Anatomical and surgical considerations of the external branch of the superior laryngeal nerve. Yonca anik, md s uperior laryngeal neuralgia is described as a rare disorder characterized by severe pain in the lateral aspect of the throat, submandibular region, and underneath the ear, pre. Rln injury can cause vocal cord paralysis, affecting the patients voice and the quality of life. Correlation of physiologically important electromyographic emg waveforms with demonstrable muscle activation is important for the reliable interpretation of evoked waveforms during intraoperative neural monitoring ionm of the vagus nerve, recurrent laryngeal nerve rln, and external branch of the superior laryngeal nerve ebsln in thyroid surgery. Superior laryngeal neuralgia usually appears as a postsurgical complication. The present study aimed to compare function of superior laryngeal nerve and. We speculated that the former was a manifestation of a musculoskeletal tension or conversion reaction disorder, whereas the latter was a sequela to a selflimiting inflammatory process. Superior laryngeal neuralgia is a rare entity first described in 1900 by avellis.
Current concepts in the management of unilateral recurrent. Excessive weight loss caused by dysphagia in superior laryngeal nerve neuralgia a case report. The superior laryngeal nerve is located along the posterior thyrohyoid space. The superior laryngeal nerve injury of a famous soprano. In treating superior laryngeal neuralgia sln, superior laryngeal nerve blocks slnbs can provide immediate relief of persistent pain. An accurate knowledge of its course should reduce the incidence of injury to the branches of the superior laryngeal nerve during surgery. Superior laryngeal nerve neuralgia slnn is an anterior neck pain syndrome that is underrecognized and, as a result, is often misdiagnosed. Serotonin mediated cluster headache, trigeminal neuralgia. There are paroxysms of unilateral submandibular pain, sometimes radiating to the eye, ear, or. Bilateral superior laryngeal nerve block was combined with topical application of local anaesthetic 140 times in 5 patients to anaesthetize the upper airway and facilitate tracheal intimation, laryngeal instrumentation, or to diminish the response to the endotracheal tube, in a patient already intubated. Prospective randomized study on injury of the external. Editorthe superior laryngeal nerve sln bifurcates near the pharynx into the external and internal sensory sln internal branches. The cricothyroid muscle is innervated by the external branch of the superior laryngeal nerve.
After descending along the side of the pharynx, it divides into two distal branches, the internal and the external laryngeal nerves. Vocal cord paralysis vcp due to recurrent laryngeal nerve rln dysfunction may herald the presence of mediastinal disease, including a variety of neoplastic, inflammatory, and vascular conditions 1, 2. The superior laryngeal nerve is a branch of the vagus nerve. Methods a total of 252 patients undergoing thyroidectomy were randomly assigned to group n the nim. Because anatomic information useful to the surgeon is difficult to come by, the aim of this study was to reinvestigate and display the rlns and superior laryngeal nerves in humans. Superior laryngeal neuralgia relieved by operation.
The recurrent laryngeal nerve passes medial and dorsal to the inferior cornu of the thyroid cartilage and lies lateral to the broad expanse of the posterior lateral aspect of the cricoid, before passing anterior on the superior aspect of the posterior cricoarytenoid muscle. We describe and chronicle a syndrome consisting of cluster headache, seasonal affective disorder, with associated trigeminal, glossopharyngeal, superior laryngeal neuralgias in an 11yearold female. Pdf preservation of the external branch of the superior laryngeal nerve ebsln during thyroidectomy is important because its injury. A trigger point is present on the lateral aspect of the throat overlying the thyrohyoid membrane. Superior laryngeal neuralgia after acute laryngitis and. The first page of the pdf of this article appears above. A diagnosis of superior laryngeal neuralgia was suggested by several characteristic features. There are two recurrent laryngeal nerves, right and left, in the human body. The recurrent and superior laryngeal nerves download. Severe dysphonia after use of a laryngeal mask airway. True neuralgia of the superior laryngeal nerve is a distinct clinical entity comparable to trigeminal and glossopharyngeal neuralgia. The origin of the schwannoma is presumed to be in the internal branch of the superior laryngeal nerve. The written informed consent before treatment was obtained for each patient.
