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Superior Laryngeal Nerve Identification and Preservation in Thyroidectomy
ORIGINAL ARTICLE Superior Laryngeal Nerve Identification and Preservation in Thyroidectomy Michael Friedman, MD; Phillip LoSavio, BS; Hani Ibrahim, MD Background: Injury to the external branch of the su- recorded and compared on an annual basis for both be- perior laryngeal nerve (EBSLN) can result in detrimen- nign and malignant disease. Overall results were also com- tal voice changes, the severity of which varies according pared with those found in previous series identified to the voice demands of the patient. Variations in its ana- through a 50-year literature review. tomic patterns and in the rates of identification re- ported in the literature have discouraged thyroid sur- Results: The 3 anatomic variations of the distal aspect geons from routine exploration and identification of this of the EBSLN as it enters the cricothyroid were encoun- nerve. Inconsistent with the surgical principle of pres- tered and are described. The total identification rate over ervation of critical structures through identification, mod- the 20-year period was 900 (85.1%) of 1057 nerves. Op- ern-day thyroidectomy surgeons still avoid the EBSLN erations performed for benign disease were associated rather than identifying and preserving it. with higher identification rates (599 [86.1%] of 696) as opposed to those performed for malignant disease Objectives: To describe the anatomic variations of the (301 [83.4%] of 361). Operations performed in recent EBSLN, particularly at the junction of the inferior con- years have a higher identification rate (over 90%). strictor and cricothyroid muscles; to propose a system- atic approach to identification and preservation of this Conclusions: Understanding the 3 anatomic variations nerve; and to define the identification rate of this nerve of the distal portion of the EBSLN and its relation to the during thyroidectomy. -
Larynx Anatomy
LARYNX ANATOMY Elena Rizzo Riera R1 ORL HUSE INTRODUCTION v Odd and median organ v Infrahyoid region v Phonation, swallowing and breathing v Triangular pyramid v Postero- superior base àpharynx and hyoid bone v Bottom point àupper orifice of the trachea INTRODUCTION C4-C6 Tongue – trachea In women it is somewhat higher than in men. Male Female Length 44mm 36mm Transverse diameter 43mm 41mm Anteroposterior diameter 36mm 26mm SKELETAL STRUCTURE Framework: 11 cartilages linked by joints and fibroelastic structures 3 odd-and median cartilages: the thyroid, cricoid and epiglottis cartilages. 4 pair cartilages: corniculate cartilages of Santorini, the cuneiform cartilages of Wrisberg, the posterior sesamoid cartilages and arytenoid cartilages. Intrinsic and extrinsic muscles THYROID CARTILAGE Shield shaped cartilage Right and left vertical laminaà laryngeal prominence (Adam’s apple) M:90º F: 120º Children: intrathyroid cartilage THYROID CARTILAGE Outer surface à oblique line Inner surface Superior border à superior thyroid notch Inferior border à inferior thyroid notch Superior horns à lateral thyrohyoid ligaments Inferior horns à cricothyroid articulation THYROID CARTILAGE The oblique line gives attachement to the following muscles: ¡ Thyrohyoid muscle ¡ Sternothyroid muscle ¡ Inferior constrictor muscle Ligaments attached to the thyroid cartilage ¡ Thyroepiglottic lig ¡ Vestibular lig ¡ Vocal lig CRICOID CARTILAGE Complete signet ring Anterior arch and posterior lamina Ridge and depressions Cricothyroid articulation -
Unusual Morphology of the Superior Belly of Omohyoid Muscle
