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Vagus nerve injuries during gastroesophageal surgery may cause significant symptoms due to loss of vagal anti-inflammatory and neuromodulator function. Many previous studies have shown high anatomical variability of the vagus nerve at the esophageal hiatus, but information on its variability in Uganda specifically and Africa in general is scanty. This study provides a reliable and detailed description of the anatomical variation and distribution of the vagus nerve in the esophageal hiatus region of post-mortem cases in Uganda. This was an analytical cross-sectional survey of 67 unclaimed post-mortem cases. Data collection used a pretested data collection form. Data were entered into Epi-Info version 6.0 data base then exported into STATA software 13.0 for analysis. The pattern of the anterior vagal trunk structures at the esophageal hiatus was: single trunk [65.7%]; biplexus [20.9%]; triplexus [8.9%] and double-but-not-connected trunks [4.5%]. The pattern of the posterior trunk structures were: single trunk [85.1%]; biplexus 10.4% and triplexus [4.5%]. There was no statistically significant gender difference in the pattern of vagal fibres. There was no major differences in the pattern from comparable British studies. The study confirmed high variability in the distribution of the vagus nerve at the esophageal hiatus, unrelated to gender differences. Surgeons must consider and identify variants of vagal innervation when carrying out surgery at the gastroesophageal junction to avoid accidental vagal injuries. Published surgical techniques for preserving vagal function are valid in Uganda.

Aims: During neck dissection (ND), the vagus nerve (VN) may be exposed to manipulation together with common carotid artery and internal jugular vein. The postsurgical gastroparesis was previous related to the VN injury. The aim of our study was to evaluate by ultrasound the VN changes in patients with unilateral and bilateral ND and to establish if there is a relationship between postoperative findings of VN and postsurgical gastroparesis. Material and methods: Seventeen patients in which 30 ND (4 unilateral and 13 bilateral) were performed, were enrolled in the study. The VN’s area and diameter were measured preoperative (baseline), one week (T1) and one month (T2) postoperative. Gastrointestinal symptoms were evaluated at T1 and T2 phases using the patient assessment of the upper gastrointestinal symptom severity index (PAGI-SYM). Results: There was a statistical difference between area and diameters of VN between T1 and baseline (p0.999). Gastrointestinal symptoms, found at the T1 phase regressed at T2 phase, were correlated with VN area and diameter changes (p

Introduction: Unilateral vocal fold paralysis (UVFP) without an identifiable cause is termed idiopathic unilateral vocal fold paralysis (IUVFP). Some authors have postulated that select cases of IUVFP have a viral etiology, but the causality has not been established. We set out to review institutional cases of IUVFP and determine if there is a correlation between upper respiratory infection symptoms and presentation of IUVFP. Methods: Cases of IUVFP were reviewed over a 10-year period (2002-2012). The history was investigated to review presenting symptoms. We specifically reviewed for symptoms of upper respiratory infection at the onset of UVFP and tallied the frequency. Symptoms included sore throat, laryngitis, cough, influenza, bronchitis, pneumonia, otalgia, and sinusitis. The seasonal onset (if possible) was determined based on the history provided from the initial consultation. Study Design: Case series. Results: Overall, 107 patients presented with IUVFP; 35.5% of patients reported symptoms of upper respiratory infection at the onset of UVFP. Among these individuals, pharyngitis/laryngitis was the most common presenting symptom; 34.2% reported cough. In total, 40.0% of patients with IUVFP reported an onset of symptoms between December and February. Conclusions: This study suggests that symptoms of upper respiratory infection frequently occur with the presentation of IUVFP. The onset of symptoms tended to occur between December and February. The mechanism of viral-mediated UVFP has not been established. Future studies to explore this pathophysiology are needed.

