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We present an unusual case of a 62-year-old male presenting with contralateral hypoglossal and recurrent laryngeal nerve palsies following endotracheal intubation for emergency cardiac surgery. Postoperative, the patient was referred to Speech and Language Therapy due to concerns regarding the safety of his swallow. Oromotor assessment revealed left-sided tongue weakness and aphonia. Flexible endoscopic evaluation of swallowing (FEES) revealed a right vocal cord palsy and severe oropharyngeal dysphagia. There were no other focal neurological signs. An MRI head did not demonstrate a medial medullary stroke or other intracranial lesion. CT neck showed no abnormality identified in relation to the course of the right vagus nerve or recurrent laryngeal nerve at the skull base or through the neck respectively. The patient required a gastrostomy for nutrition and hydration. He continued to be assessed at several month intervals over the course of a year using FEES to obtain a range of voice, secretion and swallowing outcome measures. The patient commenced intensive dysphagia therapy targeting pharyngeal drive, hyolaryngeal excursion and laryngeal sensation. Swallow manoeuvres were trialled during FEES and a head-turn to the side of the vocal cord palsy during deglutition reduced aspiration risk which expedited return to oral intake. The patient had partial recovery over twelve months. Hypoglossal nerve palsy completely resolved. The right vocal cord remained paralysed however the left vocal cord compensated enabling the patient to produce a normal voice. The patient was able to take thin fluids and regular diet and the gastrostomy was removed. [ABSTRACT FROM AUTHOR]

Aim: Dysphagia often develops after esophagectomy. The geniohyoid muscle is involved in swallowing movements, but its significance in esophagectomy patients remains unclear. We investigated the relationship of preoperative geniohyoid muscle mass with post‐esophagectomy swallowing function. Method s : We retrospectively analyzed 114 patients who underwent esophagectomy and gastric conduit reconstruction for esophageal malignancy. We evaluated preoperative geniohyoid muscle sagittal cross‐sectional areas (cm2) using computed tomography. Median values for each sex were considered as cutoff values. Dysphagia severity was assessed using the Penetration–Aspiration Scale (PAS) during video‐fluoroscopic swallowing studies performed 7–10 days postoperatively. Results: The cross‐sectional area was significantly larger in males than in females (3.2 ± 0.7 vs. 2.4 ± 0.5, p < 0.01: median in males: 3.2 cm2, and in females: 2.3 cm2). These values were used to define high and low cross‐sectional area groups. The cross‐sectional area correlated positively with grip strength (correlation coefficient (CC) = 0.530) and skeletal muscle index (CC = 0.541). Transthyretin levels (22.4 ± 6.8 vs. 25.4 ± 5.5, p = 0.03) and cross‐sectional area (2.6 ± 0.7 vs. 3.2 ± 0.8, p < 0.01) were significantly lower in patients with (PAS score ≥6; 20%) than in those without aspiration during fluoroscopic swallowing studies. Recurrent laryngeal nerve palsy was significantly more frequent in those with than in those without aspiration during fluoroscopic studies (22% vs. 5%, p = 0.03). In the multivariate analysis, low cross‐sectional area and recurrent laryngeal nerve palsy were both independent risk factors for aspiration during swallowing studies (odds ratio = 3.6, p = 0.03 and odds ratio = 6.6, p = 0.02, respectively). Conclusion: Preoperative geniohyoid muscle mass, evaluated using neck computed tomography, can predict dysphagia after esophagectomy. [ABSTRACT FROM AUTHOR]

Abstract Aim Dysphagia often develops after esophagectomy. The geniohyoid muscle is involved in swallowing movements, but its significance in esophagectomy patients remains unclear. We investigated the relationship of preoperative geniohyoid muscle mass with post‐esophagectomy swallowing function. Methods We retrospectively analyzed 114 patients who underwent esophagectomy and gastric conduit reconstruction for esophageal malignancy. We evaluated preoperative geniohyoid muscle sagittal cross‐sectional areas (cm2) using computed tomography. Median values for each sex were considered as cutoff values. Dysphagia severity was assessed using the Penetration–Aspiration Scale (PAS) during video‐fluoroscopic swallowing studies performed 7–10 days postoperatively. Results The cross‐sectional area was significantly larger in males than in females (3.2 ± 0.7 vs. 2.4 ± 0.5, p

Abstract Background Bronchial artery pseudoaneurysms (BAP) or aneurysms (BAA) are rare, potentially life-threatening and remain poorly understood. They are most commonly idiopathic but may be associated with a number of other disease processes. Bronchial artery embolisation (BAE) is considered the first line treatment while surgical techniques are reserved for patients with a clear contraindication to embolisation or where anatomical factors preclude an endovascular approach. Case presentation We present an interesting case of a 56 year-old male presenting with an idiopathic unruptured right BAP causing clinical and radiological signs of left recurrent laryngeal nerve (RLN) palsy. He was otherwise clinically well with no other reported symptoms and no significant past medical history. There were no significant findings on work-up and investigation. He was ultimately treated successfully with selective transarterial coil embolization of the right bronchial artery. This is an atypical presentation of a rare clinical entity and has not previously been published in the literature to our knowledge. Conclusions BAPs and BAAs are highly variable in their presentation, ranging from incidental asymptomatic findings to catastrophic haemorrhage, depending on their location and if they are contained or ruptured. Timely diagnosis and referral to facilitate urgent embolisation is essential to prevent potentially serious clinical sequelae. Endovascular treatment in the form of BAE is considered first line.

Background: Bronchial artery pseudoaneurysms (BAP) or aneurysms (BAA) are rare, potentially life-threatening and remain poorly understood. They are most commonly idiopathic but may be associated with a number of other disease processes. Bronchial artery embolisation (BAE) is considered the first line treatment while surgical techniques are reserved for patients with a clear contraindication to embolisation or where anatomical factors preclude an endovascular approach. Case presentation: We present an interesting case of a 56 year-old male presenting with an idiopathic unruptured right BAP causing clinical and radiological signs of left recurrent laryngeal nerve (RLN) palsy. He was otherwise clinically well with no other reported symptoms and no significant past medical history. There were no significant findings on work-up and investigation. He was ultimately treated successfully with selective transarterial coil embolization of the right bronchial artery. This is an atypical presentation of a rare clinical entity and has not previously been published in the literature to our knowledge. Conclusions: BAPs and BAAs are highly variable in their presentation, ranging from incidental asymptomatic findings to catastrophic haemorrhage, depending on their location and if they are contained or ruptured. Timely diagnosis and referral to facilitate urgent embolisation is essential to prevent potentially serious clinical sequelae. Endovascular treatment in the form of BAE is considered first line. [ABSTRACT FROM AUTHOR]

