying atropine before scald injury and then EA at nonchannel acupoints. EA at the Zusanli point significantly promoted the intestinal impelling ratio and increased the amount of mucosal blood flow after scald injury. The plasma diamine oxidase (DAO) and intestinal permeability decreased significantly after scald injury in the EA group compared with others. However, EA after atropine injection or cervical vagotomy failed to improve intestinal motility and mucosa blood flow suggesting that the mechanism of EA may be related to the activation of the cholinergic nerve pathway. PMID:26448777

  4. Phrenic nerve injury due to thoracentesis for TPN effusion in a preterm newborn: consecutive two unusual complications.

    PubMed

    Ozdemir, Ramazan; O?uz, Suna; Uras, Nurdan; Erdeve, Omer; Yilmaz, Yavuz; Ulu, Hlya; Dilmen, U?ur

    2011-01-01

    Central venous catheters ara commonly used in neonatal intensive care units as routes of parenteral nutrition. Pleural effusions caused by extravasation of parenteral alimentation fluid are a rare complication of central venous catheters in the newborn. Diaphragmatic paralysis due to phrenic nerve injury is a rare respiratory condition which may be life-threatening in infants. PMID:22233310

  5. Dihydropyridine receptor mutations cause hypokalemic periodic paralysis

    SciTech Connect

    Ptacek, L.J.; Leppert, M.F.; Tawil, R.

    1994-09-01

    Hypokalemic periodic paralysis (hypoKPP) is an autosomal dominant skeletal muscle disorder manifested by episodic weakness associated with low serum potassium. Genetic linkage analysis has localized the hypoKPP gene to chromosome 1q31-q32 near a dihydropyridine receptor (DHP) gene. This receptor functions as a voltage-gated calcium channel and is also critical for excitation-contraction coupling in a voltage-sensitive and calcium-independent manner. We have characterized patient-specific DHP receptor mutations in 11 probands of 33 independent hypoKPP kindreds that occur at one of two adjacent nucleotides within the same codon and predict substitution of a highly conserved arginine in the S4 segment of domain 4 with either histidine or glycine. In one kindred, the mutation arose de novo. Taken together, these data establish the DHP receptor as the hypoKPP gene. We are unaware of any other human diseases presently known to result from DHP receptor mutations.

  6. Change of Voice Handicap Index after treatment of benign laryngeal disorders.

    PubMed

    Stuut, Marijn; Tjon Pian Gi, Robin E A; Dikkers, Frederik G

    2014-05-01

    Voice disorders can have major impact on quality of life. Problems caused by these disorders can be experienced in different domains. The Voice Handicap Index (VHI) is a well-known voice-related quality of life instrument to measure physical, emotional and functional complaints. VHI change after treatment in seven separate benign laryngeal disorders was studied. In addition, correlation between the three domains was examined. VHI forms were completed before and 3 months after treatment. In a 5-year-period, 143 patients with seven specific diagnoses were retrospectively included. VHI improved for six diagnoses polyp (p < 0.000), cyst (p = 0.001), unilateral paralysis (p = 0.001), Reinke edema (p = 0.016), papillomatosis (p = 0.001), nodules (p = 0.002). Sulcus glottidis did not change (p = 0.897). Mean VHI after treatment was higher for females (p = 0.021). The values of the three domains correlate statistically significant. For each diagnosis, the mean VHI after treatment remained higher than in subjects with a healthy voice. Because the domains are interdependent, their absolute values could not be compared. After treatment, VHI improved in six of the seven diagnoses. The scores on the physical, emotional, and functional domain are interdependent. Scores of the different domains cannot be compared. PMID:24141520

  7. Nerve Impulses in Plants

    ERIC Educational Resources Information Center

    Blatt, F. J.

    1974-01-01

    Summarizes research done on the resting and action potential of nerve impulses, electrical excitation of nerve cells, electrical properties of Nitella, and temperature effects on action potential. (GS)

  8. Femoral nerve dysfunction

    MedlinePLUS

    Neuropathy - femoral nerve; Femoral neuropathy ... Felice, KJ. Focal neuropathies of the femoral, obturator, lateral femoral cutaneous and other nerves of the thigh and pelvis. In: Bromberg MB, Smith ...

  9. The role of MicroRNAs expression in laryngeal cancer

    PubMed Central

    2015-01-01

    MicroRNAs (miRs, miRs) is a class of small non-coding RNAs, which posttranscriptionally regulate gene expression. Deregulated miRs are frequently obseved in patients with laryngeal cancer. In addition, numerous studies have showed miRs play significant roles in the pathogenesis of laryngeal cancer through regulating tumor cell proliferation, metastasis, invasion and apoptosis. miR can play either an oncogenic or tumor suppressive role in laryngeal cancer. In our review, we summarize the recent researches on laryngeal cancer-associated miRs, focusing on their role in the pathogenesis of laryngeal cancer. As changes in the levels of specific miRs in tissues or serum associate with diagnosis and prognosis of patients, we will also discuss the potential use of miRs in laryngeal cancer diagnosis and prognosis. Furthermore, supplementation of oncomiRs or inhibition of tumor suppressive miRs in vivo may be future therapeutic strategy for laryngeal cancer. PMID:26079642

  10. Two rare cases of laryngeal intralymphatic histiocytosis.

    PubMed

    Reznitsky, Martin; Daugaard, Søren; Charabi, Birgitte Wittenborg

    2016-03-01

    We report two rare cases of intralymphatic histiocytosis causing, respectively, recurrent and persistent episodes of upper airway swelling and breathing difficulties. Case 1 was a 39-year-old man who was referred with recurrent upper airway swelling causing difficulty in breathing. A direct laryngoscopy was performed under general anesthesia due to minimal effect from treatment with antibiotics and anti-oedema medication. On examination, the larynx was found to be swollen and oedematous but not inflamed. Biopsies from the aryepiglottic folds showed intralymphatic histiocytosis. The patient was extensively examined but the only abnormal finding was a low CD4 count. The breathing difficulties fluctuated during the diagnostic process and settled after a year. Case 2 was a 35-year-old man who presented with persistent laryngeal swelling. Biopsies from the epiglottis showed intralymphatic histiocytosis. Extensive investigations were performed but discovered no abnormal findings. He received CO2 laser treatment twice and the swelling decreased. Intralymphatic histiocytosis is extremely rare in upper airway pathology. It is an important differential diagnosis in patients with recurrent and chronic laryngeal swelling and dyspnoea. PMID:25870125

  11. Diet, cigarettes and alcohol in laryngeal cancer

    SciTech Connect

    Freudenheim, J.L.; Graham, S.; Byers, T.E.; Marshall, J.R.; Haughey, B.P.; Swanson, M.K.; Wilkinson, G. )

    1991-03-11

    Diet and other risk factors for cancer of the larynx were examined in a case-control study among white males in Western New York, conducted in 1975-1985. Incident, pathologically-confirmed cases and age- and neighborhood-matched controls were interviewed to determine usual diet, and lifetime use of tobacco and alcohol. Because response rates were low for both cases and controls, this cannot be considered a population-based study. A strong association of risk with cigarette but not pipe and cigar smoking was found. Beer and hard liquor but not wine were associated with increased risk. After control for cigarettes, alcohol and education, the upper quartile odds ratio for fat was 2.40, while the odds ratio for high intake of carotenoids was 0.51. There was effect modification by smoking. Carotenoids were most negatively associated with risk among lighter smokers; dietary fat was most positively associated with risk among heavier smokers. Total calories, protein, and retinol were associated with increased risk; there was no relationship between laryngeal cancer and vitamins C and E or carbohydrate. This study again demonstrates the strong association between tobacco and alcohol and laryngeal cancer and also suggests that diets low in carotenoids and high fat may increase risk.

  12. Histopathological study of radionecrosis in laryngeal carcinoma

    SciTech Connect

    Keene, M.; Harwood, A.R.; Bryce, D.P.; van Nostrand, A.W.

    1982-02-01

    With modern radiotherapy techniques, clinical radionecrosis is uncommon following eradication of primary squamous cell carcinoma from the larynx. Histologic sections from 265 specimens, prepared by the technique of whole organ subserial step-sectioning were studied to determine the incidence and location of chondronecrosis and/or osteomyelitis in both irradiated and non-irradiated cases. Chondronecrosis occurred in only 1 of 41 early (pT1 - pT2) tumors but in 143 advanced tumors (pT - pT4) treated with radical radiotherapy and containing residual carcinoma, 27% had evidence of significant necrosis, compared with 24% of those not irradiated. Age, sex, tumor grade and previous laryngeal surgery did not appear to be significant factors in the development of necrosis in irradiated patients. The arytenoid cartilage was most frequently involved when chondronecrosis occurred in association with radiotherapy. Six total laryngectomy specimens (3%) were received from patients with symptoms of chondronecrosis and in whom no residual tumor was present. We conclude that although the incidence of clinical perichondritis is low, histologic chondronecrosis and/or osteomyelitis occurred in 26% of all the larynges studied. Radiotherapy appears to be a significant causative factor only in advanced supraglottic tumors.

  13. Laryngeal neurophysiology and its clinical uses.

    PubMed

    Woodson, G E

    1996-01-01

    A fact well known to all otolaryngologists, but which occasionally bears repeating, is that the larynx is not just an organ of communication. The larynx sits at the crossroads of the pathways of air and food intake, and serves the vital function of keeping ingested food and water from entering the lungs. Another obvious consideration, however, is that if the larynx were not there and if the breathing and alimentary passages were totally separate (as after surgical laryngectomy), then there would be no need for the larynx other than to speak. Thus, in terms of survival of the organism, laryngectomy can be considered a viable treatment option any time laryngeal dysfunction compromises health. The problem with this line of reasoning, of course, is that speech, in humanistic terms, is a very compelling need. Someone who communicates in any mode other than that of normal speech is at a distinct disadvantage in almost any culture. Therefore, at its essence, the subspecialty of laryngology has as its central mission the preservation or restoration of normal voice and speech by the natural mechanism. In accomplishing this, it is necessary to understand how the larynx functions as an integral component of the systems for speech, breathing, and swallowing. The intent of this article is to outline essential features of laryngeal function, to describe how function is impaired by diseases, and to offer examples of the clinical significance of this information. PMID:8774925

  14. Laryngeal complications by orotracheal intubation: Literature review

    PubMed Central

    Mota, Luiz Alberto Alves; de Cavalho, Glauber Barbosa; Brito, Valeska Almeida

    2012-01-01

    Sumamry Introduction:?The injuries caused for the orotracheal intubation are common in our way and widely told by literature. Generally the pipe rank of or consequence of its permanence in the aerial ways of the patient is caused by accidents in. It has diverse types of larynx injuries, caused for multiple mechanisms. Objective:?To verify, in literature, the main causes of laryngeal complications after- orotracheal intubation and its mechanisms of injury. Revision of Literature:?The searched databases had been LILACS, BIREME and SCIELO. Were updated, books and theses had been used, delimiting itself the period enters 1953 the 2009. The keywords used for the search of articles had been: complications, injuries, larynx, intubation, endotracheal, orotracheal, granulomas, stenosis. 59 references had been selected. The used criteria of inclusion for the choice of articles had been the ones that had shown to the diverse types of injuries caused for the orotracheal intubation and its pathophysiology. Final Considerations:?This revision of literature was motivated by the comment in the practical clinic of a great number of laryngeal sequels in patients submitted to the orotracheal intubation. Of that is ahead important the knowledge, for the professionals of the area of health, the types of complications and its causes, with intention to prevent them, adopting measured of prevention of these injuries. PMID:25991942

  15. Microinvasive laser surgery for laryngeal carcinoma

    NASA Astrophysics Data System (ADS)

    Lai, Jinping; Tao, Zhengde; Xiao, Jianyun; Luo, Junli; Chen, Xianghui; Zhao, Suping; Betz, Christian

    2001-08-01

    Objective: To investigate the effectiveness of microinvasive Nd:YAG laser surgery in case of early stage laryngeal carcinoma as well as it's effect on the cellular immune function of the tumor-bearing hosts. Material and Method: Thirty-seven patients with glottic Tis or T1 SCC were treated by fiberoptic laryngoscopic Nd:YAG laser surgery. Both before and after therapy, serum levels of soluble interleukin-2 receptor (SIL-2R) and interleukin- 2(IL-2) as well as the NK activity were determined via double-antibody sandwich technique, tritiated thymidine- deoxyribonucleoside incorporation and iodine 125-uridine- deoxyribunocleoside release technique, respectively. Result: All 37 patients tolerated the procedure well. A 3-8 year follow up in a subgroup of 31 patients resulted in a estimated cure rate of 87.1% (27/31). The posttherapy serum levels of SIL-2R were significantly declined (p<0.001), while those of IL-2 and NK activity were significantly elevated (p<0.001) as compared with those detected pretherapeutically. Conclusion: Therapy with fiberoptic laryngoscopic Nd:YAG laser surgery is simple, safe, effective and microinvasive for the patients with early stage laryngeal carcinoma and has an immuno-enhancing effect on its host.