Objective To analyze the outcome of epileptic patients who had redo surgery involving the vagus nerve stimulation's lead. Methods We reviewed the clinical and surgical records of all patients who had a complete vagus nerve stimulation (VNS) removal or replacement or any redo surgical procedure involving the system lead at Sainte-Anne Hospital in Paris, France. Results Between the years 1999 and 2016, 41 redo surgical procedures involving the lead or electrode were achieved, of which 23 were complete VNS explantations, 12 were complete system replacements, 5 were lead changes only, and 1 was isolated lead removal. 41% of the surgical procedures were achieved in female patients. This population has a median age at VNS implantation of 33.6 years (interquartile range [IQR], [21.4–38.6]. Median time between the VNS implantation and the redo surgery involving the lead was 4.9 years (IQR, 2.9–8). The reason for VNS removal was mainly a lack of clinical effectiveness. No preoperative or postoperative complications occurred after complete VNS system removal or lead replacement. The effectiveness of the VNS therapy remained unchanged after lead replacement. No vagus nerve injury was reported, nor did symptoms suggest that it was disabled. Conclusions Complete removal or replacement of the VNS system including the lead and the electrode is feasible and safe. These procedures should be offered to patients who would no longer benefit from the VNS or when only a lead change is needed.

Los nervios vagos han sido exhaustivamente estudiados en los adultos pero no en los niños, y mayormente en el trayecto intracraneal, más que en la periferia. El objetivo de este estudio fue proveer información más específica sobre los nervios vagos toraco-abdominales, describirlos en fetos y asociarlos con la rotación gástrica, de modo que pueda ser aplicada a procedimientos clínicos, reduciendo la morbilidad. Se disecaron treinta fetos entre 12 y 23 semanas de gestación, mayormente varones (87%), desde la parte inferior del cuello hasta el cardias, identificando los troncos y ramas de los nervios vagos. Los nervios fueron descriptos en su ingreso en el tórax en relación con las arterias carótidas, en su posición en el tercio superior del esófago asociados con el origen de las ramas cardíacas y pulmonares, en el tercio inferior del esófago con muchas variaciones en su distribución, a nivel diafragmático en el hiato esofágico y, finalmente, en relación con la posición gástrica. La discusión involucró descripciones hechas por diferentes autores incluyendo algunos estudios recientes que proporcionan resultados electrofisio-lógicos y consideraciones de aspectos clínicos, principalmente representados por procedimientos quirúrgicos y su morbilidad, ambos asociados con la lesión de los nervios vagos. Vagus nerves have been extensively studied in adults but not in fetuses, and mostly in the intracranial pathway than the peripheral one. The objective of this study was to provide more specific information on the thorax-abdominal vagus nerves, to describe them in fetuses and to associate them with the gastric rotation, so it could be applied to clinical procedures, reducing morbidity. Thirty fetuses between 12 to 23 weeks of gestation, mainly male (87%), were dissected from the lower neck to the cardias, identifying vagus nerve trunks and braches. Vagus nerves were described at the entrance in the thorax in relation with the carotid arteries, in their position at the upper third of the esophagus associated with the origin of cardiac and pulmonary branches, in the lower third of the esophagus with many variations in their distribution, at the diaphragmatic level in the esophageal hiatus and, finally, in relation with the gastric position. The discussion involved descriptions made by different authors including some recent studies providing electrophysiological results and considerations on clinical aspects, mainly represented by surgical procedures and their morbidity associated, both to vagus nerve injury.

Background: Vagus nerve injury (VNI) is a feared complication of antireflux surgery (ARS). The impact of VNI on the functional outcomes of ARS has not yet been evaluated systematically. The aim of this review was to evaluate the impact of VNI on functional and clinical outcome of ARS. Methods: A systematic search was performed until March 2015, using the following online databases: MEDLINE, Embase and the Cochrane Register of Controlled Clinical Trials. Eight studies remained available for assessment. Articles were divided into 2 groups: (a) one with unintended, accidental VNI and (b) one group comparing ARS with and without intended vagotomy. Results: The prevalence of unintended, accidental VNI ranged from 10 to 42% after ARS. No clear differences were seen in outcome for reflux control between the VNI and vagus nerve intact group. A higher prevalence of diarrhea, nausea and vomiting was observed in the VNI group. Conclusion: VNI is a feared but neglected complication of ARS. Larger prospective studies that objectively assess vagus nerve integrity before and after ARS are needed.