The requirement of prophylactic central compartment (pCCLND) dissection in intrathyroidal PTC remains controversial. The primary objective of this study was to compare disease recurrence rate, and the secondary objective was to compare late morbidity of surgery in PTC patients with cN0 disease undergoing total thyroidectomy (TT) with and without pCCLND. The setting and design are as follows: Tertiary care hospital, retrospective study (January 2000 and December 2020). This study consisted of 134 intrathyroidal PTC patients who underwent either TT (Group A, n = 23) or TT + pCCLND (Group B, n = 111). Both groups were compared with or without propensity score matching. Recurrence rate, disease free survival (DFS), and post-operative morbidity were compared between two groups. There were no significant differences in the distribution of sex, tumor size, or functional status between the groups. In Group B, 41.4% patients had central compartment metastasis. The mean follow-up was 71.6 months. Structural recurrence (8.6%) was found to be significantly high in Group A (p = 0.02), but on propensity score matching, the difference was not significant. Incidence of permanent hypoparathyroidism was significantly high in Group B (p = 0.009). The 15-year cumulative recurrence-free survival (RFS) rates of patients in the non-pCCLND and pCCLND groups were 91.3% and 100%, respectively (p = 0.281). Recurrence rate and DFS was not significantly different in patients with or without pCCLND. Post-operative morbidity is higher in patients undergoing pCCLND. [ABSTRACT FROM AUTHOR]

Dysphagia after esophagectomy is a serious complication; however, no method has been established to accurately assess swallowing function. We evaluated the association of swallowing function tests with patients' post-esophagectomy complications and nutritional statuses. We retrospectively reviewed the data of 95 patients with esophageal cancer who underwent esophagectomy between 2016 and 2021. We performed perioperative swallowing function tests, including the repetitive saliva swallowing test (RSST), maximum phonation time (MPT), and laryngeal elevation (LE). Patients with recurrent laryngeal nerve palsy (RLNP) and respiratory complications (RC) had significantly lower postoperative RSST scores than patients without them; the scores in patients with or without anastomotic leakage (AL) were similar. Postoperative MPT in patients with RLNP was shorter than that in patients without RLNP; however, it was similar to that in patients with or without AL and RC. LE was not associated with any complications. Patients with an RSST score ≤2 at 2 weeks post-esophagectomy had significant weight loss at 1, 6, and 12 months postoperatively compared with patients with an RSST score ≥3. The proportion of patients with severe weight loss (≥20% weight loss) within 1 year of esophagectomy was significantly greater in patients with RSST scores ≤2 than in those with RSST scores ≥3. Multivariate analysis showed that an RSST score ≤2 was the only predictor of severe post-esophagectomy weight loss. RSST scoring is a simple tool for evaluating post-esophagectomy swallowing function. A lower RSST score is associated with postoperative RLNP, RC, and poor nutritional status. [ABSTRACT FROM AUTHOR]

Though permanent vocal cord palsy consequent to recurrent laryngeal nerve (RLN) injury is rare following thyroidectomies, its consequences are grave enough for it to be the most feared complication postoperatively. Anesthesiologists and surgeons take various precautions to prevent its occurrence and employ various methods for its early detection. They include direct visualization of the nerve intraoperatively, use of intraoperative nerve monitoring, and post-extubation visualization of vocal cord mobility by use of direct or indirect methods. In the present narrative review, we aim to discuss the clinical evidence pertaining to the various methods adopted for the prevention and early detection of RLN palsy during thyroidectomy.

H1N1 pneumonia-associated vocal cord palsy is a rare condition. This case report highlights about a 70-year-old male, with multiple comorbidities, who presented with cough and shortness of breath. During hospitalization, he developed hoarseness of voice. On laryngoscopy, the right vocal cord was paralyzed. He was diagnosed with H1N1-associated right recurrent laryngeal nerve (RLN) paralysis. He received steroid therapy for the same and responded well. His voice completely recovered after 2 months. Viral infections are less common but important causes of recurrent nerve palsy. Other than influenza, severe acute respiratory syndrome coronavirus 2, Epstein–Barr Virus, cytomegalovirus, and varicella-zoster virus can also affect RLN. A detailed history, general examination, and appropriate investigations are important to exclude other possible etiological factors. Unilateral RLN palsy associated with viral infections is usually reversible and responds well to steroids as well as speech therapy. [ABSTRACT FROM AUTHOR]

Introperative nerve monitoring (IONM) of the recurrent laryngeal nerve (RLN) is a well-established technique to aid in thyroid/parathyroid surgery. However, there is little evidence to support its use in non-thyroid or non-parathyroid surgery. The aim of this paper was to review the current evidence regarding the use of IONM in non-thyroid/non-parathyroid surgery in the head and neck and thorax. A literature search was performed from their inception up to January 2024, including the term "recurrent laryngeal nerve monitoring". IONM in non-thyroid/non-parathyroid surgery has mainly been previously described in oesophageal surgery and in tracheal resections. However, there is little published evidence on the role of IONM with other resections in the vicinity of the RLN. Current evidence is low-level for the use of RLN IONM in non-thyroid/non-parathyroid surgery. However, clinicians should consider its use in surgery for pathologies where the RLN is exposed and could be injured. [ABSTRACT FROM AUTHOR]

Though permanent vocal cord palsy consequent to recurrent laryngeal nerve (RLN) injury is rare following thyroidectomies, its consequences are grave enough for it to be the most feared complication postoperatively. Anesthesiologists and surgeons take various precautions to prevent its occurrence and employ various methods for its early detection. They include direct visualization of the nerve intraoperatively, use of intraoperative nerve monitoring, and post-extubation visualization of vocal cord mobility by use of direct or indirect methods. In the present narrative review, we aim to discuss the clinical evidence pertaining to the various methods adopted for the prevention and early detection of RLN palsy during thyroidectomy. [ABSTRACT FROM AUTHOR]

Background: Recurrent laryngeal nerve (RLN) palsy is a serious complication of esophagectomy that affects the patient's phonation and the ability to prevent life-threatening aspiration events. The aim of this single-center, retrospective study was to investigate the clinical course of left RLN palsy and to identify the main prognostic factors for recovery. Methods: The study cohort consisted of 85 patients who had developed left RLN palsy after minimally invasive McKeown esophagectomy. Vocal cord function was assessed in all participants through laryngoscopic examinations, both in the immediate postoperative period and during follow-up. Permanent palsy was defined as no evidence of recovery after 6 months. Univariate and multivariable logistic regression analyses were applied to evaluate the associations between different variables and the outcome of palsy. Results: Twenty-two (25.8%) patients successfully recovered from left RLN palsy. On multivariable logistic regression analysis, active smoking (odds ratio [OR] 0.335, p = 0.038) and the use of thoracoscopic surgery (vs. robotic surgery; OR 0.264, p = 0.028) were identified as independent unfavorable predictors for recovery from palsy. The estimated rates of recovery derived from a logistic regression model for patients harboring two, one, or no risk factors were 13.16%, 31.15−34.75%, and 61.39%, respectively. Conclusion: Only one-quarter of patients who had developed left RLN palsy after minimally invasive McKeown esophagectomy were able to fully recover. Smoking habits and the surgical approach were identified as key determinants of recovery. Patients harboring adverse prognostic factors are potential candidates for early intervention strategies. [ABSTRACT FROM AUTHOR]