  16. Loss of signal in recurrent nerve neuromonitoring: causes and management

    PubMed Central

    Wu, Che-Wei; Wang, Mei-Hui; Chen, Cheng-Chien; Chen, Hui-Chun; Chen, Hsiu-Ya; Yu, Jing-Yi; Chang, Pi-Ying; Lu, I-Cheng; Lin, Yi-Chu

    2015-01-01

    During recurrent laryngeal nerve (RLN) neuromonitoring in thyroid surgery, laryngeal electromyography (EMG) amplitude may be correlated with the number of muscle fibers participating in the polarization and these might be correlated with the function of RLN. If RLN is severely injured during the operation, most nerve fibers do not transmit nerve impulse and substantial decrease of EMG amplitude or loss of signal (LOS) will occur. True LOS at the end of an operation often indicates a postoperative fixed vocal cord, and the surgeon should consider the optimal contralateral surgery timing in patients with planned bilateral thyroid operation to avoid the disaster of bilateral vocal cord palsy. However, LOS recovery and false LOS may occur and may lead to an unnecessary 2nd operation. Therefore, a reliable modality for intraoperative LOS evaluation and management would afford the surgeon real-time information that could help guide surgical procedure and planning. The updated causes, algorithm, and management of LOS during RLN neuromonitoring are reviewed and summarized. PMID:25713776

  17. The Acute bee paralysis virus-Kashmir bee virus-Israeli acute paralysis virus complex.

    PubMed

    de Miranda, Joachim R; Cordoni, Guido; Budge, Giles

    2010-01-01

    Acute bee paralysis virus (ABPV), Kashmir bee virus (KBV) and Israeli acute paralysis virus (IAPV) are part of a complex of closely related viruses from the Family Dicistroviridae. These viruses have a widespread prevalence in honey bee (Apis mellifera) colonies and a predominantly sub-clinical etiology that contrasts sharply with the extremely virulent pathology encountered at elevated titres, either artificially induced or encountered naturally. These viruses are frequently implicated in honey bee colony losses, especially when the colonies are infested with the parasitic mite Varroa destructor. Here we review the historical and recent literature of this virus complex, covering history and origins; the geographic, host and tissue distribution; pathology and transmission; genetics and variation; diagnostics, and discuss these within the context of the molecular and biological similarities and differences between the viruses. We also briefly discuss three recent developments relating specifically to IAPV, concerning its association with Colony Collapse Disorder, treatment of IAPV infection with siRNA and possible honey bee resistance to IAPV. PMID:19909972

  18. Laryngeal Chondrosarcoma as a Rare Cause of Subglottic Stenosis

    PubMed Central

    Kko?lu, Kerem; Canz, zlem; Do?an, Serap; Glmez, Emrah; Yce, ?mdat; a?l?, Sedat

    2014-01-01

    Laryngeal chondrosarcoma (CS) is a very rare entity. It is usually seen in 5080-year olds. It is developed from cricoid cartilage largely. Patients have laryngeal CS complaint of respiratuvar distress, dysphonia, and dysphagia generally. A submucous mass is usually seen in physical examination with an intact mucosa. Distant metastasis is rare in CSs. Main treatment is surgical excision. An 82-year-old patient who has respiratuvar distress is presented in this paper and laryngeal CS is reviewed in the light of the literature. PMID:25197601

  19. Hypokalemic Periodic Paralysis: a case report and review of the literature

    PubMed Central

    Soule, Benjamin R; Simone, Nicole L

    2008-01-01

    Hypokalemic Periodic Paralysis is one form of Periodic Paralysis, a rare group of disorders that can cause of sudden onset weakness. A case of a 29 year old male is presented here. The patient presented with sudden onset paralysis of his extremities. Laboratory evaluation revealed a markedly low potassium level. The patient's paralysis resolved upon repletion of his low potassium and he was discharged with no neurologic deficits. An association with thyroid disease is well established and further workup revealed Grave's disease in this patient. Although rare, Periodic Paralysis must differentiated from other causes of weakness and paralysis so that the proper treatment can be initiated quickly. PMID:18939979

  20. Intraoral midline mandibulotomy improves laryngeal access for transoral resection of laryngeal cancer.

    PubMed

    Saini, Alok T; Parasher, Arjun K; Kass, Jason I; Altman, Kenneth W; Miles, Brett A

    2016-01-01

    Intraoral midline mandibulotomy is a technique that can be used to increase exposure for transoral endoscopic laser microsurgery (TLS). We describe the case of a 51year old male with persistent T1 glottic carcinoma. At initial diagnosis, he had been referred for curative radiotherapy as laryngeal access was not sufficient for TLS. For treatment of his recurrence, we describe the technique of performing a midline mandibular osteotomy to improve access to the larynx allowing for safe and effective transoral endoscopic laser microsurgery. Surgical access to the larynx was greatly improved, and we were able to perform TLS in a case that would have otherwise not been amenable to TLS. An intraoral midline mandibulotomy can improve access to the larynx and allow for successful transoral resection of laryngeal cancer in patients with otherwise inaccessible tumors. PMID:26954859

  1. Partial airway obstruction following manufacturing defect in laryngeal mask airway (Laryngeal Mask Silken).

    PubMed

    Jangra, Kiran; Malhotra, Surender Kumar; Saini, Vikas

    2014-10-01

    Laryngeal mask (LM) airway is commonly used for securing airway in day-care surgeries. Various problems have been described while using LM airway. Out of those, mechanical obstruction causing airway compromise is most common. Here, we describe a case report of 4-year-old child who had partial upper airway obstruction due to LM manufacturer's defect. There was a silicon band in upper one-third of shaft of LM airway. This band was made up of the same material as that of LM airway so it was not identifiable on external inspection of transparent shaft. We suggest that such as non-transparent laryngeal mask, a transparent LM airway should also be inspected looking inside the lumen with naked eyes or by using a probe to rule out any manufacturing defect before its insertion. PMID:25422617

  2. [Thyrotoxic hypokalemic periodic paralysis in a male Kurd].

    PubMed

    Gamper, G; Stulnig, T; Weissel, M

    1998-01-01

    Thyrotoxic hypokalemic periodic paralysis has been described to occur quite frequently in male Asiatic patients. The syndrome is, however, very rare in patients of Caucasian origin. To our knowledge it has never been described in Austria so far. This is the reason why we present the following case: A 22-year old male patient of Kurdish origin suffered from two periods of typical flaccid paralysis of the extremities after strenuous physical exertion, that were 4 months apart. The periods of paralysis were quickly reversed by substitution with potassium. Graves' disease was retrospectively diagnosed to have existed already during the first period. The patient was treated with an ablative dose of 131-I (25 mCi) and can perform strenuous exercise without symptoms since. This case and the review of the literature clearly illustrates the advantage of screening for thyroid dysfunction in patients with flaccid paralysis: unnecessary further periods of paralysis can be avoided by the correct treatment of thyrotoxicosis in such patients. PMID:9816404

  3. Laryngeal stridor in multiple system atrophy: Clinicopathological features and causal hypotheses.

    PubMed

    Ozawa, Tetsutaro; Sekiya, Kanako; Aizawa, Naotaka; Terajima, Kenshi; Nishizawa, Masatoyo

    2016-02-15

    Laryngeal stridor is recognized as a characteristic clinical manifestation in patients with multiple system atrophy (MSA). However, the pathogenic mechanisms underlying this symptom are controversial. Neurogenic atrophy of the posterior cricoarytenoid muscle has been identified in cases of MSA, suggesting that laryngeal abductor weakness contributes to laryngeal stridor. However, dystonia in the laryngeal adductor muscles has also been reported to cause laryngeal stridor. Depletion of serotonergic neurons in the medullary raphe nuclei, which exert tonic drive to activate the posterior cricoarytenoid muscle, has recently been identified in MSA cases. This adds weight to the possibility that laryngeal abductor weakness underlies laryngeal stridor in MSA. Continuous positive airway pressure therapy is currently used in the treatment of laryngeal stridor, but should be used with caution in patients showing contraindications. Current knowledge of the clinical and neuropathological features of laryngeal stridor is summarized in this paper, and the hypothesized causes and possible therapeutic options for this symptom are discussed. PMID:26810550

  4. Laryngeal Leiomyosarcoma, A Case Report and Review of Articles

    PubMed Central

    Khadivi, Ehsan; Taziky, Mohammad Hossein; Jafarian, Amir Hossein; Nasseri Sadr, Msoud

    2013-01-01

    Introduction: Laryngeal leiomysarcoma is an extremely rare malignancy originating from smooth muscle cells. Its rarity is due to the fact that only less than 50 cases of pure laryngeal leiomyosarcoma and less than 10 cases of hypopharyngeal leiomyosarcaoma have been reported in modern medical literature. Even though the clinical presentation mimics that of a laryngeal carcinoma forming the major bulk of the laryngeal malignancies, the difference in management, warrants an accurate diagnosis. Case Report: We reported a case of this very rare malignancy presenting in the supraglottic region by highlighting the clinical features, histological and radiological diagnosis and management of this extremely rare malignant entity. Conclusion: An accurate histological diagnosis may be difficult; but supplementing by electron microscopy and immunohistochemical staining, the diagnosis can be reached certainly. PMID:24303449

  5. The Laryngeal Motor Cortex: Its Organization and Connectivity

    PubMed Central

    Simonyan, Kristina

    2014-01-01

    Our ability to learn and control the motor aspects of complex laryngeal behaviors, such as speech and song, is modulated by the laryngeal motor cortex (LMC), which is situated in the area 4 of the primary motor cortex and establishes both direct and indirect connections with laryngeal motoneurons. In contrast, the LMC in monkeys is located in the area 6 of the premotor cortex, projects only indirectly to laryngeal motoneurons and its destruction has essentially no effect on production of species-specific calls. These differences in cytoarchitectonic location and connectivity may be a result of hominid evolution that led to the LMC shift from the phylogenetically “old” to “new” motor cortex in order to fulfill its paramount function, i.e., voluntary motor control of human speech and song production. PMID:24929930

  6. A Case of Laryngeal Cancer Associated with Dermatomyositis

    PubMed Central

    Homma, Hirotomo; Kidokoro, Yoshinobu; Yanai, Aya; Ikeda, Katsuhisa; Wada, Ryo

    2015-01-01

    We experienced a rare case of laryngeal cancer associated with dermatomyositis. The patient was a 63-year-old male and Japanese. He was admitted to our department of Otorhinolaryngology with dysphagia for a day as a chief complaint. He became aware of hoarseness with bloody sputum and then face edema with redness a half year before. At first physical examination, he had bilateral eyelid edema with erythema, finger edema with keratinizing erythema and limb extensor erythema. Serous creatine phosphokinase was 850 IU/mL (normal range: 40-200 IU/mL). Later, he was referred to the rheumatology department and was diagnosed as having dermatomyositis. Fiberscopic examination revealed laryngeal cancer with left laryngeal palsy. We gave priority to the laryngeal treatment. As a result, the symptoms of dermatomyositis were improved.

  7. Axillary nerve injuries in contact sports: recommendations for treatment and rehabilitation.

    PubMed

    Perlmutter, G S; Apruzzese, W

    1998-11-01

    Axillary nerve injuries are some of the most common peripheral nerve injuries in athletes who participate in contact sports. Resulting deltoid muscle paralysis is secondary to nerve trauma which occurs following shoulder dislocation or a direct blow to the deltoid muscle. Compression neuropathy has been reported to occur in quadrilateral space syndrome as the axillary nerve exits this anatomic compartment. The axillary nerve is also extremely vulnerable during any operative procedure involving the inferior aspect of the shoulder, and iatrogenic injury to the axillary nerve remains a serious complication of shoulder surgery. Accurate diagnosis of axillary nerve injury is based on a careful history and physical examination as well as an understanding of the anatomy of the shoulder and the axillary nerve in particular. Inspection, palpation and neurological testing provide the bases for diagnosis. A clinically suspected axillary nerve injury should be confirmed by electrophysiological testing, including electromyography and nerve conduction studies. During the acute phase of injury, the athlete should be rested and any ligamentous or bony injury should be treated as indicated. Patients should undergo an extensive rehabilitation programme emphasising active and passive range of motion as well as strengthening of the rotator cuff, deltoid and periscapular musculature. Shoulder joint contracture should be avoided at all costs as a loss of shoulder mobility may ultimately affect functional outcome despite a return of axillary nerve function. If no axillary nerve recovery is observed by 3 to 4 months following injury, surgical exploration is indicated. Athletes who sustain injury to the axillary nerve have a variable prognosis for nerve recovery, although the return of function of the involved shoulder is typically good to excellent. We recommend that athletes who sustain axillary nerve injury may return to contact sport participation when they achieve full active range of motion of the shoulder and when shoulder strength is documented to be good to excellent by isometric or manual muscle testing. PMID:9858397

  8. Hyperbaric oxygen therapy for laryngeal radionecrosis

    SciTech Connect

    Ferguson, B.J.; Hudson, W.R.; Farmer, J.C. Jr.

    1987-01-01

    Radionecrosis of the larynx is a debilitating disease associated with pain, dysphagia, respiratory obstruction, and, in some cases, the need for laryngectomy. Persistent poor wound healing can lead to death. A series of eight patients with advanced (grades III and IV, Chandler classification) radionecrosis of the larynx treated with adjunctive hyperbaric oxygen therapy is presented. Signs and symptoms of radionecrosis were dramatically ameliorated in seven of eight patients, while one patient, despite subjective improvement, eventually required laryngectomy. There were no deaths. These results are compared to previous series on radionecrosis of the larynx in which hyperbaric oxygen was not used. This series indicates that hyperbaric oxygen therapy is a useful and effective adjunctive treatment modality in the management of laryngeal radionecrosis.

  9. [Diagnosis and therapy of laryngeal sarcoidosis].

    PubMed

    Jakse, R; Fleischmann, G

    1985-03-01

    The larynx may be involved in patients with systemic sarcoidosis or may be the first or only manifestation of the disease. The symptoms depend on the degree of involvement of the larynx, and include a sensation of lump in the throat, dysphagia, hoarseness, cough, stridor and dyspnea. The supraglottis is the most frequently affected area. There are pale pink, edematous, diffuse hypertrophy of the supraglottic structures or granular areas of the glottic and subglottic region. The diagnosis is made by the characteristic appearance of the larynx, histologic and laboratory findings and exclusion of other granulomatous diseases. Laryngeal sarcoidosis may cause life-threatening upper airway obstruction. Systemic corticosteroid therapy is the treatment of choice in most cases, but surgical excision or local steroid injections are useful in selected cases. PMID:3997572

  10. HUMAN LARYNGITIS CAUSED BY CLINOSTOMUM COMPLANATUM

    PubMed Central

    HARA, HIROTAKA; MIYAUCHI, YUJI; TAHARA, SHINSAKU; YAMASHITA, HIROSHI

    2014-01-01

    ABSTRACT A 64-year-old Japanese man visited our outpatient department complaining of an irritable sensation in the throat, occurring two days after eating raw freshwater fish (carp sashimi) at a Japanese-style inn. During laryngeal endoscopy, a slow-moving worm (fluke) was found attached to the surface of the right aryepiglottic fold. After inhalation of 4% lidocaine, the fluke was removed using endoscopic forceps. Patient’s throat symptoms immediately improved. The worm was microscopically identified as Clinostomum complanatum. C. complanatum is a digenetic trematode that usually infects fish-eating water birds. Clinostomum infections in humans are rare, and only 21 cases have been described in Japan and Korea. C. complanatum infection is known to occur after eating raw freshwater fish, which is a secondary intermediate host. In humans, the metacercariae are released into the stomach and migrate through the esophagus before lodging in the throat. Primary therapy involves endoscopic removal of the worm. PMID:25130004

  11. Localized laryngeal amyloidosis - a case report.

    PubMed

    Sz?cs, Mihly; Mhlfay, Gheorghe; Mocan, Simona Liliana; Balzs, Andor; Neagoe, Radu Mircea