Superior laryngeal nerve an overview sciencedirect topics. Ultrasound description of a superior laryngeal nerve space. This muscle stretches, tenses, and adducts the vocal cord. All other intrinsic laryngeal muscles are innervated by the recurrent laryngeal nerve. Sulphur dioxide block of laryngeal receptors in rabbits. It arises from the middle of the inferior ganglion of vagus nerve and in its course receives a branch from the superior cervical ganglion of the sympathetic nervous system the cricothyroid muscles are innervated by the superior laryngeal nerve. Superior laryngeal neuralgia sln is a relatively rare disorder that is characterized by neck pain.
However, this imaging feature can be found in ancient schwannomas. The external branch of the superior laryngeal nerve is not usually severed at supraglottic laryngectomy but the nerve is at risk during neck dissections, resection of zenkers diverticula and thyroidectomy. The superior laryngeal nerve sln is a division of the vagal nerve vn. Electrophysiological neural monitoring of the laryngeal. Relation of the external branch of the superior laryngeal.
We report the ct findings in a patient with a lateral neck mass histologically diagnosed as a laryngeal schwannoma but presenting some uncommon ct features. All inbred laryngeal muscles apart the cricothyroid muscle ctm are moved by the recurrent laryngeal nerve rln. International scholarly research notices 2011 article. The importance of the recurrent laryngeal nerve in surgery on the anterior region of the neck has motivated many published papers on critical points of its pathway, relationship with the inferior thyroid artery, penetration in the larynx, division outside the larynx, and branches communicating with the internal branch of the superior laryngeal nerve. The recurrent laryngeal nerve rln is a branch of the vagus nerve cranial nerve x that supplies all the intrinsic muscles of the larynx, with the exception of the cricothyroid muscles. Superior laryngeal nerve injury free download as powerpoint presentation. We present a series of patients who were diagnosed with and subsequently treated for slnn. Superior laryngeal neuralgia is described as a rare disorder characterized by severe pain in the lateral aspect of the throat, submandibular region, and underneath the ear, precipitated by swallowing, shouting, or turning the head. Pretoria, south, africa 2department of surgery, faculty of. Intraoperative nerve monitoring may facilitate identification of the nerve, reducing voice impairment. Van schoor1 1department of anatomy, section of clinical anatomy, faculty of health sciences, school of medicine, university of pretoria. In treating superior laryngeal neuralgia sln, superior laryngeal nerve blocks.
The recurrent laryngeal nerve is a branch of the vagus nerve and is a mixed. The recurrent and superior laryngeal nerves gregory w. Pdf the anatomy of the external branch of the superior laryngeal. Recurrent laryngeal nerve rln injury remains a challenge due to the lack of effective treatments. It is separated into two branches, the internal branch and the external branch. In 6 rabbits moving average of activity of superior laryngeal nerve sln increased when pressure in upper airways pua was positive and decreased when it was negative. Recurrent laryngeal nerve rln injury is one of the most common complications of thyroid surgery. Anatomy of the external branch of the superior laryngeal. To compare the level of intraoperative identification of external branch of the superior laryngeal nerve ebsln through classical conventional clinical methods of prevention against those applying intraoperative neuromonitoring ionm. Regional and topical anesthesia for awake endotracheal. After extensive investigations for laryngeal, dental and submandibular gland disease, the condition was treated successfully with carbamazepine. The superior laryngeal nerve arises from the inferior ganglion and descends against the lateral wall of the pharynx.
Identification of the external branch of the superior. Relation of the external branch of the superior laryngeal nerve to. The superior laryngeal nerve can be seen superficial to the thyrohyoid membrane when the medial aspect of the probe is rotated cephalad. Injury of the external branch of the superior laryngeal nerve ebsln can cause cricothyroid muscle denervation affecting high vocal tones. The superior laryngeal nerve, a branch of the vagus nerve, innervates the cricothyroid muscle of the larynx. The right recurrent laryngeal nerve approaches the larynx at a 25 angle relative to the sagittal plane, whereas the left approaches at a 4. There are only a few reported cases and treatment options for sln to date. Treatment or prevention of laryngospasm and stridor. It arises from the middle of the ganglion nodosum and in its course receives a branch from the superior cervical ganglion of the. Jeanpierre barral, alain croibier, in manual therapy for the cranial nerves, 2009. Pharmacologic interventions for this patient were examined in conjunction with current classification, location and function of serotonin receptors. Topographic anatomy of the external branch of the superior.