Background: Recurrent laryngeal nerve palsy (RLNP) after total thyroidectomy (TT) is a potentially life-threatening complication with medicolegal implications and remains underestimated. Temporary bilateral RLNP can cause acute airway obstruction, while permanent palsy persisting beyond 6 months post-TT causes long-term morbidity. This cohort study determined the incidence and clinicopathological risk factors of unilateral and bilateral RLNP in patients undergoing TT. Patients and methods: Surgical candidates (n = 812, male: female = 110:702) were assessed for vocal cord (VC) status with videolaryngoscopy preoperatively, at 72 hours, and 6 months post-TT. Serum corrected calcium and parathormone were also assessed. Demographics, surgical time, intraoperative RLN identification, and histopathology were noted. Results: Unilateral and bilateral RLNP were observed in 8 (1%) and 4 (0.5%) patients preoperatively, 56 (6.9%) and 15 (1.8%) patients postoperatively, and 11 (1.4%) and 6 (0.7%) patients after 6 months. On multivariate analysis, major determinants of unilateral temporary palsy were Hashimoto's/lymphocytic thyroiditis [odds ratio (OR) = 7.4], malignancy (OR = 4.6), and Graves' disease (OR = 3.9), while RLN nonvisualization (OR = 8.9) predicted bilateral palsy, each p < 0.05. Intraoperative RLN injury (OR = 38.1) independently predicted permanent palsy. In receiver operative characteristic analysis, surgical time and 48-hour calcium predicted RLNP at cut-points of 127 minutes and 1.94 mmol/L, respectively, with area under the curve =0.8, each p < 0.01. Conclusion: Routine pre- and postoperative videolaryngoscopy identified the true incidence of RLNP, which was relatively high. Intraoperative RLN identification improved long-term outcomes at an increased risk of temporary palsy. RLN nonvisualization, prolonged surgery, transient hypocalcemia, malignancy, Graves' disease, and thyroiditis were determinants of temporary palsy, while RLN injury or transection independently predicted permanent RLNP post-TT. Clinical significance: Routine intraoperative RLN visualization during thyroidectomy and postoperative videolaryngoscopy should be implemented in clinical practice. It provides accurate information for clinical audit of performance, particularly in teaching hospitals. Malignancy, Graves' disease, and thyroiditis, which carry an increased risk for RLNP, should be managed by high-volume surgeons. [ABSTRACT FROM AUTHOR]

Study Design: Prospective randomized controlled trial. Objectives: Adjustment of endotracheal tube cuff pressure (ETCP) in anterior cervical discectomy and fusion (ACDF) may influence the incidence of complications such as recurrent laryngeal nerve palsy (RLNP), hoarseness, and dysphagia. Methods: The prospective randomized controlled trial was designed to investigate the influence of ETCP on the incidence of postoperative complications. All eligible patients underwent vocal cord examination before and after ACDF and were randomized into a control group (CG) and intervention group (IG). Endotracheal tube cuff pressure was passively monitored in CG, and in IG, it was maintained at 20 mmHg. Outcomes were evaluated during hospitalization and during follow-up. Results: A total of 98 patients were randomized, each group consisted of 49 patients. Statistical analysis showed that gender and age did not influence the incidence of complications. In CG, duration of retractor placement and extent of approach significantly impacted the occurrence of complications. The incidence of postoperative RLNP was 8.2% in IG and 12.2% in CG, hoarseness and dysphonia were present in 18.4% in IG and in 37.5% in CG, and dysphagia in 20.8% in IG and in 22.5% in CG. Hoarseness was significantly present more in CG (P =.018). Only one patient from CG presented with RLNP after 1 year, the remaining nine patients spontaneously recovered. Conclusions: Unregulated ETCP can lead to a significantly higher incidence of hoarseness; however, its improvement rate is 100%. The early postoperative complication rate was higher in CG, and after one year, 1 patient had RLNP and 1 patient had dysphagia. [ABSTRACT FROM AUTHOR]

Abstract Aim Dysphagia is one of the most common complications after esophagectomy. However, no study has investigated the long‐term postoperative outcomes in patients with postoperative dysphagia. Here, we aimed to identify risk factors for postoperative dysphagia and to investigate long‐term postoperative outcomes in such patients. Methods This study included 304 consecutive patients with thoracic esophageal cancer who underwent curative esophagectomy. They were diagnosed with postoperative dysphagia through a contrast videofluoroscopic swallowing study, and postoperative outcomes were compared based on swallowing function. Results In total, 112 patients (37%) were diagnosed with postoperative dysphagia. Older age, low BMI, and recurrent laryngeal nerve palsy were identified as independent risk factors for postoperative dysphagia. In the dysphagia group, a significantly larger number of patients developed in‐hospital pneumonia, and hospital stays were also significantly extended. After discharge, 37 (33%) patients with postoperative dysphagia developed pneumonia. Even more than 1 year after esophagectomy, a significantly larger number of patients (24 patients, 21%) with postoperative dysphagia developed pneumonia compared to those without postoperative dysphagia. Postoperative dysphagia was identified as an independent risk factor for out‐of‐hospital pneumonia. Regarding nutritional status, there was no difference in weight loss 1 year after esophagectomy, but significant weight loss was observed 2 years after esophagectomy in the dysphagia group. Conclusion Postoperative dysphagia was associated with both preoperative patient factors and surgical factors. Moreover, patients with postoperative dysphagia had long‐term and short‐term pneumonia risk. The personalization of long‐term follow‐up through more aggressive rehabilitation and nutritional guidance is required for patients with postoperative dysphagia.

Supraclavicular brachial plexus block is well established regional anaesthesia technique for upper limb surgeries. USG guided supraclavicular brachial plexus block provides many advantages but is also associated with the rare complication of recurrent laryngeal nerve palsy, seen in 1.3% of cases. Recurrent laryngeal nerve palsy is mostly documented in right sided supraclavicular blocks than left sided supraclavicular blocks. Here, we report a case of 28 years old male undergoing right upper arm surgery under supraclavicular block who developed hoarseness of voice due to ipsilateral recurrent laryngeal nerve involvement which was followed up properly and managed successfully.

Purpose: The need for thyroid surgery in the elderly is rising due to an ageing population, the liberal use of imaging studies, and the increasing prevalence of thyroid nodules and cancer with age. Data on surgical outcomes in this population are scarce and conflicting, but essential to assess safety of short-stay surgery. This study aims to compare surgical outcomes by age. Methods: All consecutive patients undergoing thyroid surgery from January 2010 to July 2021 in a large tertiary referral centre for endocrine surgery were included in this surgical cohort. The indication for surgery, surgical morbidity (hypocalcaemia, bleeding, recurrent laryngeal nerve (RLN) palsy), and length of hospital stay were assessed in three age groups (young: 18-64y, older: 65-74y, and the elderly: 75 years and older). Results: A total of 2,030 patients (1,499 young, 370 older, and 161 elderly) were included. The indication for surgery was significantly different, with the main indications in the elderly being multinodular goitre (70.2% vs. 47.7% in young patients) and thyroid cancer (9.9% vs. 7.0%). Reintervention for bleeding was more often required in the older (4.6%) and the elderly (2.5%) patients (vs. 1.4%). There was no difference in the proportion of hypocalcaemia or RLN palsy. The length of hospital stay was significantly longer in the elderly (length of stay longer than one day 43.5% vs. 9.8%). Conclusion: Thyroid surgery in patients aged 75 years and older is a safe procedure with morbidity comparable to younger patients. However, the risk of reintervention for bleeding is higher, rendering ambulatory surgery not advisable. Trial registration: Researchregistry6182 on October 29th 2020, retrospectively registered. [ABSTRACT FROM AUTHOR]