    2015-01-01

    Amyloidosis encompasses a variety of conditions, caused by extracellular, insoluble protein fibrils that disturb the normal functioning of cells and organs. The disease may be localized or systemic, hereditary or acquired (associated with chronic inflammatory or hematological diseases). We present the case of a 49-year-old woman, with symptoms including dysphagia, dysphonia and dyspnea. After taking the case history and performing clinical examination, we suspected a laryngeal tumor to be the cause of the symptoms. Microlaryngoscopy and biopsy were performed. The histopathological examination result of the biopsy specimen was amyloidosis. Surgical excision of the tumor was performed. Our case presentation describes this rare pathological finding, its clinical manifestations, the histopathological and surgical diagnostic problems, treatment, patient evolution and the difficulties we encountered along the way, through the scope of our personal experience. PMID:26193236

  12. Genetic study of hyperkalemic periodic paralysis in horses.

    PubMed

    Spier, S J; Carlson, G P; Harrold, D; Bowling, A; Byrns, G; Bernoco, D

    1993-03-15

    Four Quarter Horses (1 stallion, 3 mares) with hyperkalemic periodic paralysis were mated to unaffected horses to determine the genetic basis of the disease. The affected stallion was bred to 11 unaffected mares (4 Quarter Horses, 1 Arabian, 2 Standardbreds, and 4 Thoroughbreds). The 3 affected mares were bred to an unaffected Quarter Horse stallion. Of the 15 offspring obtained from these matings, 9 were affected with hyperkalemic periodic paralysis, and 6 were unaffected, consistent with an autosomal dominant mode of inheritance. Diagnosis was established by results of oral administration of potassium chloride and demonstration of characteristic clinical signs accompanied by hyperkalemia. Oral administration of potassium chloride resulted in marked increases in plasma potassium concentrations in affected and unaffected foals, although hyperkalemia was associated with clinical signs of hyperkalemic periodic paralysis in the affected foals. Evaluation of blood samples from affected and unaffected offspring revealed no linkage with erythrocyte and serum markers at 24 loci. PMID:8468218

  13. A rare cause of acute flaccid paralysis: Human coronaviruses.

    PubMed

    Turgay, Cokyaman; Emine, Tekin; Ozlem, Koken; Muhammet, S Paksu; Haydar, A Tasdemir

    2015-01-01

    Acute flaccid paralysis (AFP) is a life-threatening clinical entity characterized by weakness in the whole body muscles often accompanied by respiratory and bulbar paralysis. The most common cause is Gullian-Barre syndrome, but infections, spinal cord diseases, neuromuscular diseases such as myasthenia gravis, drugs and toxins, periodic hypokalemic paralysis, electrolyte disturbances, and botulism should be considered as in the differential diagnosis. Human coronaviruses (HCoVs) cause common cold, upper and lower respiratory tract disease, but in the literature presentation with the lower respiratory tract infection and AFP has not been reported previously. In this study, pediatric case admitted with lower respiratory tract infection and AFP, who detected for HCoV 229E and OC43 co-infection by the real-time polymerase chain reaction, has been reported for the first time. PMID:26557177

  14. A rare cause of acute flaccid paralysis: Human coronaviruses

    PubMed Central

    Turgay, Cokyaman; Emine, Tekin; Ozlem, Koken; Muhammet, S. Paksu; Haydar, A. Tasdemir

    2015-01-01

    Acute flaccid paralysis (AFP) is a life-threatening clinical entity characterized by weakness in the whole body muscles often accompanied by respiratory and bulbar paralysis. The most common cause is GullianBarre syndrome, but infections, spinal cord diseases, neuromuscular diseases such as myasthenia gravis, drugs and toxins, periodic hypokalemic paralysis, electrolyte disturbances, and botulism should be considered as in the differential diagnosis. Human coronaviruses (HCoVs) cause common cold, upper and lower respiratory tract disease, but in the literature presentation with the lower respiratory tract infection and AFP has not been reported previously. In this study, pediatric case admitted with lower respiratory tract infection and AFP, who detected for HCoV 229E and OC43 co-infection by the real-time polymerase chain reaction, has been reported for the first time. PMID:26557177

  15. An fMRI investigation of racial paralysis

    PubMed Central

    Mason, Malia F.; Vandello, Joseph A.; Biga, Andrew; Dyer, Rebecca

    2013-01-01

    We explore the existence and underlying neural mechanism of a new norm endorsed by both black and white Americans for managing interracial interactions: “racial paralysis’, the tendency to opt out of decisions involving members of different races. We show that people are more willing to make choices—such as who is more intelligent, or who is more polite—between two white individuals (same-race decisions) than between a white and a black individual (cross-race decisions), a tendency which was evident more when judgments involved traits related to black stereotypes. We use functional magnetic resonance imaging to examine the mechanisms underlying racial paralysis, to examine the mechanisms underlying racial paralysis, revealing greater recruitment of brain regions implicated in socially appropriate behavior (ventromedial prefrontal cortex), conflict detection (anterior cingulate cortex), deliberative processing (dorsolateral prefrontal cortex), and inhibition (ventrolateral prefrontal cortex). We also discuss the impact of racial paralysis on the quality of interracial relations. PMID:22267521

  16. Hypokalemic Paralysis Complicated by Concurrent Hyperthyroidism and Chronic Alcoholism

    PubMed Central

    Tsai, Ming-Hsien; Lin, Shih-Hua; Leu, Jyh-Gang; Fang, Yu-Wei

    2015-01-01

    Abstract Thyrotoxic periodic paralysis (TPP) is characterized by the presence of muscle paralysis, hypokalemia, and hyperthyroidism. We report the case of a young man with paralysis of the lower extremities, severe hypokalemia, and concurrent hyperthyroidism. TPP was suspected; therefore, treatment consisting of judicious potassium (K+) repletion and ?-blocker administration was initiated. However, urinary K+ excretion rate, as well as refractoriness to treatment, was inconsistent with TPP. Chronic alcoholism was considered as an alternative cause of hypokalemia, and serum K+ was restored through vigorous K+ repletion and the addition of K+-sparing diuretics. The presence of thyrotoxicosis and hypokalemia does not always indicate a diagnosis of TPP. Exclusion of TPP can be accomplished by immediate evaluation of urinary K+ excretion, acid-base status, and the amount of potassium chloride required to correct hypokalemia at presentation. PMID:26426670

  17. Alterations in the laryngeal mucosa after exposure to asbestos.

    PubMed Central

    Kambic, V; Radsel, Z; Gale, N

    1989-01-01

    The laryngeal mucosa of 195 workers in an asbestos cement factory (Salonit Anhovo, Yugoslavia) and in a control group was examined. The factory manufactures asbestos cement products containing about 13% of asbestos (8% amosite, 12% crocidolite, and 80% chrysotile) of different provenance. Alterations in the laryngeal mucosa were more frequent in the factory workers than in the control group. The changes, mostly consistent with chronic laryngitis, were closely related to the degree of workplace pollution and less so to the duration of employment Ten workers exhibiting the most severe clinical changes underwent biopsy, the results of which showed histomorphological changes characteristic of hyperplastic chronic laryngitis. Four tissue specimens were examined also by scanning electron microscopy and in three of them asbestos fibres were found on the epithelial surface. No case of laryngeal carcinoma was identified. On the basis of our results it is thought that asbestos related changes of the larynx should receive more attention and that the use of the term "laryngeal asbestosis" is justified. The clinical picture is non-specific but in view of their frequency such changes should be considered a consequence of exposure to asbestos. Images PMID:2489023

  18. Laryngeal dislocation after ventral fusion of the cervical spine.

    PubMed

    Krauel, Jenny; Winkler, Dietrich; Münscher, Adrian; Tank, Sascha

    2013-05-01

    We report on a 70-year-old patient who underwent ventral fusion of the cervical spine (C3/4 and C4/5) for spinal canal stenosis performed by the neurosurgery department. The patient suffered an exceedingly rare complication of the surgery - laryngeal dislocation. Had the deformed laryngeal structures been overlooked and the patient extubated as usual after surgery, reintubation would have been impossible due to the associated swelling, which might have had disastrous consequences. Leftward dislocation of the larynx became apparent post-operatively, but prior to extubation. Extubation was therefore postponed and a subsequent computed tomography (CT) scan revealed entrapment of laryngeal structures within the osteosynthesis. A trial of repositioning using microlaryngoscopy performed by otolaryngology (ears, nose and throat) specialists failed, making open surgical revision necessary. At surgery, the entrapped laryngeal tissue was successfully mobilised. Laryngeal oedema developed despite prompt repositioning; thus, necessitating tracheotomy and long-term ventilation. Laryngeal dislocation may be an unusual cause of post-operative neck swelling after anterior cervical spine surgery and should be considered in the differential diagnosis if surgical site haematoma and other causes have been ruled out. Imaging studies including CT of the neck may be needed before extubation to confirm the suspicion and should be promptly obtained to facilitate specific treatment. PMID:23983289

  19. An instance of sleep paralysis in Moby-Dick.

    PubMed

    Herman, J

    1997-07-01

    It is suggested that picturesque medical conditions can, at times, be encountered in literary works composed prior to their clinical delineation. This is true of sleep paralysis, of which the first scientific description was given by Silas Weir Mitchell in 1876. A quarter of a century earlier, Herman Melville, in Moby-Dick, gave a precise account of a case, including the predisposing factors and sexual connotations, all in accord with modern theory. The details of Ishmael's attack of sleep paralysis, the stresses leading up to it, and the associations causing him to recall the experience are given here. PMID:9322274

  20. Mumps, cervical zoster, and facial paralysis: coincidence or association?

    PubMed

    Kondo, Kenji; Kanaya, Kaori; Baba, Shintaro; Yamasoba, Tatsuya

    2014-01-01

    The association of mumps with peripheral facial paralysis has been suggested, but its pathogenesis remains unclear. An 8-year-old girl simultaneously developed left peripheral facial paralysis, ipsilateral cervical herpes zoster, and bilateral mumps sialadenitis. Elevated anti-mumps and anti-varicella zoster virus IgM antibodies in serological testing indicated recent infection of mumps and reactivation of VZV. Molecular studies have provided mounting evidence that the mumps virus dysregulates the host's immune system and enables the virus to proliferate in the infected host cells. This dysregulation of the immune system by mumps virus may have occurred in our patient, enabling the latent VZV infection to reactivate. PMID:24653846

  1. Mumps, Cervical Zoster, and Facial Paralysis: Coincidence or Association?

    PubMed Central

    Kanaya, Kaori

    2014-01-01

    The association of mumps with peripheral facial paralysis has been suggested, but its pathogenesis remains unclear. An 8-year-old girl simultaneously developed left peripheral facial paralysis, ipsilateral cervical herpes zoster, and bilateral mumps sialadenitis. Elevated anti-mumps and anti-varicella zoster virus IgM antibodies in serological testing indicated recent infection of mumps and reactivation of VZV. Molecular studies have provided mounting evidence that the mumps virus dysregulates the host's immune system and enables the virus to proliferate in the infected host cells. This dysregulation of the immune system by mumps virus may have occurred in our patient, enabling the latent VZV infection to reactivate. PMID:24653846

  2. Fatal Dysrhythmia Following Potassium Replacement for Hypokalemic Periodic Paralysis

    PubMed Central

    Ahmed, Imdad; Chilimuri, Sridhar S.

    2010-01-01

    We present a case of fatal rebound hyperkalemia in a patient with thyrotoxic periodic paralysis (TPP) treated with potassium supplementation. Although TPP is a rare hyperthyroidism-related endocrine disorder seen predominantly in men of Asian origin, the diagnosis should be considered in patients of non-Asian origins presenting with hypokalemia, muscle weakness or acute paralysis. The condition may present as a life threatening emergency and unfamiliarity with the disease could result in a fatal outcome. Immediate therapy with potassium chloride supplementation may foster a rapid recovery of muscle strength and prevent cardiac arrhythmias secondary to hypokalemia, but with a risk of rebound hyperkalemia. PMID:20411077

  3. Office-Based Intracordal Hyaluronate Injections Improve Quality of Life in Thoracic-Surgery-Related Unilateral Vocal Fold Paralysis.

    PubMed

    Fang, Tuan-Jen; Hsin, Li-Jen; Chung, Hsiu-Feng; Chiang, Hui-Chen; Li, Hsueh-Yu; Wong, Alice M K; Pei, Yu-Chen

    2015-10-01

    Thoracic-surgery-related unilateral vocal fold paralysis (UVFP) may cause severe morbidity and can cause profound functional impairment and psychosocial stress in patients with pre-existing thoracic diseases. In-office intracordal hyaluronate (HA) injections have recently been applied to improve voice and quality of life in patients with vocal incompetence, but their effect on thoracic-surgery-related UVFP remains inconclusive. We therefore conducted a prospective study to clarify the effect of early HA injection on voice and quality of life in patients with thoracic-surgery-related UVFP. Patients with UVFP within 3 months after thoracic surgery who received office-based HA injection were recruited. Quantitative laryngeal electromyography, videolaryngostroboscopy, voice-related life quality (voice outcome survey), laboratory voice analysis, and health-related quality of life (SF-36) were evaluated at baseline, and at 1 month postinjection. A total of 104 consecutive patients accepted office-based HA intracordal injection during the study period, 34 of whom were treated in relation to thoracic surgery and were eligible for inclusion. Voice-related life quality, voice laboratory analysis, and most generic quality of life domains were significantly improved at 1 month after in-office HA intracordal injection. No HA-related complications were reported. Single office-based HA intracordal injection is a safe and effective treatment for thoracic-surgery-related UVFP, resulting in immediate improvements in patient quality of life, voice quality, and swallowing ability. PMID:26448034

  4. Office-Based Intracordal Hyaluronate Injections Improve Quality of Life in Thoracic-Surgery-Related Unilateral Vocal Fold Paralysis

    PubMed Central

    Fang, Tuan-Jen; Hsin, Li-Jen; Chung, Hsiu-Feng; Chiang, Hui-Chen; Li, Hsueh-Yu; Wong, Alice M.K.; Pei, Yu-Chen