Case Report http://dx.doi.org/10.5115/acb.2014.47.4.271 pISSN 2093-3665 eISSN 2093-3673 Unusual morphology of the superior belly of omohyoid muscle Rajesh Thangarajan, Prakashchandra Shetty, Srinivasa Rao Sirasanagnadla, Melanie Rose D’souza Department of Anatomy, Melaka Manipal Medical College (Manipal Campus), Manipal University, Manipal, Karnataka, India Abstract: Though anomalies of the superior belly of the omohyoid have been described in medical literature, absence of superior belly of omohyoid is rarely reported. Herein, we report a rare case of unilateral absence of muscular part of superior belly of omohyoid. During laboratory dissections for medical undergraduate students, unusual morphology of the superior belly of the omohyoid muscle has been observed in formalin embalmed male cadaver of South Indian origin. The muscular part of the superior belly of the omohyoid was completely absent. The inferior belly originated normally from the upper border of scapula, and continued with a fibrous tendon which ran vertically lateral to sternohyoid muscle and finally attached to the lower border of the body of hyoid bone. The fibrous tendon was about 1 mm thick and received a nerve supply form the superior root of the ansa cervicalis. As omohyoid mucle is used to achieve the reconstruction of the laryngeal muscles and bowed vocal folds, the knowledge of the possible anomalies of the omohyoid muscle is important during neck surgeries. Key words: Superior belly, Fibrous tendon, Omohyoid, Neck surgery Received March 12, 2014; Revised April 3, 2014; Accepted April 28, 2014 Introduction bellies, absence and adhesion to sternohyoid are the reported anomalies of the superior belly of the OH [2]. -
Levator Claviculae Muscle: a Case Report Konstantinos Natsis*, Stylianos Apostolidis, Elisavet Nikolaidou, Georgios Noussios, Trifon Totlis and Nikolaos Lazaridis
Open Access Case report Levator claviculae muscle: a case report Konstantinos Natsis*, Stylianos Apostolidis, Elisavet Nikolaidou, Georgios Noussios, Trifon Totlis and Nikolaos Lazaridis Address: Department of Anatomy, Medical School, Aristotle University of Thessaloniki, P.O. Box: 300, 54124 Thessaloniki, Greece Email: KN* - [email protected]; SA - [email protected]; EN - [email protected]; GN - [email protected]; TT - [email protected]; NL - [email protected] * Corresponding author Published: 15 May 2009 Received: 12 February 2008 Accepted: 8 April 2009 Cases Journal 2009, 2:6712 doi: 10.1186/1757-1626-2-6712 This article is available from: http://casesjournal.com/casesjournal/article/view/6712 © 2009 Natsis et al; licensee Cases Network Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract In the current study a levator claviculae muscle, found in a 65-year old male cadaver, is presented. We describe the topography and morphology of this accessory muscle, which may be found in 1-3% of the population. Moreover, we discuss the embryologic origin of the muscle along with its clinical importance. Introduction In the current study we present a case of a levator Levator claviculae or cleidocervical muscle is a super- claviculae muscle found in a cadaver and we discuss the numerary muscle in humans, in contrast to anthropoids embryologic origin of the muscle along with its clinical and lower mammals where this muscle is found normally importance. -
Unusual Organization of the Ansa Cervicalis: a Case Report
CASE REPORT ISSN- 0102-9010 UNUSUAL ORGANIZATION OF THE ANSA CERVICALIS: A CASE REPORT Ranjana Verma1, Srijit Das2 and Rajesh Suri3 Department of Anatomy, Maulana Azad Medical College, New Delhi-110002, India. ABSTRACT The superior root of the ansa cervicalis is formed by C1 fibers carried by the hypoglossal nerve, whereas the inferior root is contributed by C2 and C3 nerves. We report a rare finding in a 40-year-old male cadaver in which the vagus nerve fused with the hypoglossal nerve immediately after its exit from the skull on the left side. The vagus nerve supplied branches to the sternohyoid, sternothyroid and superior belly of the omohyoid muscles and also contributed to the formation of the superior root of the ansa cervicalis. In this arrangement, paralysis of the infrahyoid muscles may result following lesion of the vagus nerve anywhere in the neck. The cervical location of the vagus nerve was anterior to the common carotid artery within the carotid sheath. This case report may be of clinical interest to surgeons who perform laryngeal reinnervation and neurologists who diagnose nerve disorders. Key words: Ansa cervicalis, hypoglossal nerve, vagus nerve, variations INTRODUCTION cadaver. The right side was normal. The neck region The ansa cervicalis is a nerve loop formed was dissected and the neural structures in the carotid by the union of superior and inferior roots. The and muscular triangle regions were exposed, with superior root is a branch of the hypoglossal nerve particular attention given to the organization of the containing C1 fibers, whereas the inferior root is ansa cervicalis. -