Background: Although single-port mediastinoscopic radical esophagectomy is ultimate minimally invasive surgery for esophageal cancer without thoracotomy or the thoracoscopic approach, the high incidence of recurrent laryngeal nerve (RLN) palsy remains a pivotal clinical issue.Methods: This study included 41 patients who underwent single-port mediastinoscopic radical esophagectomy with mediastinal lymphadenectomy between September 2014 and March 2022. Among these, continuous nerve monitoring (CNM) for RLN was done in 25 patients (CNM group), while the remaining 16 patients underwent without CNM (non-CNM group). Clinical benefits of CNM for RLN were evaluated.Results: The overall incidence of postoperative RLN palsy was 14.6% (6/41). The CNM group showed a significantly lower incidence of postoperative RLN palsy as compared to the non-CNM group (P = 0.026: CNM vs. non-CRNM: 4.0% (1/25) vs. 31.2% (5/16)). The CNM group had a lower incidence of postoperative pneumoniae (CNM vs. non-CNM: 4.0% (1/25) vs. 18.8% (3/16)) and shorter days of postoperative hospital stay (CNM vs. non-CNM: 13 days vs. 41 days). Multivariate analysis revealed that the CNM use (odds ratio 0.07; 95% CI 0.05-0.98) was an independent factor avoiding postoperative RLN palsy.Conclusion: The CNM for RLN contributes to a remarkable reduction in the risk of postoperative RLN palsy and improvement in outcomes in single-port mediastinoscopic radical esophagectomy. [ABSTRACT FROM AUTHOR]

Ortner's syndrome refers to the compression of the recurrent laryngeal nerve by cardiovascular disorders of various etiologies. We describe a rare case of Ortner's syndrome caused by thoracic aorta aneurysm and a brief review of literature on this unusual cause of Ortner's syndrome. Hoarseness of voice due to the compression of recurrent laryngeal nerve by thoracic aorta aneurysm could be a harbinger of aneurysmal rupture. [ABSTRACT FROM AUTHOR]

Purpose: To explore the efficacy of interventional ultrasound treatment for hoarseness caused by nondisconnected recurrent laryngeal nerve injury after thyroidectomy., Materials and Methods: In this retrospective study, we analysed the clinical data of 21 patients who underwent interventional ultrasound therapy (ultrasound-guided injection of a Diprospan and saline mixture) for postthyroidectomy hoarseness at our hospital between August 1, 2023, and January 31, 2024 (the Diprospan group) and randomly selected 21 patients who did not receive any treatment for postthyroidectomy hoarseness during the same period as the control group. The average vocal cord activity improvement time for the Diprospan group was calculated and compared with that of untreated patients from previous studies. Vocal cord activity improvement rates were assessed at 1, 2, and 3 mo after thyroidectomy, and changes in the voice handicap index (VHI) and the subjective listening perception scale (GRBAS) scores before and after treatment were evaluated. Additionally, the efficacy was compared between patients treated within 2 wk (timely intervention group, TI group) and those treated 2 wk after thyroidectomy (delayed intervention group, DI group) to explore the impact of treatment timing on outcomes., Results: In the Diprospan group, the average vocal cord activity improvement time was 44.6 ± 4.7 d for those treated within 2 wk after thyroidectomy and 17.7 ± 1.5 d for those treated 2 wk after thyroidectomy, both of which were significantly shorter than the 6 mo to 1 y reported in the literature. The improvement rates at 1, 2, and 3 mo after thyroidectomy were significantly greater in the Diprospan group than in the control group (0.0% vs. 28.6%, 23.8% vs. 81.0%, 33.3% vs. 90.5%, p < 0.05). The VHI score (72.6 ± 21.2 vs. 12.6 ± 24.7, p < 0.001) and GRBAS score (12.0 vs. 0.0, p < 0.001) significantly improved after treatment. Compared with the DI group, the TI group also showed faster voice recovery (19.8 ± 5.8 d vs. 14.0 ± 2.6 d, p < 0.05). No treatment-related adverse reactions were observed., Conclusion: Interventional ultrasound is a safe and effective treatment for hoarseness after thyroidectomy, as it effectively improves vocal cord mobility and accelerates voice recovery., Competing Interests: Declaration of competing interest The authors declare that there are no conflicts of interest., (Copyright © 2024 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.)

Background: Thyroid surgeries are commonly done nowadays for benign and malignant conditions. Recurrent laryngeal nerve palsy (RLNP) is an important and potentially catastrophic complication of thyroid surgery. The purpose of the study was to determine the impact of rigid endoscopy (Hopkins rod-lens telescope) performed at different time intervals on the diagnosis of RLNP in post-thyroid surgery patients. Aims and Objectives: To assess Proper Timing of Laryngoscopy in Post-thyroid Surgery patients to Detect RLN Injury. Materials and Methods: Rigid endoscopy was performed postoperatively at day 0 (T0), at 2nd day post-op (T1), and day 14 (T2). For patients with RLNP, repeated examinations were performed at 2 months (T3), 6 months (T4), and 12 months (T5). Results: The study included 50 patients of thyroid swelling with different diagnoses. Overall, 35 patients appeared for postoperative laryngoscopic examination of the vocal folds at our center, providing 61 nerves at risk. RLNP rate was 8.1% at T0, 11.5% at T1, 9.8% at T2, 8.1% at T3, 4.9% at T4, and 3.3% at T5. T1 was significantly superior to all other time intervals in terms of diagnosis of RLNP but statistically not significant. Conclusion: Rigid endoscopy is essential for the detection of vocal cord paralysis after thyroidectomy. We report different time evaluation criteria of vocal cord morbidity with great and significant variability of results. Second day post-op inspection of the larynx (T1) is suggested.

Aim: Dysphagia is one of the most common complications after esophagectomy. However, no study has investigated the long‐term postoperative outcomes in patients with postoperative dysphagia. Here, we aimed to identify risk factors for postoperative dysphagia and to investigate long‐term postoperative outcomes in such patients. Methods: This study included 304 consecutive patients with thoracic esophageal cancer who underwent curative esophagectomy. They were diagnosed with postoperative dysphagia through a contrast videofluoroscopic swallowing study, and postoperative outcomes were compared based on swallowing function. Results: In total, 112 patients (37%) were diagnosed with postoperative dysphagia. Older age, low BMI, and recurrent laryngeal nerve palsy were identified as independent risk factors for postoperative dysphagia. In the dysphagia group, a significantly larger number of patients developed in‐hospital pneumonia, and hospital stays were also significantly extended. After discharge, 37 (33%) patients with postoperative dysphagia developed pneumonia. Even more than 1 year after esophagectomy, a significantly larger number of patients (24 patients, 21%) with postoperative dysphagia developed pneumonia compared to those without postoperative dysphagia. Postoperative dysphagia was identified as an independent risk factor for out‐of‐hospital pneumonia. Regarding nutritional status, there was no difference in weight loss 1 year after esophagectomy, but significant weight loss was observed 2 years after esophagectomy in the dysphagia group. Conclusion: Postoperative dysphagia was associated with both preoperative patient factors and surgical factors. Moreover, patients with postoperative dysphagia had long‐term and short‐term pneumonia risk. The personalization of long‐term follow‐up through more aggressive rehabilitation and nutritional guidance is required for patients with postoperative dysphagia. [ABSTRACT FROM AUTHOR]