    2015-01-01

    Abstract Thoracic-surgery-related unilateral vocal fold paralysis (UVFP) may cause severe morbidity and can cause profound functional impairment and psychosocial stress in patients with pre-existing thoracic diseases. In-office intracordal hyaluronate (HA) injections have recently been applied to improve voice and quality of life in patients with vocal incompetence, but their effect on thoracic-surgery-related UVFP remains inconclusive. We therefore conducted a prospective study to clarify the effect of early HA injection on voice and quality of life in patients with thoracic-surgery-related UVFP. Patients with UVFP within 3 months after thoracic surgery who received office-based HA injection were recruited. Quantitative laryngeal electromyography, videolaryngostroboscopy, voice-related life quality (voice outcome survey), laboratory voice analysis, and health-related quality of life (SF-36) were evaluated at baseline, and at 1 month postinjection. A total of 104 consecutive patients accepted office-based HA intracordal injection during the study period, 34 of whom were treated in relation to thoracic surgery and were eligible for inclusion. Voice-related life quality, voice laboratory analysis, and most generic quality of life domains were significantly improved at 1 month after in-office HA intracordal injection. No HA-related complications were reported. Single office-based HA intracordal injection is a safe and effective treatment for thoracic-surgery-related UVFP, resulting in immediate improvements in patient quality of life, voice quality, and swallowing ability. PMID:26448034

  5. Incidence of laryngeal cancer and exposure to acid mists.

    PubMed Central

    Steenland, K; Schnorr, T; Beaumont, J; Halperin, W; Bloom, T

    1988-01-01

    To determine the relation between exposure to acid mist and laryngeal cancer, the smoking habits, drinking habits, and incidence of laryngeal cancer of 879 male steelworkers exposed to acid mists during pickling operations was ascertained. Sulphuric acid mist was the primary exposure for most men in this cohort. These men had all worked in a pickling operation for a minimum of six months before 1965, with an average duration of exposure of 9.5 years. Exposures to sulphuric acid in the 1970s averaged about 0.2 mg/m3, and earlier exposures were probably similar. Interviews were conducted with all cohort members or their next of kin in 1986 and medical records of decedents were reviewed. Nine workers were identified who had been diagnosed as having laryngeal cancer, using a conservative case definition that required medical record confirmation for any case among decedents and confirmation by a physician for any case among live individuals. Using data from national surveys of cancer incidence as referent rates, 3.44 laryngeal cancers would have been expected. Excess smoking by the exposed cohort compared with the United States population resulted in an upward adjustment of the expected number of cases of laryngeal cancer to 3.92. The standardised incidence rate ratio for laryngeal cancer was 2.30 (9/3.92), with a one sided p value of 0.01 (assuming a Poisson distribution). The finding of excess laryngeal cancer in this cohort is consistent with four other studies published since 1981. PMID:3203082

  6. Ovine fetal laryngeal chemoreflex thresholds and respiratory effects.

    PubMed

    Chan, K; Kullama, L K; Day, L; Ogundipe, A; Ross, M G

    1997-01-01

    In newborn infants, laryngeal contact with solutions of low chloride concentration or pH evokes swallowing, laryngeal adduction, and respiratory inhibition (laryngeal chemoreflex). To determine whether the laryngeal chemoreflex is present during fetal life and its effect on fetal respiratory activity, eight time-bred ewes (128 +/- 2 days) were prepared with fetal electrocortical diaphragm and esophageal electrodes and a nasopharyngeal catheter. After a 60-minute control period, increasing volumes (0.1 to 1.0 ml/kg) of 0.15 mol/L NaCl or distilled water (0.05 to 1.0 ml/kg) and decreasing concentrations of NaCl (0.15 to 0.02 mol/L) at a fixed volume (0.3 ml/kg) were sequentially administered through the nasopharyngeal catheter (38 degrees C). The minimum water volume that stimulated swallowing was significantly less than the minimum 0.15 mol/L NaCl volume (0.10 +/- 0.02 vs. 0.70 +/- 0.05 ml/kg). The maximum NaCl concentration that stimulated swallowing was 0.04 +/- 0.01 mol/L During the control period, respiratory activity averaged 14.6 +/- 0.7 breaths/minute and did not change during absent swallow responses or isotonic saline-induced swallows. However, respiratory activity significantly decreased during water (4.7 +/- 0.6 breaths/minute) and hypotonic saline-induced swallow responses (3.7 +/- 0.7 breaths/minute). Fetal electrocortical activity did not change during absent or stimulated swallows. We conclude that laryngeal water or hypotonic saline solution may stimulate fetal swallowing and suppress fetal respiratory activity, similar to the newborn laryngeal chemoreflex. We speculate that an exaggeration of the laryngeal chemoreflex apnea response in the newborn may predispose to sudden infant death syndrome. PMID:9018264

  7. Laryngeal Lymphoma: The High and Low Grades of Rare Lymphoma Involvement Sites

    PubMed Central

    Degaetano, James; Farrugia, Eric; Magri, Claude; Refalo, Nicholas; Camilleri, David J.

    2014-01-01

    The larynx is an extremely rare site of involvement by lymphomatous disease. We present two cases of isolated laryngeal high-grade and another low-grade lymphoma, together with a literature review of laryngeal lymphoma management. PMID:25140179

  8. Acute Flaccid Paralysis: The New, The Old, and The Preventable

    PubMed Central

    Macesic, N.; Hall, V.; Mahony, A.; Hueston, L.; Ng, G.; Macdonell, R.; Hughes, A.; Fitt, G.; Grayson, M. L.

    2016-01-01

    Acute flaccid paralysis (AFP) has a changing epidemiology with ongoing polio outbreaks and emerging causes such as nonpolio enteroviruses and West Nile virus (WNV). We report a case of AFP from the Horn of Africa that was initially classified as probable polio but subsequently found to be due to WNV. PMID:26788545

  9. A rare case of paralysis in an endemic area

    PubMed Central

    Yardimci, Bulent; Kazancioglu, Rumeyza

    2015-01-01

    Thyrotoxicosis mostly presents with tachycardia, tremor, weight loss and other hypermetabolism signs. However, there are other unusual signs of thyrotoxicosis such as paralysis. This unusual clinical presentation may postpone prompt diagnosis and treatment. In this case report, we present a 27-years-old woman, who presented with quadriparesis at the emergency department. PMID:26101516

  10. Marek's disease virus induced transient paralysis--a closer look

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Marek’s Disease (MD) is a lymphoproliferative disease of domestic chickens caused by a highly cell-associated alpha herpesvirus, Marek’s disease virus (MDV). Clinical signs of MD include depression, crippling, weight loss, and transient paralysis (TP). TP is a disease of the central nervous system...

  11. [Management of oculo-palpebral consequences in facial paralysis].

    PubMed

    Alliez, A; Malet, T; Bertrand, B; Degardin, N; Benichou, L; Bardot, J; Labb, D

    2015-10-01

    Facial paralysis prognostic depends on eye lesion. In this pathology, lacrymal and palpebral functions will be modified: bad eye closure and leak of tears secretions. It can leads to corneal complications from keratitis to corneal abcedation and visual dysfonction. This chapter details different procedures and their indications to avoid this kind of complications. PMID:26321239

  12. Acute Flaccid Paralysis: The New, The Old, and The Preventable.

    PubMed

    Macesic, N; Hall, V; Mahony, A; Hueston, L; Ng, G; Macdonell, R; Hughes, A; Fitt, G; Grayson, M L

    2016-01-01

    Acute flaccid paralysis (AFP) has a changing epidemiology with ongoing polio outbreaks and emerging causes such as nonpolio enteroviruses and West Nile virus (WNV). We report a case of AFP from the Horn of Africa that was initially classified as probable polio but subsequently found to be due to WNV. PMID:26788545

  13. Reversible diaphragmatic paralysis caused by a malpositioned chest tube.

    PubMed

    Nakagama, Yu; Kaneko, Yukihiro; Ono, Hiroshi

    2015-10-01

    We report a case of reversible diaphragmatic paralysis caused by a malpositioned chest tube, a diagnosis to consider when unexplained respiratory failure occurs following drainage of pleural effusion. Prompt recognition and removal of the tube led to full recovery of diaphragm function. PMID:25547366

  14. Hypokalemic Periodic Paralysis in a Hyperthyroid Black Woman

    PubMed Central

    Hackshaw, Kevin V.; Coker, Ernest

    1988-01-01

    In this case of periodic paralysis and thyrotoxicosis, investigation of the patient's family revealed other members similarly affected. To the best of the authors' knowledge, it represents the first reported instance of this familial association in the case of a black woman. PMID:3249338

  15. Secondary Sjogren's syndrome presenting with hypokalemic periodic paralysis

    PubMed Central

    Dormohammadi Toosi, Taraneh; Naderi, Neda; Movassaghi, Shafieh; Seradj, Mehran Heydari; Khalvat, Ali; Shahbazi, Fatemeh

    2014-01-01

    Renal tubular acidosis (RTA) may develop in a large population of patients with Sjogren's syndrome (SS), but most of the subjects are asymptomatic. Here, we report a patient with known rheumatoid arthritis and symptoms of xerostomia, xerophthalmia and periodic paralysis. SS should be considered as a cause of RTA. The treatment of the underlying disorder may ameliorate the symptoms. PMID:25988057

  16. Acute Flaccid Paralysis Associated with Novel Enterovirus C105

    PubMed Central

    Horner, Liana M.; Poulter, Melinda D.; Brenton, J. Nicholas

    2015-01-01

    An outbreak of acute flaccid paralysis among children in the United States during summer 2014 was tentatively associated with enterovirus D68 infection. This syndrome in a child in fall 2014 was associated with enterovirus C105 infection. The presence of this virus strain in North America may pose a diagnostic challenge. PMID:26401731

  17. Secondary Sjogren's syndrome presenting with hypokalemic periodic paralysis.

    PubMed

    Dormohammadi Toosi, Taraneh; Naderi, Neda; Movassaghi, Shafieh; Seradj, Mehran Heydari; Khalvat, Ali; Shahbazi, Fatemeh

    2014-11-01

    Renal tubular acidosis (RTA) may develop in a large population of patients with Sjogren's syndrome (SS), but most of the subjects are asymptomatic. Here, we report a patient with known rheumatoid arthritis and symptoms of xerostomia, xerophthalmia and periodic paralysis. SS should be considered as a cause of RTA. The treatment of the underlying disorder may ameliorate the symptoms. PMID:25988057

  18. A rare case of paralysis in an endemic area.

    PubMed

    Yardimci, Bulent; Kazancioglu, Rumeyza

    2015-01-01

    Thyrotoxicosis mostly presents with tachycardia, tremor, weight loss and other hypermetabolism signs. However, there are other unusual signs of thyrotoxicosis such as paralysis. This unusual clinical presentation may postpone prompt diagnosis and treatment. In this case report, we present a 27-years-old woman, who presented with quadriparesis at the emergency department. PMID:26101516

  19. 4.7-T diffusion tensor imaging of acute traumatic peripheral nerve injury.

    PubMed

    Boyer, Richard B; Kelm, Nathaniel D; Riley, D Colton; Sexton, Kevin W; Pollins, Alonda C; Shack, R Bruce; Dortch, Richard D; Nanney, Lillian B; Does, Mark D; Thayer, Wesley P

    2015-09-01

    Diagnosis and management of peripheral nerve injury is complicated by the inability to assess microstructural features of injured nerve fibers via clinical examination and electrophysiology. Diffusion tensor imaging (DTI) has been shown to accurately detect nerve injury and regeneration in crush models of peripheral nerve injury, but no prior studies have been conducted on nerve transection, a surgical emergency that can lead to permanent weakness or paralysis. Acute sciatic nerve injuries were performed microsurgically to produce multiple grades of nerve transection in rats that were harvested 1 hour after surgery. High-resolution diffusion tensor images from ex vivo sciatic nerves were obtained using diffusion-weighted spin-echo acquisitions at 4.7 T. Fractional anisotropy was significantly reduced at the injury sites of transected rats compared with sham rats. Additionally, minor eigenvalues and radial diffusivity were profoundly elevated at all injury sites and were negatively correlated to the degree of injury. Diffusion tensor tractography showed discontinuities at all injury sites and significantly reduced continuous tract counts. These findings demonstrate that high-resolution DTI is a promising tool for acute diagnosis and grading of traumatic peripheral nerve injuries. PMID:26323827

  20. Management of the eye in facial paralysis.

    PubMed

    Sohrab, Mahsa; Abugo, Usiwoma; Grant, Michael; Merbs, Shannath

    2015-04-01

    Facial nerve palsy, whether the cause is idiopathic, or following such insults as surgery, trauma, or malignancy, places the health of the ocular surface at risk. Reduced or absent orbicularis oculi function results in lagophthalmos and exposure of the cornea, which is exacerbated by eyelid malposition. Management of the exposure keratopathy is paramount to prevent corneal breakdown, scarring, and permanent vision loss. Significant exposure keratopathy can be complicated by loss of corneal sensation, leading to a neurotrophic corneal ulcer. Initial management consists of artificial tear drops and ointment for corneal lubrication and strategies to address the lagophthalmos. Once the condition of the ocular surface has been stabilized, a variety of surgical treatment options are available depending on the severity and persistence of eyelid and ocular findings. The most common surgical options include temporary or permanent tarsorrhaphy for lagophthalmos, upper eyelid weight placement for retraction, and lateral canthoplasty with or without a middle lamellar spacer for lower eyelid retraction. External eyelid loading is a good option in patients who are poor surgical candidates or who have a known temporary palsy of short duration. The goal of all such procedures must be protection of the ocular surface through optimization of eyelid position. PMID:25958900

  1. Transplantation of Olfactory Ensheathing Cells to Evaluate Functional Recovery after Peripheral Nerve Injury

    PubMed Central

    Guerout, Nicolas; Paviot, Alexandre; Bon-Mardion, Nicolas; Honor, Axel; OBongo, Rais; Duclos, Clia; Marie, Jean-Paul

    2014-01-01

    Olfactory ensheathing cells (OECs) are neural crest cells which allow growth and regrowth of the primary olfactory neurons. Indeed, the primary olfactory system is characterized by its ability to give rise to new neurons even in adult animals. This particular ability is partly due to the presence of OECs which create a favorable microenvironment for neurogenesis. This property of OECs has been used for cellular transplantation such as in spinal cord injury models. Although the peripheral nervous system has a greater capacity to regenerate after nerve injury than the central nervous system, complete sections induce misrouting during axonal regrowth in particular after facial of laryngeal nerve transection. Specifically, full sectioning of the recurrent laryngeal nerve (RLN) induces aberrant axonal regrowth resulting in synkinesis of the vocal cords. In this specific model, we showed that OECs transplantation efficiently increases axonal regrowth. OECs are constituted of several subpopulations present in both the olfactory mucosa (OM-OECs) and the olfactory bulbs (OB-OECs). We present here a model of cellular transplantation based on the use of these different subpopulations of OECs in a RLN injury model. Using this paradigm, primary cultures of OB-OECs and OM-OECs were transplanted in Matrigel after section and anastomosis of the RLN. Two months after surgery, we evaluated transplanted animals by complementary analyses based on videolaryngoscopy, electromyography (EMG), and histological studies. First, videolaryngoscopy allowed us to evaluate laryngeal functions, in particular muscular cocontractions phenomena. Then, EMG analyses demonstrated richness and synchronization of muscular activities. Finally, histological studies based on toluidine blue staining allowed the quantification of the number and profile of myelinated fibers. All together, we describe here how to isolate, culture, identify and transplant OECs from OM and OB after RLN section-anastomosis and how to evaluate and analyze the efficiency of these transplanted cells on axonal regrowth and laryngeal functions. PMID:24637657

  2. Ulnar nerve damage (image)

    MedlinePLUS

    ... arm. The nerve is commonly injured at the elbow because of elbow fracture or dislocation. The ulnar nerve is near ... surface of the body where it crosses the elbow, so prolonged pressure on the elbow or entrapment ...