EDS Awareness in the TMJ Patient
EDS Awareness in the TMJ Patient TMJ and CCI with the EDS Patient “The 50/50” Myofascial Pain Syndrome EDNF, Baltimore, MD August 14,15, 2015 Generation, Diagnosis and Treatment of Head Pain of Musculoskeletal Origin Head pain generated by: • Temporomandibular joint dysfunction • Cervicocranial Instability • Mandibular deviation • Deflection of the Pharyngeal Constrictor Structures Parameters & Observations . The Myofascial Pain Syndrome (MPS) is a description of pain tracking in 200 Ehlers-Danlos patients. Of the 200 patients, 195 were afflicted with this pain referral syndrome pattern. The MPS is in direct association and correlation to Temporomandibular Joint dysfunction and Cervico- Cranial Instability syndromes. Both syndromes are virtually and always correlated. Evaluation of this syndrome was completed after testing was done to rule out complex or life threatening conditions. The Temporomandibular Joint TMJ Dysfunction Symptoms: Deceptively Simple, with Complex Origins 1) Mouth opening, closing with deviation of mandibular condyles. -Menisci that maybe subluxated causing mandibular elevation. -Jaw locking “open” or “closed”. -Inability to “chew”. 2) “Headaches”/”Muscles spasms” (due to decreased vertical height)generated in the temporalis muscle, cheeks areas, under the angle of the jaw. 3) Osseous distortion Pain can be generated in the cheeks, floor of the orbits and/or sinuses due to osseous distortion associated with “bruxism”. TMJ dysfunction cont. (Any of the following motions may produce pain) Pain With: . Limited opening(closed lock): . Less than 33 mm of rotation in either or both joints . Translation- or lack of . Deviations – motion of the mandible to the affected side or none when both joints are affected . Over joint pain with or without motion around or . -
The Role of Strap Muscles in Phonation Laryngeal Model in Vivo
Journal of Voice Vol. 11, No. 1, pp. 23-32 © 1997 Lippincott-Raven Publishers, Philadelphia The Role of Strap Muscles in Phonation In Vivo Canine Laryngeal Model Ki Hwan Hong, *Ming Ye, *Young Mo Kim, *Kevin F. Kevorkian, and *Gerald S. Berke Department of Otolaryngology, Chonbuk National University, Medical School, Chonbuk, Korea; and *Division of Head and Neck Surgery, UCLA School of Medicine, Los Angeles, California, U.S.A. Summary: In spite of the presumed importance of the strap muscles on laryn- geal valving and speech production, there is little research concerning the physiological role and the functional differences among the strap muscles. Generally, the strap muscles have been shown to cause a decrease in the fundamental frequency (Fo) of phonation during contraction. In this study, an in vivo canine laryngeal model was used to show the effects of strap muscles on the laryngeal function by measuring the F o, subglottic pressure, vocal in- tensity, vocal fold length, cricothyroid distance, and vertical laryngeal move- ment. Results demonstrated that the contraction of sternohyoid and sternothy- roid muscles corresponded to a rise in subglottic pressure, shortened cricothy- roid distance, lengthened vocal fold, and raised F o and vocal intensity. The thyrohyoid muscle corresponded to lowered subglottic pressure, widened cricothyroid distance, shortened vocal fold, and lowered F 0 and vocal inten- sity. We postulate that the mechanism of altering F o and other variables after stimulation of the strap muscles is due to the effects of laryngotracheal pulling, upward or downward, and laryngotracheal forward bending, by the external forces during strap muscle contraction. -