Objective This report describes the technique for implanting a vagus nerve stimulator via a single low anterior cervical incision and discusses the advantages of this technique over that of the more commonly used 2-incision technique. Methods The authors performed a retrospective review of all patients who underwent implantation of a vagus nerve stimulator by the senior author over a 10-year period. Results One hundred thirty-one patients underwent implantation of vagus nerve stimulators via the single-incision technique. There were no instances of vagus nerve injury, postoperative hematoma, or wound infection, and cosmesis was excellent. Conclusion The single-incision technique described here for implantation of vagus nerve stimulators is technically straightforward and safe, and has significant advantages over the 2-incision technique.

Cranial nerve palsy is a rare neurological complication of epidural and subarachnoid blocks. Most of these complications are attributed to secondary intracranial hypotension due to cerebrospinal fluid leakage following dural puncture. Vocal fold paralysis (VFP) seems more likely to be overlooked and underreported due to delayed onset of symptoms and lack of attribution of dysphonia to spinal anesthesia. Therefore, VFP can often be missed and described as idiopathic. This article describes a case of VFP due to vagus nerve injury following subarachnoid block.

OBJECT This investigation was done to examine, following implantation of vagus nerve stimulators, the relationship of vocal cord paralysis to the inner diameter of the coils used to attach the stimulator lead to the nerve. Methods All data in this investigation were collected, as mandated by the FDA, by the manufacturer of vagus nerve stimulators and were made available without restrictions for analysis by the authors. The data reflect all initial device implantations in the United States for the period from 1997 through 2012. Results Vocal cord paralysis was reported in 193 of 51,882 implantations. In patients aged 18 years and older, the incidence of paralysis was 0.26% when the stimulator leads had coil diameters of 3 mm and 0.51% when the leads had 2-mm-diameter coils (p < 0.05). Across all age groups, the incidence of vocal cord paralysis increased with age at implantation for leads having 2-mm-diameter coils. Conclusions In patients aged 18 years and older, vocal cord paralysis occurred at almost twice the rate with the implantation of vagus nerve stimulator leads having 2-mm-diameter coils than with leads having 3-mm-diameter coils. The incidence of vocal cord paralysis increases with patient age at implantation.

Dysphagia secondary to peripheral cranial nerve injury originates from weak and uncoordinated contraction-relaxation of cricopharyngeal muscle. We report on two patients who suffered vagus nerve injury during surgery and showed sudden dysphagia by opening dysfunction of upper esophageal sphincter (UES). Videofluoroscopy-guided balloon dilatation of UES was performed. We confirmed an early improvement of the opening dysfunctions of UES, although other neurologic symptoms persisted. While we did not have a proper comparison of cases, the videofluoroscopy-guided balloon dilatation of UES is thought to be helpful for the early recovery of dysphagia caused by postoperative vagus nerve injury.

The fracture of the Atlas is a serious trauma, associated with important diagnostic traps. Whether operative or noninvasive treatment should be used depends on the type of fracture. Paralysis of brain nerves are exceptionally rare. We present a case in which fracture of the atlas was associated with paralysis of the 9th through 12th brain nerves, to which differential diagnostic considerations are discussed.

Complications associated with carotid endarterectomy range from local nerve injuries and difficulties in controlling blood pressure to transient or permanent neurologic deficits and death. A thorough knowledge of such possible complications and of techniques to avoid and manage them is essential. This article reviews the anatomic and technical factors that relate to such complications and discusses their possible causes and management.

An electron microscope investigation has been made into the regeneration of unmyelinated axons in the vagus nerve of the rabbit. Following a localized crush injury of the vagus nerve in the neck at the level of the thyroid cartilage, the regenerating unmyelinated axons become diverted into the recurrent laryngeal branch, which is normally composed almost entirely of myelinated fibres. Here the regenerating unmyelinated axons become arrayed around the regenerating myelinated axons, but are associated with separate Schwann cells.

IT seems to have been widely assumed that autonomic neurones respond to axonal damage much as do somatic motoneurones. From an extensive series of experiments on the albino rat, however, we have obtained evidence that autonomic preganglionic neurones are much more seriously affected. Thus, when the cervical vagus on one side was either crushed or cut, we consistently found in more than 100 animals that changes in the cells of the dorsal motor nucleus of the vagus were more severe and more protracted than in those of the hypoglossal nucleus when its nerve was similarly treated. The changes are seen particularly well in histochemical preparations designed to show the distribution of various metabolic enzymes. In the work described here attention was concentrated on alterations in the cholinesterases and in acid phosphatase.