  3. Electromechanical Nerve Stimulator

    NASA Technical Reports Server (NTRS)

    Tcheng, Ping; Supplee, Frank H., Jr.; Prass, Richard L.

    1993-01-01

    Nerve stimulator applies and/or measures precisely controlled force and/or displacement to nerve so response of nerve measured. Consists of three major components connected in tandem: miniature probe with spherical tip; transducer; and actuator. Probe applies force to nerve, transducer measures force and sends feedback signal to control circuitry, and actuator positions force transducer and probe. Separate box houses control circuits and panel. Operator uses panel to select operating mode and parameters. Stimulator used in research to characterize behavior of nerve under various conditions of temperature, anesthesia, ventilation, and prior damage to nerve. Also used clinically to assess damage to nerve from disease or accident and to monitor response of nerve during surgery.

  4. Nerve Injuries in Athletes.

    ERIC Educational Resources Information Center

    Collins, Kathryn; And Others

    1988-01-01

    Over a two-year period this study evaluated the condition of 65 athletes with nerve injuries. These injuries represent the spectrum of nerve injuries likely to be encountered in sports medicine clinics. (Author/MT)

  5. Optic Nerve Decompression

    MedlinePLUS

    ... this delicate surgery without any cuts to the face. In the following sections, we will review the indications, risks and benefits of endoscopic optic nerve decompression. Indications The reasons for optic nerve decompression usually ...

  6. Assessing nerves in leprosy.

    PubMed

    Garbino, José Antonio; Heise, Carlos Otto; Marques, Wilson

    2016-01-01

    Leprosy neuropathy is dependent on the patient's immune response and expresses itself as a focal or multifocal neuropathy with asymmetric involvement. Leprosy neuropathy evolves chronically but recurrently develops periods of exacerbation during type 1 or type 2 reactions, leading to acute neuropathy. Nerve enlargement leading to entrapment syndromes is also a common manifestation. Pain may be either of inflammatory or neuropathic origin. A thorough and detailed evaluation is mandatory for adequate patient follow-up, including nerve palpation, pain assessment, graded sensory mapping, muscle power testing, and autonomic evaluation. Nerve conduction studies are a sensitive tool for nerve dysfunction, including new lesions during reaction periods or development of entrapment syndromes. Nerve ultrasonography is also a very promising method for nerve evaluation in leprosy. The authors propose a composite nerve clinical score for nerve function assessment that can be useful for longitudinal evaluation. PMID:26773623

  7. Effects of Odontobuthus Doriae Scorpion Venom on Mouse Sciatic Nerve

    PubMed Central

    Vatanpour, Hossein; Jalali, Amir; G. Rowan, Edward; Rahim, Fakher

    2013-01-01

    Temporary paralysis is a rare manifestation of envenoming following the yellow Iranian scorpion, Odontobuthus doriae (O. doriae). Thus, to elucidate the underlying mechanism, we investigated the neurotoxic effect of venom in the sciatic nerve, the possible mechanism in a mice model. The neurotoxicity and temperature effects in the venom-induced neurotoxicity were examined using the mouse sciatic nerve and mouse phrenic nerve-hemidiaphragm (MHD) preparations. O .doriae venom (1 ?g/mL) caused changes in the perineural waveform associated with nerve terminal action potentials. Venom affected on both negative and positive components of the waveform which is known as a compound action potential. The timeresponse relationship of venom-induced depression of resting membrane potential (RMP) was significant (p < 0.05). No significant difference in augmentation was seen in room temperature in comparison with 37C. In conclusion, although there was no evidence that the venom had any specific curarizing action at the neuromuscular junction, the results suggest that the venom exerts its neuromuscular transmission on the sciatic nerve through potassium and sodium ionic-currents. Furthermore, the influence of temperature on neurotoxicity was ineffective on blockade of the neuromuscular transmission in-vitro. PMID:24250682

  8. A decade of laryngeal dysplasia in Paisley, Scotland.

    PubMed

    Montgomery, Jenny; White, Aileen

    2012-03-01

    Laryngeal dysplasia is a known premalignant condition. A recent consensus statement by otorhinolaryngologists and pathologists on the diagnosis and management of laryngeal dysplasia Mehanna et al. (Clin Otol 35:170-176, 2010) identified a need for retrospective data on epidemiological aspects of laryngeal dysplasia as well as responses to treatment. A retrospective search was made on the hospital pathology database for cases of laryngeal dysplasia. Searches were made under "Larynx", "Dysplasia", "Carcinoma in situ" and "Vocal Cord". The search dates were between 1998 to the present day. The returned records were checked with the pathology reports and the case notes of these patients requested for analysis. A proforma was completed for each patient with laryngeal dysplasia. These patients were then anonymised, entered into a spreadsheet and analysed. The initial search returned 937 patients. Of these patients, 505 (54%) had benign laryngeal pathology, 131 (14%) had laryngeal dysplasia and 301 (32%) had invasive cancer on biopsy. Patients who developed malignancy within 3 months of being diagnosed with laryngeal dysplasia were excluded. This left 110 patients for analysis. Of the dysplastic patients, 40 (36%) had mild dysplasia, 31 (28%) had moderate dysplasia and 39 (35%) had severe dysplasia/carcinoma in situ; 70% were male. The median age was 63 (min 21, max 90, ave 62.5); 74 (67%) were smokers or ex-smokers. Progression of dysplasia was seen in 7 (6%) patients. Malignant transformation was seen in 18 (16%) patients. The average time for malignant change was 43 months (min 4 months, max 192 months and median 15.5 months; 73 (66%) patients were treated by microlaryngeal resection, 2 (2%) were treated by vocal cord stripping, 28 (25%) were treated by endolaser therapy, and 1 (1%) patient was treated by using the microdebrider skimming blade and 6 (5%) were treated by radiotherapy. Cure of dysplasia or downgrading of severity in these treatment subgroups was 62 (85%), 2 (100%), 24 (86%), 1 (100%) and 4 (66%), respectively. Our study reiterates that laryngeal dysplasia carries a significant risk of developing malignancy. Management of this condition varies widely. Endolaser resection is becoming more frequently employed in the UK. Our study is biased heavily towards cold steel dissection. Although there is increasing practice in the UK to promote early discharge, we feel it may be safer to keep patients under surveillance for longer periods. Despite this, all patients who returned after discharge or failing to attend with invasive cancer did so with new symptoms. PMID:21739097

  9. Engineering Peripheral Nerve Repair

    PubMed Central

    Marquardt, Laura; Sakiyama-Elbert, Shelly E.

    2013-01-01

    Current approaches for treating peripheral nerve injury have resulted in promising, yet insufficient functional recovery compared to the clinical standard of care, autologous nerve grafts. In order to design a construct that can match the regenerative potential of the autograft, all facets of nerve tissue must be incorporated in a combinatorial therapy. Engineered biomaterial scaffolds in the future will have to promote enhanced regeneration and appropriate reinnervation by targeting the highly sensitive response of regenerating nerves to their surrounding microenvironment. PMID:23790730

  10. Optic Nerve Pit

    MedlinePLUS

    ... Conditions Frequently Asked Questions Español Condiciones Chinese Conditions Optic Nerve Pit What is optic nerve pit? An optic nerve pit is a ... may be seen in both eyes. How is optic pit diagnosed? If the pit is not affecting ...

  11. Immunohistochemical analysis of laryngeal muscles in normal horses and horses with subclinical recurrent laryngeal neuropathy.

    PubMed

    Rhee, Hannah S; Steel, Catherine M; Derksen, Frederik J; Robinson, N Edward; Hoh, Joseph F Y

    2009-08-01

    We used immunohistochemistry to examine myosin heavy-chain (MyHC)-based fiber-type profiles of the right and left cricoarytenoideus dorsalis (CAD) and arytenoideus transversus (TrA) muscles of six horses without laryngoscopic evidence of recurrent laryngeal neuropathy (RLN). Results showed that CAD and TrA muscles have the same slow, 2a, and 2x fibers as equine limb muscles, but not the faster contracting fibers expressing extraocular and 2B MyHCs found in laryngeal muscles of small mammals. Muscles from three horses showed fiber-type grouping bilaterally in the TrA muscles, but only in the left CAD. Fiber-type grouping suggests that denervation and reinnervation of fibers had occurred, and that these horses had subclinical RLN. There was a virtual elimination of 2x fibers in these muscles, accompanied by a significant increase in the percentage of 2a and slow fibers, and hypertrophy of these fiber types. The results suggest that multiple pathophysiological mechanisms are at work in early RLN, including selective denervation and reinnervation of 2x muscle fibers, corruption of neural impulse traffic that regulates 2x and slow muscle fiber types, and compensatory hypertrophy of remaining fibers. We conclude that horses afflicted with mild RLN are able to remain subclinical by compensatory hypertrophy of surviving muscle fibers. PMID:19398607

  12. A comparison of fiberoptical guided tracheal intubation via laryngeal mask and laryngeal tube

    PubMed Central

    Metterlein, Thomas; Plank, Christoph; Sinner, Barbara; Bundscherer, Anika; Graf, Bernhard M.; Roth, Gabriel

    2015-01-01

    Background: Fiberoptical assisted intubation via a placed laryngeal mask airway (LMA) has been described as save and easy procedure to manage a difficult airway. The laryngeal tube (LT) is a promising alternative to the LMA as supraglottic airway device. Fiberoptical assisted intubation via LT is possible, however considered more difficult. The aim of this study was to compare the fiberoptical assisted intubation via LT and LMA. Materials and Methods: A total of 22 anesthesiologists with different levels of experience participated in the study performed on an adult airway model. Primarily the supraglottic device was placed and correct position was confirmed by successful ventilation. A 5 mm internal diameter tracheal tube was loaded onto a flexible 3.6 mm fiberscope and the so prepared device was inserted into the proximal lumen of the LMA or the LT. The glottis was passed under visual control and the tube advanced into the trachea. After removal of the fiberscope, ventilation was examined clinically by inspection. Success rates, procedure time and observed complications of LMA versus LT were compared (U-test; P < 0.05). Results: Placement of the endotracheal tube was successful in all attempts using both the LMA and LT. There was no difference in the time needed for the placement procedure (33 [26-38] s LMA; 35 [32-38] s LT). Only minor technical complications were observed in both groups. Conclusion: A fiberoptical assisted intubation via LT can be considered as a relevant alternative in advanced airway management. PMID:25558197

  13. Laryngeal function reconstruction with hyoid osteomuscular flap in partial laryngectomy for laryngeal cancer

    PubMed Central

    WEI, BOJUN; SHEN, HONG; XIE, HONG

    2015-01-01

    The present study aimed to evaluate the clinical outcome of using a hyoid osteomuscular flap to repair the laryngeal defect after extended vertical partial laryngectomy. A total of 26 glottic cancer patients underwent reconstruction with osteomuscular hyoid flaps following tumor resections. Ipsilateral arytenoid cartilage was resected in all cases, and the upper region of the cricoid cartilage was resected in 11 cases. Selective ipsilateral level II, III and IV neck dissections were performed in node (N)-positive patients and ipsilateral level II, and III neck dissections in N0 patients. The bone grafts were then fixed to the cricoid and contralateral thyroid cartilages. Invasion of the thyroid cartilage endochorium was present in 12 cases and lymph nodes metastases was present in 11 cases. The extubation rate of the tracheostomy tube was 100%. The glottides of all patients were almost symmetrical. Patients were followed up for 2–7 years. One patient developed local recurrence, ipsilateral regional recurrence, contralateral regional recurrence and lung metastasis, respectively. The disease-free survival rates at 3 and 5 years were 100% (20/20) and 79% (11/14), respectively. Overall, laryngeal function recovered well upon hyoid osteomuscular flap reconstruction following extended vertical partial laryngectomy, with a high extubation rate and good sound quality. PMID:26622546

  14. Common peroneal nerve palsy: a clinical and electrophysiological review.

    PubMed Central

    Berry, H; Richardson, P M

    1976-01-01

    In a series of 70 patients (75 cases of common peroneal nerve palsy) the common causes were trauma about the knee or about the hip, compression, and underlying neuropathy. A few palsies occurred spontaneously for no apparent reason. The prognosis was uniformly good in the compression group; recovery was delayed but usually satisfactory in patients who had suffered stretch injuries. In the acute stage, when clinical paralysis appears to be complete, electrophysiological studies are a useful guide to prognosis. They may also indicate an underlying neuropathy and they detect early evidence of recovery. The anatomical peculiarities of the common peroneal nerve are noted and aspects of the clinical picture, management, and prognosis of palsy are discussed. PMID:1011026

  15. Comparison of i–gel™ and laryngeal mask airway in anesthetized paralyzed patients

    PubMed Central

    Reza Hashemian, Seyed Mohammad; Nouraei, Navid; Razavi, Seyed Sadjad; Zaker, Ebrahim; Jafari, Alireza; Eftekhari, Parivash; Radmand, Golnar; Mohajerani, Seyed Amir; Radpay, Badiozzaman