Purpose: Left upper mediastinal lymph node dissection (UMLND)—a technically demanding step of McKeown esophagectomy—is frequently complicated by recurrent laryngeal nerve (RLN) palsy. Under the hypothesis that robotic esophagectomy (RE) could increase the safety and feasibility of UMLND, we retrospectively investigated the degree to which a pre-existing experience in video-assisted thoracoscopic esophagectomy (VATE) may affect the learning curves of this critical part of RE. Methods: Surgeon A had previously performed > 150 VATE procedures before transitioning to RE. While surgeon B had previously assisted to 50 RE, his pre-existing VATE experience consisted of less than five procedures. A total of 103 and 76 McKeown RE procedures were performed by surgeons A and B, respectively. The learning curve of left UMLND for each surgeon was examined using the cumulative sum method. Results: The inflection point of RLN palsy for surgeon A occurred at patient 31. While the nerve palsy rate decreased from 32.3 to 4.2% (p < 0.001), the number of nodes harvested during left UMLND did not appreciably change. Surgeon B showed a bimodal learning curve for RLN palsy with primary and secondary inflection points at patients 15 and 49, respectively. The RLN palsy rate initially decreased from 66.7% (patients 1–15) to 14.7% (patients 16–49), followed by an additional decline to 3.7% (patients 50–76). However, the number of nodes harvested during left UMLND showed a downtrend which was paralleled by decreasing rates of RLN palsy. These results indicate that surgeon B has not yet reached an ideal balance between an extensive UMLND and nerve protection. Conclusion: The pre-existing VATE experience seems to affect the learning curves of left UMLND during RE. [ABSTRACT FROM AUTHOR]

Background: Despite the risk of recurrent laryngeal nerve (RLN) palsy during esophagectomy, no established method of monitoring RLN injury is currently available. Methods: This study included 187 patients who underwent esophagectomy between 2011 and 2018. Among these, intraoperative nerve monitoring (IONM) was done in 142 patients (IONM group), while the remaining 45 patients underwent conventional surgery without IONM (control group). We investigated the incidence of postoperative complications with regard to the use of IONM. Results: The overall incidence of postoperative RLN palsy was 28% (52/187). The IONM group showed a significantly lower incidence of postoperative RLN palsy as compared to that in the control group (p = 0.004). The overall incidence of postoperative pneumonia was 22% (41/187) in those with Clavien–Dindo (CD) classification beyond grade 2. There were no significant differences between the incidence of any grade of postoperative pneumonia and the use of IONM (p = 0.195 and 0.333; CD > 2 and > 3, respectively). Multivariate analysis demonstrated that tumors in the upper third [odds ratio (OR) 3.12; 95% confidence interval (CI) 1.04–9.29] and lack of IONM use (OR 2.51; 95% CI 1.17–5.38) were independent factors causing postoperative RLN palsy after esophagectomy. Conclusion: IONM helps to reduce the risk of postoperative RLN palsy after esophageal cancer surgery. [ABSTRACT FROM AUTHOR]

Vocal cord palsy, injection laryngoplasty, calcium phosphate cement, vocal fold medialization, recurrent laryngeal nerve palsy METHODS Indications Patients with unilateral vocal fold paralysis who can undergo general anesthesia are eligible for this surgery. We have established a novel injection laryngoplasty technique using calcium phosphate cement (CPC, BIOPEX-R, Hoya, Tokyo, Japan) since 2003.2 CPC has been commercially available as a kit for bone graft substitutes in Japan since 2000. Keywords: Vocal cord palsy; injection laryngoplasty; vocal fold medialization; calcium phosphate cement; recurrent laryngeal nerve palsy EN Vocal cord palsy injection laryngoplasty vocal fold medialization calcium phosphate cement recurrent laryngeal nerve palsy 1099 1103 5 04/13/22 20220501 NES 220501 INTRODUCTION Following the use of paraffin injection by Brunings in 1911,1 various materials such as liquid silicone, fat, fascia, atelocollagen, and hyaluronic acid have been used for injection laryngoplasty. [Extracted from the article]

Introduction: Cranial nerve injury (CNI) is a common complication of carotid endarterectomy (CEA), with an incidence varying between 3% and 30% according to the definition of CNI and diagnostic modalities. The recurrent laryngeal branch of the vagus nerve (CN X) is the third most commonly injured nerve during CEA. The vast majority of CNI (99.3%) are due to neuropraxia and therefore transient. Report: A 72-year-old male with a history of multiple ischemic cerebrovascular attacks (CVA) received an elective carotid endarterectomy on the left side. The postoperative period was complicated with acute inspiratory stridor. Evaluation by the Ear, Nose, Throat (ENT) department showed bilateral vocal cord palsy due to neuropraxia during the endarterectomy with pre-existent paralysis of the right vocal cord caused by the previous CVA. Since the patient had been aphasic for several years, hoarseness due to unilateral vocal cord palsy could not be assessed preoperatively. Discussion: Acute stridor is caused by a sudden narrowing of the airway due to the median position of both paralysed vocal cords. Patients often require a tracheotomy to secure the airway. Most cases of bilateral vocal cord dysfunction are provoked by the inability to recognize pre-existent unilateral recurrent laryngeal nerve (RLN) paralysis. Thorough screening and adequate history taking are paramount to prevent this rare condition. Symptoms of unilateral injury to the RLN include hoarseness, dysphonia, cough, dysphagia or aspiration. However, patients may be entirely asymptomatic in up to 32% of unilateral RLN lesion cases, leading to decreased sensitivity of exclusively screening with physical examination. Laryngeal examination to assess vocal cord function is recommended for patients who are either hoarse, have a history of laryngeal trauma, are known with neurological deficits or have undergone previous surgical procedures associated with a high risk of unilateral vocal cord paralysis, even if they are presently asymptomatic.

Abstract Aim To evaluate the efficacy of intraoperative neuromonitoring in identifying recurrent laryngeal nerves and decreasing the incidence of nerve injury in minimally invasive esophagectomies for esophageal cancers. Methods A total of 167 minimally invasive esophagectomy patients were retrospectively reviewed. They were divided into intraoperative neuromonitoring (n = 84) and no intraoperative neuromonitoring (n = 83) groups, based on whether or not intraoperative neuromonitoring was used during surgery. We compared short‐term surgical outcomes and incidence of recurrent laryngeal nerve palsy between the two groups before and after propensity score matching. The association between the loss of signal and recurrent laryngeal nerve palsy was also evaluated. Results The incidence of recurrent laryngeal nerve palsy (grade 2 and higher) was lower in the intraoperative neuromonitoring group than in the no intraoperative neuromonitoring group (6.0% vs 21.2%, P = 0.02). The rate of recurrent laryngeal nerve palsy recovery within 6 months was also significantly higher in the intraoperative neuromonitoring group (87.5% vs 20.0%, P

Objective: To determine the frequency of recurrent laryngeal nerve injury (RLNI) after thyroid surgery for benign disease. Study Design: Cross-sectional study. Place and Duration of Study: Otorhinolaryngology Department, Combined Military Hospital Rawalpindi and Combined Military Hospital, Quetta, from May 2015 to May 2018. Methodology: All the patients underwent preoperative evaluation of vocal cords by indirect laryngoscopy for vocal cord disease and function. Lobectomy, subtotal thyroidectomy or total thyroidectomy were performed under general anaesthesia by the consultants having more than three years post-fellowship experience of thyroid surgery. Immediate postoperative visualization of vocal cords was performed at the time of endotracheal tube extubation with a laryngoscope by an otolaryngologist with the help of an anesthesiologist to assess vocal cord mobility. Results: Out of 179 cases, there were 42 (23.46%) males and 137 (76.54%) female patients. The recurrent laryngeal nerve injury was found in 11 (6.2%) cases. The statistical analysis did not show an association of recurrent laryngeal nerve injury with agegroups, gender or type of thyroid surgery (p>0.05). Conclusion: The frequency of recurrent laryngeal nerve injury RLNI after thyroid surgery for the benign disease was 6.2%. [ABSTRACT FROM AUTHOR]