Injury to the superior laryngeal nerve sln is often overlooked and also not well understood. The superior laryngeal nerve is a terminal branch of the vagus nerve cranial nerve x and receives sympathetic input from. Three cases of idiopathic superior laryngeal neuralgia treated by. Superior laryngeal neuralgia free download as powerpoint presentation. Three cases of idiopathic superior laryngeal neuralgia. The treatment of superior laryngeal nerve paralysis centers on voice therapy. A 46yearold patient had a right superior laryngeal neuralgia. Is the superior laryngeal nerve really safe when using harmonic. Stim 3 was used to identify the external branch of the. Superior laryngeal nerve injury larynx health sciences. The internal branch of the superior laryngeal nerve runs along with the superior laryngeal artery, just below the greater cornu of the hyoid bone. Results the recurrent laryngeal nerve in 88% of cases is seen in the tracheooesophageal groove and in 12% of cases, the nerve is seen on lateral surface of trachea.
A new application for superior laryngeal nerve block. A psychogenic voice disorder cooccurred or evolved with the symptoms and signs of unilateral superior laryngeal nerve paresis. After so 2 exposure of upper airways sln activity at pua 0 decreased to 40% and was no longer affected by changes in pua. The present study provided the topographic information of.
The internal laryngeal nerve provides sensory innervation to the glottis and laryngeal vestibule through the thyrohyoid membrane. In this study, we established a new drug delivery system consisting of a tube of healall oral. The right recurrent laryngeal nerve is thus at greater risk than the left when the cloward retractor is placed in the space between the larynx and the carotid sheath and opened maximally. It is characterized by paroxysms of unilateral, lancinating pain, which radiates from the side of the thyroid cartilage to the. A case of superior laryngeal nerve paresis and psychogenic. A prospective, randomized trial of nerve monitoring of the external branch of the superior laryngeal nerve during thyroidectomy under localregional anesthesia and iv sedation. Superior laryngeal neuralgia after acute laryngitis and treatment with a single injection of a local anesthetic omer aydin, md. Superior laryngeal neuralgia is an uncommon condition that requires prompt treatment.
This pdf is available for free download from a site hosted by medknow publications. The internal superior laryngeal nerve ibsln enervates the larynxs mucus membranes, and the external superior laryngeal nerve ebsln controls the cricothyroid and inferior constrictor muscles found in the throat. The pain was reversed by superior laryngeal nerve block, followed by superior larnygeal neurectomy. This disorder has failed to achieve the status of general recognition among the cephalic neuralgias. The study included 102 patients with interventions on the thyroid gland performed in the surgical clinics of st. Refractory neuralgia of the superior laryngeal nerve. From an anatomical point of view, the superior laryngeal nerve branches off the vagus nerve. Ct showed unusual calcified components, very rarely observed and potentially misleading for diagnosis.
Ct features of an unusual calcified schwannoma of the. Injection therapy of the superior laryngeal nerve neuralgia with a mixture of 2% lidocaine and 40% triamcinolone acetenoide. Clinical characteristics, diagnostic workup, and treatment options are presented and compared to other lessknown anterior neck pain syndromes. Often however, this is not discernible intraoperatively and likely to originate from the smaller distal nerve fibres in the laryngeal submucosa. Injury to the external branch of the superior laryngeal nerve esln can cause a hoarse or weak voice with dysergia of the cricothyroid. An in vivo model of external superior laryngeal nerve paralysis. Injury to the recurrent laryngeal nerve rln is an unwelcome and not unfrequent complication of operations on or near the upper thoracic or cervical esophagus. The sinus tract can be lateral to the recurrent laryngeal nerve and inferior to the superior laryngeal nerve.
The recurrent laryngeal nerves supply all of the intrinsic muscles of the larynx except for the cricothyroid muscle and any damage to the recurrent laryngeal can result in vocal cord dysfunction. Monitoring the external branch of the superior laryngeal. Although slnb was effective, the procedure can increase the risks due to the proximity to the carotid artery, external vein, and other vessels. The right and left nerves are not symmetrical, with the left nerve looping under the aortic arch, and the right nerve looping under.
Although vocal cord function contributes to the ability to breathe, swallow, and phonate effectively, up to 40% of individuals with vcp may be asymptomatic 3. Whether its orphanage derives from narrowminded expulsion from the neurological domain of cephalic neuralgias to the entfield, or can be attributed to its rarity though this did not keep glossopharyngeal neuralgia from rightfully assuming its place among equals, or to the hazy outlines of. Superior laryngeal nerve syndrome and the evaluation of. Recovery of laryngeal function after intraoperative injury.
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