    2014-01-01

    Background: The i-gel™ is a new device introduced recently. It differs from other supraglottic airway devices. It has a non-inflatable, gel-made cuff. Previously used devices, have some disadvantages which are claimed to be absent in i-gel™. In this study we aimed to compare the performance of the laryngeal mask airway (LMA)-Classic™ and i-gel™ during anesthesia in paralyzed patients. Materials and Methods: A total of 64 anaesthetized patients with paralysis were enrolled in a single-blind, randomized control trial to be intubated with one of the devices. We compared the device insertion parameters, some ventilatory parameters, and adverse effects after device insertion. Results: Vital signs were not significantly different between groups. Regarding duration of insertion attempts, the difference between groups was significant (P < 0.05); while the number of insertion attempts was insignificant (P = 0.265). There was no significant difference between both groups regarding postoperative complications (cough, sore throat, and blood on the cuff) (P > 0.05). Airway leak was assessed in both groups and data showed no significant difference (P = 0.662). Additionally, end-tidal CO2 change regarding the baseline value was significantly different after 10 and 15 min of anesthesia (P < 0.05). Conclusions: Successful insertion time was shorter significantly for i-gel™. As i-gel™ has easy application, it is advantageous to be used during cardiopulmonary resuscitation by non-anesthetists in which time is very important. We concluded that i-gel™ can be an alternative to LMA-Classic™ for controlled ventilation during anesthesia as it is easier to be placed. PMID:25625059

  16. Metastasis of Laryngeal Squamous Cell Carcinoma to Bilateral Thigh Muscles

    PubMed Central

    Lucas, Zarah; Veytsman, Irina

    2014-01-01

    Importance. Laryngeal cancer infrequently results in distant metastases, but metastasis to skeletal muscle is extremely uncommon. Observations. A 55-year-old male presenting with progressive dyspnea and hoarseness was found to have Stage IVA T4aN2cM0 laryngeal cancer and eventually underwent total laryngectomy. Before the patient could be started on adjuvant chemoradiation, the patient developed masses on both thighs. Biopsy revealed metastatic squamous cell carcinoma consistent with the primary laryngeal cancer. He was offered palliative chemotherapy; however, he developed new soft tissue masses to the left of his stoma and in the prevertebral area one week later. He also had new cervical and supraclavicular nodes and a pathological compression fracture of L3. Patient died within 4 months of diagnosis. Conclusions. Distant metastasis such as skeletal metastasis portends a poor prognosis. Further studies are required to determine the best course of treatment in these patients. PMID:25580324

  17. Occupational laryngitis caused by formaldehyde: a case report.

    PubMed

    Roto, P; Sala, E

    1996-03-01

    Formaldehyde is commonly accepted to be an allergen and irritant. However, specifically diagnosed occupational respiratory diseases caused by formaldehyde are relatively rare. Occupational laryngitis was diagnosed in a 47-year-old dairy foreman. He had been exposed for 9 years to formaldehyde emitted from a milk-packing machine situated underneath his office. His exposure level varied considerably. Under normal process conditions, the measured formaldehyde level was 0.03 mg/m3. The patient was examined by different specialists over 1 1/2 years. It was concluded that he had psychogenic dysphonia. However, a specific laryngeal provocation test with formaldehyde carried out at the Finnish Institute of Occupational Health was positive. His laryngitis was so serious that he was pensioned. During the 3 years of follow-up his condition gradually worsened. He now reacts especially to tobacco smoke and other air impurities known to contain formaldehyde. PMID:8833780

  18. Primary localized laryngeal amyloidosis presenting with dysphonia: a case report.

    PubMed

    Chow, Vanessa; Gardner, Kate; Howlett, David

    2012-01-01

    Localized laryngeal amyloidosis is a rare disease with poorly understood aetiology. The commonest symptom at presentation is dysphonia and for a correct diagnosis of amyloidosis to be made a high index of suspicion is needed [Fraihat A, Ardah A. Laryngeal amyloidosis: a case report. J R Med Serv 2005;17:57-9; Passerotti GH, Caniello M, Hachiya A, Santoro PP, Imamura R, Tsuji DH. Multiple sited amyloidosis in the upper aerodigestive tract: case report and literature review. Rev Bras Otorrinolaringol 2008;74:462-6]. We present a case of a 48-year-old male who was investigated over a 5-year period for persistent and progressive hoarseness of voice before the accurate diagnosis of localized amyloidosis was reached. Management of this case consisted of local treatment with endoscopic carbon dioxide laser excision of laryngeal lesions to good effect and exclusion of systemic disease with yearly follow-up for monitoring disease progression. PMID:24968392

  19. The presence of Helicobacter pylori in laryngeal squamous cell carcinoma.

    PubMed

    Yilmaz, Ismail; Erkul, E; Berber, U; Kucukodaci, Z; Narli, G; Haholu, A; Demirel, D

    2016-03-01

    A definitive relationship between Helicobacter pylori (HP) and upper respiratory tract disorders has not been established. In this case-control study, we investigated the relationship between HP and laryngeal carcinoma by real-time PCR method in Turkey. 74 subjects were enrolled from patients who were admitted to the Otolaryngology Department. Formalin-fixed-paraffin-embedded tissue samples with laryngeal cancer were used and all samples were evaluated by real-time PCR method. Our study population included 72 males and 2 females with a mean age range of 62.7years. Helicobacter Pylori was detected in only one case. The positive case was also investigated with histopathologic evaluation and HP immunohistochemistry. However, we could not detect HP in this case with both methods. This study revealed that HP might not contribute to the pathogenesis of laryngeal carcinoma. A definitive relationship between HP and upper respiratory tract disorders has not been established. PMID:25721196

  20. Peripheral nerve blockade as an exclusive approach to obturator nerve block in anterior cruciate ligament reconstructive surgery

    PubMed Central

    Simeoforidou, Marina; Basdekis, George; Tsiaka, Katerina; Chantzi, Eleni; Vretzakis, George

    2013-01-01

    Background Obturator nerve block plays an additive role on the quality of analgesia for knee surgery. Since the use of dual guidance increases the success rate of nerve blocks, we investigated the feasibility of performing anterior cruciate ligament reconstruction under dual-guided blockade of obturator with femoral and sciatic nerves. Furthermore, we propose a novel method for the assessment of obturator nerve block. Methods Fifty-seven patients undergoing anterior cruciate ligament repair were studied. Neurostimulating needles were guided out-of-plane by ultrasound. To induce the obturator nerve block, 10 ml of ropivacaine 0.5% were injected after eliciting contractions of adductor longus, brevis and magnus followed by block assessment for 30 minutes by examining the patient lift and left down the leg. Results The sonographic recognition of obturator nerve was easy and quick in all cases. Time for applying the block was 119.9 ± 79.2 sec. Assessing this block with lifting-leaving down the leg gave satisfactory results in 24.0 ± 5.07 min. After performing femoral-sciatic blocks, the inflation of tourniquet resulted in VAS score of > 0 in 2/57 patients and operation in 12/57. Total dose of fentanyl was 120.1 ± 64.6 µg and of midazolam 1.86 ± 0.8 mg. In 6 patients propofol was administered for sedation and 1 of them required ventilation with laryngeal mask airway, converting the anesthesia technique to general anesthesia. Conclusions Our data suggest that anterior cruciate ligament reconstruction can be performed under obturator-femoral-sciatic blocks. Identification of obturator nerve with ultrasound is easy and the block can be assessed by observing how the patient lifts and leaves down the leg. PMID:24363843

  1. Layer 5 Pyramidal Neurons' Dendritic Remodeling and Increased Microglial Density in Primary Motor Cortex in a Murine Model of Facial Paralysis

    PubMed Central

    Urrego, Diana; Troncoso, Julieta; Múnera, Alejandro

    2015-01-01

    This work was aimed at characterizing structural changes in primary motor cortex layer 5 pyramidal neurons and their relationship with microglial density induced by facial nerve lesion using a murine facial paralysis model. Adult transgenic mice, expressing green fluorescent protein in microglia and yellow fluorescent protein in projecting neurons, were submitted to either unilateral section of the facial nerve or sham surgery. Injured animals were sacrificed either 1 or 3weeks after surgery. Two-photon excitation microscopy was then used for evaluating both layer 5 pyramidal neurons and microglia in vibrissal primary motor cortex (vM1). It was found that facial nerve lesion induced long-lasting changes in the dendritic morphology of vM1 layer 5 pyramidal neurons and in their surrounding microglia. Dendritic arborization of the pyramidal cells underwent overall shrinkage. Apical dendrites suffered transient shortening while basal dendrites displayed sustained shortening. Moreover, dendrites suffered transient spine pruning. Significantly higher microglial cell density was found surrounding vM1 layer 5 pyramidal neurons after facial nerve lesion with morphological bias towards the activated phenotype. These results suggest that facial nerve lesions elicit active dendrite remodeling due to pyramidal neuron and microglia interaction, which could be the pathophysiological underpinning of some neuropathic motor sequelae in humans. PMID:26064916

  2. Optic Nerve Elongation

    PubMed Central

    Alvi, Aijaz; Janecka, Ivo P.; Kapadia, Silloo; Johnson, Bruce L.; McVay, William

    1996-01-01

    The length of the optic nerves is a reflection of normal postnatal cranio-orbital development. Unilateral elongation of an optic nerve has been observed in two patients with orbital and skull base neoplasms. In the first case as compared to the patient's opposite, normal optic nerve, an elongated length of the involved optic nerve of 45 mm was present. The involved optic nerve in the second patient was 10 mm longer than the normal opposite optic nerve. The visual and extraocular function was preserved in the second patient. The first patient had only light perception in the affected eye. In this paper, the embryology, anatomy, and physiology of the optic nerve and its mechanisms of stretch and repair are discussed. ImagesFigure 1Figure 2Figure 3Figure 4Figure 5Figure 6Figure 7Figure 8Figure 9Figure 10Figure 11Figure 13 PMID:17170975

  3. Chondronecrosis of the larynx following use of the laryngeal mask airway.

    PubMed

    Beswick, Daniel M; Collins, Jeremy; Nekhendzy, Vladimir; Damrose, Edward J

    2015-04-01

    This case describes the development of laryngeal chondronecrosis after use of the laryngeal mask airway (LMA). A 69-year-old male with prior laryngeal irradiation underwent total knee replacement with general anesthesia via LMA. Postoperatively, he developed laryngeal chondronecrosis, bilateral vocal fold immobility, and aspiration, necessitating tracheostomy and gastrostomy placement. He improved with hyperbaric oxygen therapy, intravenous antibiotics, and endoscopic repair of a residual fistula. Vocal fold motion returned and he was decannulated. Chondronecrosis of the larynx may occur with the use of the LMA, and caution should be used in patients with a history of prior laryngeal irradiation. PMID:25345975

  4. Fraser syndrome with laryngeal webs: Report of two cases and a review of the literature.

    PubMed

    Izadi, Farzad; Ahmadi, Aslan; Zobairy, Hosna; Bakhti, Sepideh; Hirbod, Hengameh; Safdarian, Mahdi

    2015-11-01

    Fraser syndrome is a rare genetic disorder characterized by cryptophthalmos, syndactyly and laryngeal atresia. Although laryngeal webs occur uncommonly, they are the main cause of death in the first week of life in these patients. In this paper, we report two cases of Fraser syndrome with laryngeal webs. One of them was a twelve-year-old girl, primarily diagnosed with a supraglottic laryngeal web. In the course of treatment, a second web was also identified at the level of vocal cords, which is to our knowledge the first case of Fraser syndrome with two laryngeal webs in different levels. PMID:26384833

  5. Determination of laryngeal muscle tension in professional singers.

    PubMed

    Chernobelsky, S I

    1996-01-01

    In order to study internal laryngeal muscular tension, 60 opera singers were examined. We determined the EGG quasi-open quotient (QOQ) by means of a crescendo singing task. The region between low (QOQ in 'piano') and high vocal intensity (QOQ in 'forte') is called volume of the QOQ. It was revealed that the volume of the QOQ is a reliable indication of the laryngeal muscular tension of the singers. This method reveals the early stages of muscular tension disturbances before objective changes in the larynx are present. PMID:8823985

  6. Critical analysis of robotic surgery for laryngeal tumours.

    PubMed

    Esteban, Francisco; Menoyo, Alicia; Abrante, Antonio

    2014-01-01

    In recent years, transoral robotic surgery (TORS) with the Da Vinci robot has been used for the removal of laryngeal cancers with the objective to improve functional and aesthetic outcomes without worsening survival. The advantages of TORS are described in this article. However, its disadvantages, mainly high cost amongst others, do not make robotic surgery the current treatment of choice for laryngeal tumours; transoral laser surgery is superior in most cases. Major technical improvements are expected. Smaller, more ergonomic, new-generation robots better adapted to the head and neck will probably be available in the near future. PMID:24626048

  7. Reflux Laryngitis: Correlation between the Symptoms Findings and Indirect Laryngoscopy

    PubMed Central

    Silva, Carlos Eduardo Dilen da; Niedermeier, Bruno Taccola; Portinho, Fernando

    2015-01-01

    Introduction The indirect laryngoscopy has an important role in the characterization of reflux laryngitis. Although many findings are nonspecific, some strongly suggest that the inflammation is the cause of reflux. Objective The aim of this study was to evaluate the correlation between reflux symptoms and the findings of indirect laryngoscopy. Methods We evaluated 27 patients with symptoms of pharyngolaryngeal reflux disease. Results Laryngoscopy demonstrated in all patients the presence of hypertrophy of the posterior commissure and laryngeal edema. The most frequent symptoms were the presence of dry cough and foreign body sensation. Conclusion There was a correlation between the findings at laryngoscopy and symptoms of reflux. PMID:26157498

  8. Transoral robotic surgery (TORS) for laryngeal and hypopharyngeal cancers.

    PubMed

    Dziegielewski, Peter T; Kang, Stephen Y; Ozer, Enver

    2015-12-01

    Transoral robotic surgery (TORS) is increasingly used in laryngeal/hypopharyngeal cancer surgery. Ablative procedures described in these anatomical sites include: (i) supraglottic laryngectomy, (ii) total laryngectomy, (iii) glottic cordectomy, and (iv) partial pharyngectomy. TORS supraglottic laryngectomy remains the most commonly performed of these procedures. Initial oncologic and functional outcomes with these procedures are promising and comparable to other treatment options. As robotic instrumentation technology advances a rise in TORS laryngeal/hypopharyngeal surgery is anticipated. J. Surg. Oncol. 2015;112:702-706. 2015 Wiley Periodicals, Inc. PMID:26266762

  9. Histoplasmosis Presenting as a Laryngeal Ulcer in an Immunocompetent Host.

    PubMed

    John, Mary; Koshy, Jency Maria; Mohan, Sangeetha; Paul, Preethi

    2015-06-01

    Histoplasmosis is a granulomatous disease of worldwide distribution caused by a dimorphic fungus Histoplasma capsulatum. Majority of primary infections in immunocompetent hosts are asymptomatic or may present with flu-like illness. Histoplasmosis may occur in three forms: (i) Primary acute pulmonary form, (ii) chronic pulmonary and (iii) disseminated form. The manifestations of disseminated form of histoplasmosis are fever, weakness, weight loss, hepatosplenomegaly, and mucocutaneous lesions. The mucosal involvement could be oropharyngeal or laryngeal involvement. We report an unusual case of histoplasmosis presenting as a laryngeal ulcer in an immunocompetent host. PMID:26710405

  10. Experimental and numerical study of patterns in laryngeal flow

    NASA Astrophysics Data System (ADS)

    Chisari, N. E.; Artana, G.; Sciamarella, D.