Bilateral vocal cord paralysis poses life-threatening risks to patients who do not undergo prompt diagnostic intervention and airway management. Although developing bilateral vocal cord paralysis is extremely rare, if injury does occur, it is more frequently due to surgical resection sequelae in the neck. This case is particularly unique as we present a patient with a history of stage III laryngeal carcinoma status post chemotherapy in remission, who developed respiratory distress three days following an upper endoscopy procedure for an esophageal stricture at the level of the cricopharyngeus muscle, where he received a botulinum injection. This manuscript discusses the anatomy, clinical practices of botulinum toxin, nerve innervation, and mechanisms of injury for patients who develop bilateral recurrent laryngeal nerve injury. In addition, this manuscript details vocal cord positioning and how the positioning of the cords during laryngoscopy investigation can lead to diagnostic confirmation. With few reported cases of bilateral recurrent laryngeal nerve injury secondary to botulinum toxin particularly at the cricopharyngeus level, this report should serve as a guide for future clinicians regarding the risks of using this toxin, the risks of local spread, and management., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Potesta et al.)

Background: Thyroid surgeries are commonly done nowadays for benign and malignant conditions. Recurrent laryngeal nerve palsy (RLNP) is an important and potentially catastrophic complication of thyroid surgery. The purpose of the study was to determine the impact of rigid endoscopy (Hopkins rod-lens telescope) performed at different time intervals on the diagnosis of RLNP in post-thyroid surgery patients. Aims and Objectives: To assess Proper Timing of Laryngoscopy in Post-thyroid Surgery patients to Detect RLN Injury. Materials and Methods: Rigid endoscopy was performed postoperatively at day 0 (T0), at 2nd day post-op (T1), and day 14 (T2). For patients with RLNP, repeated examinations were performed at 2 months (T3), 6 months (T4), and 12 months (T5). Results: The study included 50 patients of thyroid swelling with different diagnoses. Overall, 35 patients appeared for postoperative laryngoscopic examination of the vocal folds at our center, providing 61 nerves at risk. RLNP rate was 8.1% at T0, 11.5% at T1, 9.8% at T2, 8.1% at T3, 4.9% at T4, and 3.3% at T5. T1 was significantly superior to all other time intervals in terms of diagnosis of RLNP but statistically not significant. Conclusion: Rigid endoscopy is essential for the detection of vocal cord paralysis after thyroidectomy. We report different time evaluation criteria of vocal cord morbidity with great and significant variability of results. Second day post-op inspection of the larynx (T1) is suggested. [ABSTRACT FROM AUTHOR]

We sought to analyse the effect of the introduction of intraoperative nerve monitoring (IONM) in our routine surgical practice and to provide a circumstantial analysis of direct costs of IONM in total thyroidectomy and of indirect costs associated with vocal fold palsy, as centred in the health care system of Italy. We retrospectively compared outcomes of 232 total thyroidectomies performed between November 2017 and October 2019, respectively, before (109 TT-Group A) and after (123 TT-Group B) adopting IONM technology in November 2018. We analysed the costs of IONM per procedure and rate and costs of vocal fold palsy events (temporary and permanent). Overall, there were 61 thyroid cancers (32 in Group B) and 171 multinodular goitres (91 in Group B). We recorded 5 cases of vocal fold palsy (4.6%—4 transient, 1 permanent) in Group A and none in Group B (p = 0.016). IONM consumables cost 219 eur per case. Healthcare and social cost of Vocal fold palsy ranged between 3200 eur (function recovery < 1 month postoperatively) and over 32,000 eur (permanent event). When only direct costs are considered, IONM can hardly be cost effective. In this study, cost of IONM implementation was offset by the absence of complications attributable to recurrent laryngeal nerve dysfunction. [ABSTRACT FROM AUTHOR]

Introduction: Even though incidence of recurrent laryngeal nerve palsy (RLNP) is low, it affects importantly the quality of life of patients and remains one of main medicolegal litigation problems in surgery. Intraoperative neuromonitoring (IONM) has become widely accepted tool helping in recurrent laryngeal nerve identification, however no clear association of IONM with RLNP rate has been demonstrated. The aim of our study was to assess whether training in IONM influences rates of RNLP after thyroid surgery as an independent factor.Material and Methods: We analysed retrospectively 1235 patients who underwent thyroidectomy at the 1st Department of General and Endocrine Surgery, Medical University of Bialystok. Possible risk factors for RLNP were evaluated: application or not of IONM, the extent of surgery or thyroid pathology in correlation with surgeons' experience in IONM (trained or untrained).Results: There were 2351 nerves at risk (NAR) and 39 RNLP were diagnosed after thyroid surgery (1.66%). Surgeons trained in IONM performed 52.2% of all operations (1200 NAR) with 7 RLNP (0.58%), whereas not-trained had 32 RLNP for 1151 NAR (2.8%; p < 0.001). After 182 thyroidectomies (357 NAR) guided by IONM (14.7%) 3 RLNP were observed (0.84%) vs. 36 palsies per 1994 NAR without IONM (1.81%; p = 0.189). The highest danger of RLNP was reported after reoperations and the lowest after subtotal thyroidectomies. We found no association between thyroid pathology and RLNP rate.Conclusions: According to our study training in IONM decreases chances of RLNP especially during total or near total thyroidectomy. [ABSTRACT FROM AUTHOR]

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Introduction: Voice change due to injury to the Recurrent Laryngeal nerve and the external branch of the superior laryngeal nerve is an important complication of Thyroid Surgery Objectives: Video Laryngeal Stroboscopy comes in handy for the detection of vocal cord palsies postoperatively that may be missed on routine examination, to know the extent of the pathology. Methods: 100 patients with thyroid swelling who have been evaluated and planned for thyroidectomy in a tertiary care centre between June 2016 to June 2018 were taken as subjects for this prospective observational study. Clinical examination and Video Laryngeal Stroboscopy were done pre operatively and compared to the same on third post-operative day and 1month following surgery. Results: Preoperative Video Laryngeal Stroboscopy was normal in all subjects. 26 out of 100 subjects had subjective postoperative voice change of various degrees. Out of 26 patients, 22 were diagnosed to have Recurrent Laryngeal Nerve palsy and 4 with Superior Laryngeal Nerve palsy .Most common symptoms post-surgery were Voice fatigue in 26% followed by decreased pitch range in 13% and hoarseness in 6% cases. Bowing of vocal cords was seen in 4 subjects (4%), Asymmetry of travelling mucosal wave (slight to severe) in 8 subjects (8%), incomplete glottis closure in 6 subjects (6%). Conclusion: Video Laryngeal Stroboscopy is a useful tool in evaluation of patients with suspected laryngeal paralysis. Paralysis of Superior Laryngeal Nerve, Recurrent Laryngeal Nerve or both results in asymmetric laryngeal vibration that is easily identified by even inexperienced observers using Stroboscopy in an otherwise normal rigid telescopy of larynx