    2009-05-01

    Unsteady airflow is investigated in a channel with a geometry approximating that of the human larynx. The laryngeal flow is simulated by solving the Navier-Stokes equations for an incompressible two-dimensional viscous fluid, and visualized using the Schlieren technique in an experimental setup consisting of a rigid replica of the larynx, with and without ventricular bands. This study shows the spontaneous formation of vortex couples in several regions of the laryngeal profile, and at different stages of the evolution of the starting glottal jet.

  11. Acquisition of detailed laryngeal flow measurements in geometrically realistic models

    PubMed Central

    Farley, Jayrin; Thomson, Scott L.

    2011-01-01

    Characterization of laryngeal flow velocity fields is important to understanding vocal fold vibration and voice production. One common method for acquiring flow field data is particle image velocimetry (PIV). However, because using PIV with models that have curved surfaces is problematic due to optical distortion, experimental investigations of laryngeal airflow are typically performed using models with idealized geometries. In this paper a method for acquiring PIV data using models with realistic geometries is presented. Sample subglottal, intraglottal, and supraglottal PIV data are shown. Capabilities and limitations are discussed, and suggestions for future implementation are provided. PMID:21877775

  12. Laryngeal carcinoma presenting as polymyositis: A paraneoplastic syndrome

    PubMed Central

    Sahu, Ritesh; Rathaur, Bhanu Pratap; Chaudhari, Tejendra Sukdeo; Shukla, Rakesh; Malhotra, Kiran Preet

    2016-01-01

    Laryngeal carcinoma is rarely associated with paraneoplastic syndrome. Inflammatory myopathy presenting as paraneoplastic event is commonly associated with carcinomas of ovary, lung, pancreas, stomach, colorectal, and non-Hodgkin's lymphoma. We report a case of elderly male, who presented with proximal muscle weakness and found to be associated with laryngeal carcinoma. Diagnosis of polymyositis (PM) was confirmed based on clinical features, laboratory test, and muscle biopsy. Exclusion of other commonly associated malignancies was done. This patient improved gradually after 6 months of immunosuppressive therapy and management of underlying cancer. PMID:27011653

  13. Familial incidence of hyperkalemic periodic paralysis in quarter horses.

    PubMed

    Naylor, J M; Robinson, J A; Bertone, J

    1992-02-01

    The pedigrees of 17 horses with hyperkalemic paralysis were studied. All were first-, second-, or third-generation offspring of a common sire, 16 were registered Quarter Horses. Analysis indicated that it was unlikely that the concentration of hyperkalemic periodic paralysis in the offspring of this sire was attributable to chance. The familial nature of this condition should help veterinarians diagnostically. It also suggests that it is possible to reduce the incidence of this condition by breeding from non-affected lines of horses and reinforces the need for studies to determine whether the disease is genetic in origin. Although more affected horses were second-generation offspring, the proportion of horses affected was largest in the first generation and decreased progressively with each generation. This is probably because horses in the earlier generations have been observed for longer periods and thus clinical signs are more likely to have been noticed in these horses. PMID:1548168

  14. Hyperkalemic periodic paralysis episode during halothane anesthesia in a horse.

    PubMed

    Bailey, J E; Pablo, L; Hubbell, J A

    1996-06-01

    A 7-month-old Quarter Horse filly was admitted for surgical repair of a right olecranon fracture. Anesthesia was achieved with xylazine hydrochloride, guaifenesin, ketamine hydrochloride, and halothane. Two and a half hours after induction of anesthesia, myotonia, muscle fasciculations, and sweating, concurrent with high serum potassium concentration and associated electrocardiographic changes consistent with hyperkalemic periodic paralysis, were observed. Treatment included intermittent positive-pressure ventilation, changing intravenous administration of fluids from lactated Ringer's solution to 0.9% NaCl solution, and administration of calcium gluconate, glycopyrrolate, dopamine, and sodium bicarbonate. Clinical signs resolved with the return of serum potassium concentrations to the reference range. The horse was confirmed to be heterozygous for hyperkalemic periodic paralysis by DNA testing. PMID:8675475

  15. Recurrent Hypokalemic Periodic Paralysis Unmasks Sjogren Syndrome without Sicca Symptoms.

    PubMed

    Hung, Yao-Min; Huang, Neng-Chyan; Wann, Shue-Ren; Chang, Yun-Te; Wang, Jyh-Seng

    2015-04-01

    Hypokalemic Periodic Paralysis (HPP) may occur as a rare complication of Sjogren Syndrome (SS) and Renal Tubular Acidosis (RTA). A 64-year male patient came with HPP, and was later diagnosed with distal RTA. The patient, who had no xerostomia and xerophthalmia, was diagnosed with primary SS from serologic and histologic findings of minor salivary gland biopsy. The patient recovered after potassium replacement therapy. Renal biopsy was also performed and revealed evidence of tubulointerstitial nephritis. Corticosteroids were administered and there was no recurrence of HPP during a 4-year follow-up period. The case highlights the significance of acute hypokalemia management in emergency department as it can unmask SS even if the SS is not associated with sicca symptoms. Hypokalemic paralysis associated with normal anion gap metabolic acidosis should prompt toward the diagnosis of SS. PMID:25933458

  16. Mounier-Kuhn syndrome and bilateral vocal cord paralysis.

    PubMed

    Dincer, H Erhan; Holweger, Joshua D

    2012-07-01

    Mounier-Kuhn syndrome is a rare disorder of unknown cause that is characterized by atrophy of the elastic and smooth muscle of the tracheobronchial tree leading to tracheobronchomegaly and bronchiectasis. The syndrome is likely underdiagnosed, because the patients usually present with common respiratory symptoms such as productive cough and usually labeled as chronic obstructive pulmonary disease. Diagnosis is established on the basis of radiologic findings. Association with bilateral vocal cord paralysis has not been described. Treatment is mainly supportive. Symptomatic patients may require endobronchial stenting if airway collapse is encountered. Here, we described a patient who presented with hoarseness and pneumonia. Further studies confirmed the diagnosis of Mounier-Kuhn syndrome with bilateral vocal cord paralysis. PMID:23207474

  17. Thyrotoxic periodic paralysis: an endocrine cause of paraparesis.

    PubMed

    Munir, Atif

    2014-05-01

    Periodic paralysis is a muscle disorder that belongs to the family of diseases called channelopathies, manifested by episodes of painless muscle weakness. Periodic paralysis is classified as hypokalemic when episodes occur in association with low potassium levels. Most cases are hereditary. Acquired cases have been described in association with hyperthyroidism. Diagnosis is made on clinical and biochemical grounds. Patients may be markedly hypokalemic during the episode and respond well to potassium supplementation. Episodes can be prevented by achieving a euthyroid state. This report describes a young gentleman presenting with thyrotoxic hypokalemic paraparesis. The condition needs to be considered in the differential diagnosis of neuromuscular weakness in the context of hypokalemia by the treating physicians. PMID:24906287

  18. Bilateral Facial Paralysis Case Presentation and Discussion of Differential Diagnosis

    PubMed Central

    Jain, Vishal; Deshmukh, Anagha; Gollomp, Stephen

    2006-01-01

    Bilateral facial paralysis is a rare condition and therefore represents a diagnostic challenge. We report the case of a 34-year-old healthy woman with sequential bilateral facial paralysis as a sole manifestation of sarcoidosis. She initially presented with an isolated left sided Bell's palsy without any symptoms to suggest alternative diagnoses. Within a month there was progression to peripheral facial paresis on the contra lateral side, prompting a diagnosis of Lyme disease. Her physical examination and chest x-ray did not reveal any clinical evidence of sarcoidosis. After failing to respond to an empiric trial of intravenous ceftriaxone for a presumptive diagnosis of Lyme disease, computed tomography scan of the chest was ordered which demonstrated bilateral hilar lymphadenopathy. Bronchoscopic biopsy confirmed a diagnosis of sarcoidosis. The patient then made a complete recovery on steroid therapy. We discuss the differential diagnosis of facial diplegia and focus on the clinical presentation, diagnosis and treatment of neurosarcoidosis. PMID:16808763

  19. The Role of H. pylori in the Development of Laryngeal Squamous Cell Carcinoma

    PubMed Central

    Gen, Ra?an; a?l?, Sedat; Yce, ?mdat; Vural, Alperen; Okuducu, Hac?; Pat?ro?lu, Tahir; Gney, Ercihan

    2013-01-01

    Aim. This study aims to investigate the possible role of H. pylori as a cause of laryngeal squamous cell carcinoma. Method. This controlled study was performed with 31 consecutive laryngeal cancer and 28 cancer-free patients who underwent direct laryngoscopy and biopsy of laryngeal lesions. To document the previous H. pylori infection, serological analysis of the antibody titers was done. Immunohistochemical analyses were applied to the tissue samples. Results. Serology was found positive at the 90.3% of the laryngeal cancer patients and 96.4% of the benign group. There were no statistically significant differences between the two groups (P > 0.05). Immunohistochemical analysis results were determined as negative at all of the specimens of laryngeal cancer patients and patients with benign lesions. Conclusion. There were no signs of colonization of H. pylori in laryngeal tissues of both groups' patients. It is thought that no relationship exists between the H. pylori infection and laryngeal squamous cell carcinoma. PMID:24198443

  20. Parotid mass: Epstein-Barr virus and facial paralysis.

    PubMed

    Long, C M; Kerschner, J E

    2001-06-01

    Infectious mononucleosis is a common diagnosis in the pediatric and young adult population. Symptoms include low grade fever, malaise, odynophagia, and cervical lymphadenopathy. Neurological manifestations are uncommon, but include cranial nerve neuropathies. We describe a case of infectious mononucleosis in a pediatric patient who presented with a parotid mass and facial nerve palsy. Diagnosis was confirmed with a monospot test and Epstein-Barr virus antibody panel. The patient was managed conservatively with near total recovery of facial nerve function. This case demonstrates the need to consider infectious etiology prior to surgical intervention of a pediatric patient with facial nerve paresis and a parotid mass. PMID:11378191

  1. Hind limb paralysis from electrical shock in three gilts.

    PubMed

    Steffen, D J; Schoneweis, D A; Nelssen, J L

    1992-03-15

    Three crossbred gilts developed hind limb paralysis attributable to multiple vertebral body fractures after nonfatal electrical shock. Fractures have been reported in swine and other animals that died from electrocution, but in this case, the pigs were not killed, and lesions that suggested electrical shock were not observed. Electrical shock should be considered as a cause of unexplained spinal cord injury in swine in intensive production units, and electrical service to the pens should be carefully checked. PMID:1568927

  2. A rare case of thyrotoxic periodic paralysis precipitated by hydrocortisone

    PubMed Central

    Chakrabarti, Subrata

    2015-01-01

    Thyrotoxic periodic paralysis (TPP) is a rare, but serious condition characterized by acute paralytic attacks and hypokalemia in association with thyrotoxicosis. Although carbohydrate rich meals, strenuous exercise, alcohol, emotional stress are known precipitants of TPP, steroid treatment has rarely been reported to induce TPP. We report a case in which a patient with previously untreated Grave's disease developed TPP following administration of Intravenous hydrocortisone for control of severe anaphylaxis, which to best of our knowledge is very rare. PMID:25810683

  3. A rare case of thyrotoxic periodic paralysis precipitated by hydrocortisone.

    PubMed

    Chakrabarti, Subrata

    2015-01-01

    Thyrotoxic periodic paralysis (TPP) is a rare, but serious condition characterized by acute paralytic attacks and hypokalemia in association with thyrotoxicosis. Although carbohydrate rich meals, strenuous exercise, alcohol, emotional stress are known precipitants of TPP, steroid treatment has rarely been reported to induce TPP. We report a case in which a patient with previously untreated Grave's disease developed TPP following administration of Intravenous hydrocortisone for control of severe anaphylaxis, which to best of our knowledge is very rare. PMID:25810683

  4. [Thyrotoxic hypocalemic periodic paralysis: report of 3 cases].

    PubMed

    Dias, José Côdo Albino; Moura, Betânia Silva de; Gomes, Erika Figueiredo; Mirachi, Guilherme Borim; Metzger Filho, Otto; Dias, Cristina Borim Côdo

    2004-12-01

    Thyrotoxic hypokalemic periodic paralysis (THPP) is a rare hyperthyroidism complication much more frequent in Asians and Caucasians. We present 3 cases of THPP occurring in Brazilian male patients with 28 years old (y) (Case 1), 29 y (Case 2) and 60 y (Case 3), respectively. They were admitted following an episode of flacid paralysis of extremities. Whereas case 1 reported recurring episodes of paralysis crises, cases 2 and 3 reported only one episode. Signs and symptoms of thyrotoxicosis, such as weigh loss, diaphoresis, extremities tremor, palpitation and mild diffuse goiter were present in the first case; while the second case only presented ophthalmopathy and the third patient referred that 2 years before his admission he presented an episode of cardiac arrhythmia but did not have thyroid function evaluation at that time. Their laboratory findings were hypokalemia, low TSH and raised free T4. They were treated with intravenous potassium, oral propranolol and tiamazol with remission of the symptoms. We report these cases to emphasize the importance of recognizing hyperthyroid periodic paralyses to avoid missing a treatable and curable condition. PMID:15761566

  5. Intracordal auricular cartilage injection for unilateral vocal fold paralysis.

    PubMed

    Lim, Yun-Sung; Lee, Yoon Se; Lee, Jin-Choon; Lee, Byung-Joo; Wang, Soo-Geun; Park, Hee-June; Nam, Su-Bong; Bae, Yong-Chan

    2015-01-01

    We evaluated the efficacy and outcome of intracordal auricular cartilage injection in patients with unilateral vocal fold paralysis. Our interest developed from findings of a canine model study that reported that histologic characteristics of cartilage were preserved 2 and 3 years after intracordal autologous cartilage injection. Between May 2002 and July 2010, 29 patients with breathy dysphonia caused by unilateral vocal fold paralysis underwent intracordal auricular cartilage injection. Each subject underwent preoperative and postoperative perceptual assessments, acoustical voice analysis, and videostroboscopy. Fourteen patients were male, and the mean age was 52-years old. Patients were tracked for a mean duration of 257 days. Injections were performed through a transoral approach under general anesthesia. Perceptual assessments by GRBAS scale, acoustic parameters of jitter, shimmer, noise-to-harmonic ratio, and maximum phonation time significantly improved at 3, 6, and 12 months after cartilage injection (p?paralysis. Autologous auricular cartilage can be a safe, effective, and alternative material for vocal fold medialization, and can be a long lasting one. PMID:24764320

  6. Surgical treatment for thyrotoxic hypokalemic periodic paralysis: case report

    PubMed Central

    2012-01-01

    Thyrotoxic hypokalemic periodic paralysis (THPP) is a rare, potentially life-threatening endocrine emergency. It is characterized by recurrent muscle weakness and hypokalemia. Because many THPP patients do not have obvious symptoms and signs of hyperthyroidism, misdiagnosis may occur. The published studies revealed that definitive therapy for THPP is control of hyperthyroidism by medical therapy, radioactive iodine or surgery, but the long-term post-operative follow-up result was not observed. We reported two cases of medically refractory THPP with recurrent paralysis of extremities and hypokalemia, and both were combined with thyroid nodules. Both patients were treated with total thyroidectomy; the pathology revealed that one is Graves' disease with thyroid papillary carcinoma, and the other is adenomatous goiter with papillary hyperplasia. No episode of periodic paralysis was noted and laboratory evaluation revealed normal potassium level during the post-operative follow up. Our experience suggests that total thyroidectomy by experienced surgeon is an appropriate and definite treatment for medically refractory THPP, especially in cases combined with thyroid nodules. PMID:22273473

  7. Dengue-associated hypokalemic paralysis: causal or incidental?

    PubMed

    Malhotra, Hardeep Singh; Garg, Ravindra Kumar

    2014-05-15

    Dengue-associated hypokalemic paralysis is considered an important but under-emphasized neuromuscular complication of dengue virus infection. Review of the published literature reveals that 35 instances of hypokalemic paralysis associated with dengue have been recorded from the Indian subcontinent and all but two, were males. The median age of presentation is 29 years and moderate to severe grade pure motor quadriparesis is precipitated during the phase of defervescence of moderate to high-grade fever. Recovery starts within 12h of potassium supplementation and is usually complete in a couple of days. Redistribution or increased loss of potassium from the body is speculated as the pathophysiological mechanism involved in the causation of hypokalemia. It is not possible to derive the exact etiopathological correlation from the published literature either due to a lack of comprehensive reporting or inadequate work-up of the patients. Curious is the fact that only 35 patients had manifest-paralysis when more than two-thirds affected with the dengue virus exhibit hypokalemia; whether this indicates a genetically mediated channel disorder or an incidental association remains to be seen. PMID:24680561

  8. Non-recurrent nerve from the vagus anterio-medially located in the carotid sheath

    PubMed Central

    Grleyik, Emin

    2015-01-01

    Non-recurrent inferior laryngeal nerve (ILN) arising from the vagus nerve is a rare anatomic variation. The vagus descends vertically in the cervical neurovascular bundle, between and posterior to common carotid artery (CCA) and internal jugular vein (IJV). The vagus has also some anatomic variations. We present a case of two coincident anatomic variations both ILN and the vagus nerve. A patient with multinodular goiter was surgically treated with total thyroidectomy. Both two ILNs were identified, fully exposed and preserved along their cervical courses. We found that the right non-recurrent ILN directly arises from cervical vagal trunk, and enters the larynx at usual point after a short transverse course parallel to the inferior thyroid artery. The vagus nerve, easily exposed after dissection of the right lobe of the thyroid gland, is located medially to the CCA. We discovered the association of non-recurrent ILN and medially located vagus nerve in the same patient. Non-recurrent nerve and medially located vagus nerve in the cervical neurovascular bundle are two different variations. The coincidence of right non-recurrent ILN arising from cervical part of the vagus medial to the CCA in the same patient is a very interesting feature. The safety of thyroid operations is dependent on proper identification, dissection and full exposition of ILN. The safe procedure requires complete knowledge on the anatomy of neural structures including all their anatomic variations. PMID:26504426

  9. Spinal nerve root stimulation.

    PubMed

    Kellner, Christopher P; Kellner, Michael A; Winfree, Christopher J

    2011-01-01

    Spinal nerve root stimulation (SNRS) is a neuromodulation technique that is used to treat chronic pain. This modality places stimulator electrode array(s) along the spinal nerve roots, creating stimulation paresthesias within the distribution of the target nerve root(s), thereby treating pain in that same distribution. There are several different forms of spinal nerve root stimulation, depending upon the exact electrode positioning along the nerve roots. SNRS combines the minimally invasive nature, central location, and ease of placement of spinal cord stimulation with the focal targeting of stimulation paresthesias of peripheral nerve stimulation. This hybrid technique may be an effective alternative for patients in whom other forms of neurostimulation are either ineffective or inappropriate. PMID:21422788

  10. Management of laryngeal radionecrosis: Animal and clinical experience

    SciTech Connect

    Oppenheimer, R.W.; Krespi, Y.P.; Einhorn, R.K.

    1989-05-01

    Radiation necrosis of the laryngeal cartilages is an uncommon complication of radiotherapy for laryngeal carcinoma. It is a devastating process for which there is no one acceptable treatment. Medical management offers only temporary, symptomatic relief, which further necessitates surgical treatment. Surgical management may start with a tracheotomy; however, it often ends with a total laryngectomy. Physiologically, the necrotic cartilages are the source of the problem. It is a general surgical principle that nonviable tissue must be excised to promote healing. Therefore, if the affected laryngeal cartilages were removed, the larynx should heal. Total or near total removal of the thyroid and cricoid cartilages with preservation of the endolaryngeal soft tissues has not been reported in the literature. Theoretically, if the entire cartilaginous framework is removed, there would be no structural support for the airway. We have found using animal models, that submucosal resection of the laryngeal cartilages, leaving the perichondrium and endolaryngeal soft tissues intact can result in a competent airway. Animal and clinical experience will be presented.

  11. An OT Account of Laryngealization in Cuzco Quechua.

    ERIC Educational Resources Information Center

    Parker, Steve

    Classical phonemic accounts of Cuzco (Peru) Quechua posit three distinct types of stops: plain, aspirated, and glottalized. A later analysis argued instead for a root-level feature of laryngealization governed by a small number of formal mechanisms. This latter analysis is taken one step further, showing that even greater explanatory power may be

  12. Laryngeal Muscles Are Spared in the Dystrophin Deficient "mdx" Mouse

    ERIC Educational Resources Information Center

    Thomas, Lisa B.; Joseph, Gayle L.; Adkins, Tracey D.; Andrade, Francisco H.; Stemple, Joseph C.

    2008-01-01

    Purpose: "Duchenne muscular dystrophy (DMD)" is caused by the loss of the cytoskeletal protein, dystrophin. The disease leads to severe and progressive skeletal muscle wasting. Interestingly, the disease spares some muscles. The purpose of the study was to determine the effects of dystrophin deficiency on 2 intrinsic laryngeal muscles, the…

  13. A bony connection signals laryngeal echolocation in bats.

    PubMed

    Veselka, Nina; McErlain, David D; Holdsworth, David W; Eger, Judith L; Chhem, Rethy K; Mason, Matthew J; Brain, Kirsty L; Faure, Paul A; Fenton, M Brock

    2010-02-18

    Echolocation is an active form of orientation in which animals emit sounds and then listen to reflected echoes of those sounds to form images of their surroundings in their brains. Although echolocation is usually associated with bats, it is not characteristic of all bats. Most echolocating bats produce signals in the larynx, but within one family of mainly non-echolocating species (Pteropodidae), a few species use echolocation sounds produced by tongue clicks. Here we demonstrate, using data obtained from micro-computed tomography scans of 26 species (n = 35 fluid-preserved bats), that proximal articulation of the stylohyal bone (part of the mammalian hyoid apparatus) with the tympanic bone always distinguishes laryngeally echolocating bats from all other bats (that is, non-echolocating pteropodids and those that echolocate with tongue clicks). In laryngeally echolocating bats, the proximal end of the stylohyal bone directly articulates with the tympanic bone and is often fused with it. Previous research on the morphology of the stylohyal bone in the oldest known fossil bat (Onychonycteris finneyi) suggested that it did not echolocate, but our findings suggest that O. finneyi may have used laryngeal echolocation because its stylohyal bones may have articulated with its tympanic bones. The present findings reopen basic questions about the timing and the origin of flight and echolocation in the early evolution of bats. Our data also provide an independent anatomical character by which to distinguish laryngeally echolocating bats from other bats. PMID:20098413

  14. Laryngeal obstruction caused by lymphoma in an adult dairy cow

    PubMed Central

    Lard, Hlne; Nichols, Sylvain; Babkine, Marie; Chnier, Sonia

    2014-01-01

    A Holstein cow was presented for inspiratory dyspnea. Endoscopic evaluation revealed swollen arytenoids and a presumptive diagnosis of bilateral arytenoidal chondritis was made. A partial arytenoidectomy was performed, the right arytenoid was submitted for histopathology, and a diagnosis of laryngeal lymphoma was made. Due to the poor prognosis, the cow was euthanized. PMID:24489391

  15. Laryngeal Muscles Are Spared in the Dystrophin Deficient "mdx" Mouse

    ERIC Educational Resources Information Center

    Thomas, Lisa B.; Joseph, Gayle L.; Adkins, Tracey D.; Andrade, Francisco H.; Stemple, Joseph C.

    2008-01-01

    Purpose: "Duchenne muscular dystrophy (DMD)" is caused by the loss of the cytoskeletal protein, dystrophin. The disease leads to severe and progressive skeletal muscle wasting. Interestingly, the disease spares some muscles. The purpose of the study was to determine the effects of dystrophin deficiency on 2 intrinsic laryngeal muscles, the

  16. Catecholamine inputs to expiratory laryngeal motoneurons in rats.

    PubMed

    Zhao, Wen-Jing; Sun, Qi-Jian; Guo, Rui-Chen; Pilowsky, Paul M

    2015-02-15

    Many respiration-related interneurons and motoneurons receive a catecholaminergic input, but the extent and distribution of this input to recurrent laryngeal motoneurons that innervate intrinsic muscles of the larynx are not clear. In the present study, we examined the catecholaminergic input to expiratory laryngeal motoneurons in the caudal nucleus ambiguus by combining intracellular labeling of single identified motoneurons, with immunohistochemistry to reveal tyrosine hydroxylase immunoreactive (catecholaminergic) terminal varicosities. Close appositions were found between the two structures, with 18??5 close appositions per motoneuron (n?=?7). Close appositions were more frequently observed on distal rather than proximal dendrites. Axosomatic appositions were not seen. In order to determine the source of this input, microinjections of cholera toxin B subunit (1%, 20 nl) were made into the caudal nucleus ambiguus. Retrogradely labeled neurons, located in the ipsilateral nucleus tractus solitarius and the area postrema, were tyrosine hydroxylase-positive. Our results not only demonstrate details of the extent and distribution of potential catecholamine inputs to the expiratory laryngeal motoneuron, but further indicate that the inputs, at least in part, originate from the dorsomedial medulla, providing a potential anatomical basis for previously reported catecholaminergic effects on the laryngeal adductor reflex. PMID:25224923

  17. Laser Doppler flux-metry in laryngeal squamous cell carcinoma.

    PubMed

    Jacob, A; Davis, J P; Birchall, M A

    2003-02-01

    Tumour angiogenesis has recently attracted a great deal of attention as a critical part of oncogenesis and a necessary prerequisite for a malignant phenotype. Novel antiangiogenic therapy for solid tumours including laryngeal cancer is entering clinical trials. Quantifying microvessel density is considered the gold standard for measuring baseline angiogenesis and indeed 'the response to intervention'. We hypothesize that laser Doppler flux-metry could provide a non-invasive reliable method of quantifying blood flux within tumours. The aims were to determine whether a laser Doppler flux meter could be used as a reliable and reproducible method of estimating blood flux in the human larynx and to establish baseline Doppler flux recordings for the human larynx. The method used was a validation study in patients with laryngeal squamous cell cancer and normal controls. Statistical analysis was performed using SPSS software. We have demonstrated good reproducibility of laser Doppler measurements in human laryngeal mucosa (correlation coefficient 0.956 @P = 0.01). We have also derived arbitrary means of laser Doppler flux-metry in normal laryngeal mucosa and in squamous cell carcinoma of the larynx. Comparisons between normal and tumour laser Doppler flux-metry (LDF) readings showed no significant difference. We suggest that Laser Doppler flux-metry is a potentially useful tool with which to study blood flow in the larynx and propose arbitrary LDF levels for the normal and diseased human larynx. PMID:12580876

  18. Laryngeal Aerodynamics Associated with Oral Contraceptive Use: Preliminary Findings

    ERIC Educational Resources Information Center

    Gorham-Rowan, Mary; Fowler, Linda

    2009-01-01

    The purpose of this study was to examine possible differences in laryngeal aerodynamic measures during connected speech associated with oral contraceptive (OC) use. Eight women taking an OC, and eight others not taking an OC, participated in the study. Three trials of syllable /p[subscript alpha] /repetitions were obtained using a

  19. Laryngeal Aerodynamics Associated with Oral Contraceptive Use: Preliminary Findings

    ERIC Educational Resources Information Center

    Gorham-Rowan, Mary; Fowler, Linda

    2009-01-01

    The purpose of this study was to examine possible differences in laryngeal aerodynamic measures during connected speech associated with oral contraceptive (OC) use. Eight women taking an OC, and eight others not taking an OC, participated in the study. Three trials of syllable /p[subscript alpha] /repetitions were obtained using a…

  20. Translabyrinthine resection of neurofibromatosis type 2 associated vestibular and facial schwannomas, repair of facial nerve, and placement of auditory brainstem implant.

    PubMed

    Schwartz, Marc S; Lekovic, Gregory P; Brackmann, Derald E; Voelker, Courtney C J

    2014-01-01

    We present video of gross-total resection of a large cerebellopontine angle tumor consisting of both vestibular and facial schwannoma components via the translabyrinthine route in a patient with neurofibromatosis type 2. The facial nerve is reconstructed using a greater auricular nerve graft, and an auditory brainstem implant is placed. Prior to surgery the patient had no facial nerve function on the operative side and had lost useful hearing. He also had usable vision only on the ipsilateral side and had contralateral vocal cord paralysis. The video can be found here: http://youtu.be/IOkEND-0vhI . PMID:24380525