Introduction Even though incidence of recurrent laryngeal nerve palsy (RLNP) is low, it affects importantly the quality of life of patients and remains one of main medicolegal litigation problems in surgery. Intraoperative neuromonitoring (IONM) has become widely accepted tool helping in recurrent laryngeal nerve identification, however no clear association of IONM with RLNP rate has been demonstrated. The aim of our study was to assess whether training in IONM influences rates of RNLP after thyroid surgery as an independent factor. Material and methods We analysed retrospectively 1235 patients who underwent thyroidectomy at the 1st Department of General and Endocrine Surgery, Medical University of Bialystok. Possible risk factors for RLNP were evaluated: application or not of IONM, the extent of surgery or thyroid pathology in correlation with surgeons’ experience in IONM (trained or untrained). Results There were 2351 nerves at risk (NAR) and 39 RNLP were diagnosed after thyroid surgery (1.66%). Surgeons trained in IONM performed 52.2% of all operations (1200 NAR) with 7 RLNP (0.58%), whereas not-trained had 32 RLNP for 1151 NAR (2.8%; p < 0.001). After 182 thyroidectomies (357 NAR) guided by IONM (14.7%) 3 RLNP were observed (0.84%) vs. 36 palsies per 1994 NAR without IONM (1.81%; p = 0.189). The highest danger of RLNP was reported after reoperations and the lowest after subtotal thyroidectomies. We found no association between thyroid pathology and RLNP rate. Conclusions According to our study training in IONM decreases chances of RLNP especially during total or near total thyroidectomy.

Purpose: Minimally invasive esophagectomy (MIE) has been increasingly used, but many reports have stated that recurrent laryngeal nerve (RLN) palsy after MIE is a major complication associated with postoperative pneumonia. Prevention of RLN palsy clearly has been a challenging task. The study aim was to determine if a three-dimensional (3-D) stereoscopic vision system can reduce the RLN palsy rate after MIE. Methods: This was a retrospective study of MIE (McKeown esophagectomy) using a 3-D or 2-D stereoscopic vision system to treat 358 patients in the prone position between April 2010 and March 2019. The patients who underwent 3-D MIE (3-D group) or 2-D MIE (2-D group) were matched by using propensity score matching. After matching, the perioperative outcomes were compared between the groups. Results: After propensity score matching, 154 patients were analyzed (77 patients, 3-D group; 77 patients, 2-D group). There were no significant differences in the patients' baseline characteristics in the matched cohort. There were no significant differences in the rates of pneumonia (Clavien–Dindo (C–D) grade ≥ II, 3-D vs. 2-D, 11 (14%) vs. 12 (16%)), anastomotic leakage (C–D grade ≥ II, 10 (13%) vs. 18 (23%)) and mortality. The rates of left RLN palsy (C–D grade ≥ IIIa, 1 (1.3%) vs. 7 (9.1%), P = 0.029), right RLN palsy (C–D grade ≥ I, 2 (3%) vs. 8 (10%), P = 0.049), comprehensive complication index (CCI®) (8.5 vs. 14.3, P = 0.011), and postoperative hospital stay period (median: 25 vs. 30 days, P = 0.034) were significantly lower in the 3-D group than in the 2-D group, respectively. Conclusions: In MIE, the 3-D viewing system was one of the factors that reduced postoperative morbidities such as the rates of each RLN palsy and CCI®, leading to shorter postoperative hospital stay. [ABSTRACT FROM AUTHOR]

Over the past decade, the use of neuromonitoring in thyroid surgery has become well established and is increasing accepted across the world. In addition, new developments in energy devices have significantly improved efficacy in achieving hemostasis in thyroid surgery. Few studies focused on the complication rates in energy device-assisted sutureless neuro-monitored thyroidectomy. This study investigates a novel LigaSure Small Jaw (LSJ) technique for sutureless thyroidectomy and compares the surgical complication rates between LSJ and conventional clamp-and-tie technique in one thousand consecutive neuro-monitored thyroidectomy patients. Five hundred patients received sutureless thyroidectomy performed with LSJ (Group L), and 500 patients received surgery performed with conventional clamp-and-tie technique (Group C). Complication rates of postoperative hematoma, hypocalcemia and recurrent laryngeal nerve (RLN) palsy were compared between groups. The overall complication rates of hematoma, hypocalcemia (temporary/ permanent), and RLN (temporary/ permanent) palsy were 0.9%, 24.9% (24.6%/0.3%), and 1.7% (1.5%/0.2%), respectively. Group L and Group C significantly differed in postoperative hematoma rate (0.0% vs. 1.8%, respectively; p = 0.0026) and in postoperative hypocalcemia rate (20.1% vs. 30.0%, respectively; p = 0.0032). The incidence of RLN palsy did not significantly differ between Group L and Group C (1.38% vs. 2.08%; p = 0.2652). The overall surgical complication rates are low in neuro-monitored thyroidectomy. The LSJ is feasible for performing completely sutureless thyroidectomy and obtains superior outcomes of postoperative hematoma and hypocalcemia in comparison with clamp-and-tie hemostatic technique. The novel LSJ technique using double or overlapped sealing is useful for sutureless thyroidectomy. However, surgeons must carefully observe the tissue contraction that may reduce the LSJ-RLN distance and increase the risk of thermal injury during the LSJ activation.

Abstract Ortner syndrome or cardiovocal syndrome is hoarseness of voice due to left recurrent laryngeal nerve palsy as a result of cardiovascular abnormality. It is not known that pneumothorax has any association with Ortner syndrome. A 56‐year‐old gentleman, with previous history of 20 pack‐year smoking and 1‐year history of hypertension, presented to us with cough for two weeks with intermittent haemoptysis, as well as hoarseness of voice for the past one year. Direct laryngoscopy confirmed that he had left vocal cord palsy. Clinical and radiological investigations suggested that he had left pneumothorax. Left chest tube thoracostomy was performed and computed tomography of chest revealed aortic isthmus aneurysm with dissection extending to distal left common iliac artery and residual left hydropneumothorax. The patient was then referred to the vascular team and cardiothoracic team for further management.

Over the past decade, the use of neuromonitoring in thyroid surgery has become well established and is increasing accepted across the world. In addition, new developments in energy devices have significantly improved efficacy in achieving hemostasis in thyroid surgery. Few studies focused on the complication rates in energy device-assisted sutureless neuro-monitored thyroidectomy. This study investigates a novel LigaSure Small Jaw (LSJ) technique for sutureless thyroidectomy and compares the surgical complication rates between LSJ and conventional clamp-and-tie technique in one thousand consecutive neuro-monitored thyroidectomy patients. Five hundred patients received sutureless thyroidectomy performed with LSJ (Group L), and 500 patients received surgery performed with conventional clamp-and-tie technique (Group C). Complication rates of postoperative hematoma, hypocalcemia and recurrent laryngeal nerve (RLN) palsy were compared between groups. The overall complication rates of hematoma, hypocalcemia (temporary/ permanent), and RLN (temporary/ permanent) palsy were 0.9%, 24.9% (24.6%/0.3%), and 1.7% (1.5%/0.2%), respectively. Group L and Group C significantly differed in postoperative hematoma rate (0.0% vs. 1.8%, respectively; p = 0.0026) and in postoperative hypocalcemia rate (20.1% vs. 30.0%, respectively; p = 0.0032). The incidence of RLN palsy did not significantly differ between Group L and Group C (1.38% vs. 2.08%; p = 0.2652). The overall surgical complication rates are low in neuro-monitored thyroidectomy. The LSJ is feasible for performing completely sutureless thyroidectomy and obtains superior outcomes of postoperative hematoma and hypocalcemia in comparison with clamp-and-tie hemostatic technique. The novel LSJ technique using double or overlapped sealing is useful for sutureless thyroidectomy. However, surgeons must carefully observe the tissue contraction that may reduce the LSJ-RLN distance and increase the risk of thermal injury during the LSJ activation. [ABSTRACT FROM AUTHOR]

The incidence of recurrent laryngeal nerve palsy (RLNP) following minimally invasive esophagectomy has yet to be satisfactorily reduced. Use of intraoperative neuromonitoring (IONM), specifically of the RLN, during thyroidectomy has been reported to reduce the incidence of RLN injury. We now apply IONM during curative prone thoracoscopic esophagectomy, and we conducted a retrospective study to evaluate the feasibility and efficacy of intermittent monitoring of the RLN during the surgery. The study involved 32 consecutive patients who underwent esophagectomy with radical lymph node dissection for esophageal cancer. The patients were of two groups: an IONM group (n = 17) and a non-IONM group (n = 15). We chiefly strip around the esophagus preserving the membranous structure, which contains the tracheoesophageal artery, lymph nodes, and RLN. In the IONM group patients, we stimulated the RLN and measured the electromyography (EMG) amplitude after dissection, at the dissection starting point and dissection end point on both sides. For the purpose of the study, we compared outcomes between the two groups of patients. IONM was carried out successfully in all 17 patients in the IONM group. The incidence of RLNP was significantly reduced in this group. We found that both RLNs can be identified by mean of IONM easily, immediately, and safely and that the EMG amplitude attenuation rate is particularly useful for predicting RLNP. [ABSTRACT FROM AUTHOR]

Anterior cervical discectomy and fusion (ACDF) is a surgical procedure used to manage spine pathology including disc herniation, spondylosis, and myelopathy. During the operation, the vertebral segment of interest is accessed via the anterior neck and the disc space is fully resected along with osteophytes to relieve the compression along the affected nerve. While the procedure is regarded as being highly effective in improving symptoms, there are several complications associated with the surgery that patients should be cautioned about. We present a case of a patient with oropharyngeal and cervical esophageal dysphagia and left vocal cord paralysis following a C5/C6, C6/C7, and C7/T1 ACDF for multilevel cervical stenosis and disc herniation. Otolaryngology evaluation confirmed vocal cord paralysis from recurrent laryngeal nerve palsy (RLNP) and the patient's symptoms were managed with a vocal cord injection and speech therapy. This report explores the surgical approach for ACDF along with its complications and postoperative care., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Echevarria et al.)

Aim. In this study, we aimed to investigate the effects of Ultrasonic Coagulation (UC), Bipolar Energy Sealing System (BESS), Intra Operative Nerve Monitoring (IONM) and surgical experience on the complications of thyroid surgery. Method. The data of 1627 patients who underwent thyroid surgery for various indications in our department between 2009 and 2018 were analyzed retrospectively and the effects of different technological devices on complications were investigated. Results. Transient recurrent laryngeal nerve (RLN) palsy was higher between 2009 and 2013, when IONM was not in routine use (p=0.029). There were no significant differences between two energy devices (UC and BESS) in terms of transient or permanent RLN palsy, bleeding, and transient or permanent hypocalcemia. Multivariate analysis showed that young age (0.006), female gender (0.016), surgery type (p<0.001), and lateral neck dissection (p=0.026) are independent risk factors for transient hypocalcemia. Conclusion. The results indicate that there is no superior hemostatic device. IONM and specific branching decrease transient RLN palsy. Female gender, young age, completion thyroidectomy, and lateral neck dissection were independent risk factors for the development of transient hypocalcemia. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the efficacy of intraoperative neuromonitoring in identifying recurrent laryngeal nerves and decreasing the incidence of nerve injury in minimally invasive esophagectomies for esophageal cancers. Methods: A total of 167 minimally invasive esophagectomy patients were retrospectively reviewed. They were divided into intraoperative neuromonitoring (n = 84) and no intraoperative neuromonitoring (n = 83) groups, based on whether or not intraoperative neuromonitoring was used during surgery. We compared short‐term surgical outcomes and incidence of recurrent laryngeal nerve palsy between the two groups before and after propensity score matching. The association between the loss of signal and recurrent laryngeal nerve palsy was also evaluated. Results: The incidence of recurrent laryngeal nerve palsy (grade 2 and higher) was lower in the intraoperative neuromonitoring group than in the no intraoperative neuromonitoring group (6.0% vs 21.2%, P = 0.02). The rate of recurrent laryngeal nerve palsy recovery within 6 months was also significantly higher in the intraoperative neuromonitoring group (87.5% vs 20.0%, P < 0.01). The positive and negative predictive values of intraoperative neuromonitoring for recurrent laryngeal nerve palsy were 60% (9/15) and 86.9% (60/69), respectively. The duration from paralysis to recovery was shorter in recurrent laryngeal nerve palsy cases with negative loss of signal results than in cases with positive loss of signal results (median: 43 days vs 95 days). Conclusion: Intraoperative neuromonitoring is useful in identifying recurrent laryngeal nerves and may aid in reducing the incidence of recurrent laryngeal nerve injury during esophageal surgery. [ABSTRACT FROM AUTHOR]

Background and Study Aims Recurrent laryngeal nerve palsy (RLNP) is a potential complication of anterior discectomy and fusion (ACDF). There still is substantial disagreement on the actual prevalence of RLNP after ACDF as well as on risk factors for postoperative RLNP. The aim of this study was to describe the prevalence of postoperative RLNP in a cohort of consecutive cases of ACDF and to examine potential risk factors. Materials and Methods This retrospective study included patients who underwent ACDF between 2005 and 2019 at a single neurosurgical center. As part of clinical routine, RLNP was examined prior to and after surgery by independent otorhinolaryngologists using endoscopic laryngoscopy. As potential risk factors for postoperative RLNP, we examined patient's age, sex, body mass index, multilevel surgery, and the duration of surgery. Results 214 consecutive cases were included. The prevalence of preoperative RLNP was 1.4% (3/214) and the prevalence of postoperative RLNP was 9% (19/211). The number of operated levels was 1 in 73.5% (155/211), 2 in 24.2% (51/211), and 3 or more in 2.4% (5/211) of cases. Of all cases, 4.7% (10/211) were repeat surgeries. There was no difference in the prevalence of RLNP between the primary surgery group (9.0%, 18/183) versus the repeat surgery group (10.0%, 1/10; p = 0.91). Also, there was no difference in any characteristics between subjects with postoperative RLNP compared with those without postoperative RLNP. We found no association between postoperative RLNP and patient's age, sex, body mass index, duration of surgery, or number of levels (odds ratios between 0.24 and 1.05; p values between 0.20 and 0.97). Conclusions In our cohort, the prevalence of postoperative RLNP after ACDF was 9.0%. The fact that none of the examined variables was associated with the occurrence of RLNP supports the view that postoperative RLNP may depend more on direct mechanical manipulation during surgery than on specific patient or surgical characteristics. [ABSTRACT FROM AUTHOR]