Chapter Anatomy
Chapter Anatomy 1 Kyriakos Anastasiadis and Chandi Ratnatunga Chapter Location of extensions of the upper lobes, as well as relationships to the innominate vein, have been described (Figs. 1.3). The thymus gland is located in the anterosuperior me- Thus, rather than being located in its classical anterior po- diastinum. It usually extends from the thyroid gland to sition, one or both of the upper lobe thymus may even lie the level of the fourth costal cartilage. It lies posterior to behind the innominate vein. Moreover, it has to be noted the pretracheal fascia, the sternohyoid and sternothyroid that besides the classical location of the gland, ectopic muscles and the sternum (mostly behind the manubrium thymic tissue could be found in the mediastinal fat of the and the upper part of its body). It is located anteriorly majority of patients. This is now accepted as the normal to the innominate vein and is found between the pari- etal pleura and extrapleural fat and central to the phrenic nerves. It lies on the pericardium, with the ascending aorta and aortic arch behind it, while in the neck it lies over the trachea. Parallel to the gland on each side lie the phrenic nerves, which converge towards the gland at its middle segment (particularly important issue in thymec- tomy procedures). The gland consists classically of two lobes, even though other lobular structures may be pres- ent (Figs. 1.1, 1.2). The thyrothymic ligament connects the upper parts of its lobes to the thyroid gland. A variety Fig. 1.2 Midline cervicothoracic sagittal section material de- monstrating the thymus gland location (1=thyroid isthmus, 2=superficial layer of cervical fascia, 3=pretracheal cervical fa- scia, 4=brachiocephalic trunk, 5=pretracheal space, 6=left bra- chiocephalic vein, 7=sternothyroid muscle, 8=anterior wall of Fig. -
The Anomalous Human Levator Claviculae Muscle: a Case Report
Central Annals of Vascular Medicine & Research Case Report *Corresponding author Kunwar P Bhatnagar, Department of Anatomical Sciences and Neurobiology, University of Louisville, 7000 Creekton, USA, Tel: 150-2456-4779; Email: bhatnagar@ The Anomalous Human Levator louisville.edu Submitted: 08 February 2021 Claviculae Muscle: A Case Accepted: 20 February 2021 Published: 24 February 2021 ISSN: 2378-9344 Report Copyright © 2021 Bhatnagar KP, et al. Kunwar P Bhatnagar1* and Timothy D Smith2 OPEN ACCESS 1Department of Anatomical Sciences and Neurobiology, University of Louisville, USA 2School of Physical Therapy, Slippery Rock University, USA Keywords • Anomalous muscle • Levator claviculae Abstract • omo-trachelien • Omocervicalis This case report describes the observation of a unilaterally present anomalous levator claviculae muscle in a 66 -year-old human male. The observations were made during routine laboratory dissections. In our 80- • Sternomastoideus some years of cumulative human dissection education prior to this detection, this was the first observation (with about 45 cadavers dissected yearly) of this muscle. The levator claviculae muscle was observed with intact nerve supply from the ventral ramus of C3, indicating its functional status. The muscle was lambda (λ)-shaped with its stem oriented cranially, attaching to the fascia of the longus capitis muscle at the level of the transverse process of the fourth cervical vertebra. More inferiorly, the stem splits into a pars medialis and pars lateralis each with fascial attachments to the clavicle within the middle third of the bone. Both parts had fascial attachments to the clavicle within the middle third of the bone, and the lateral part passed medial to the external jugular vein. -
11/1 Welcome to Our Unit on the Organs of Action
LEGS & ARMS UNIT MODULE 1 1 Welcome to Beyond Trigger Point Seminars Legs and Arms Unit Module 1 on the Quadriceps, Adductors & Hamstrings. In this unit we will be exploring myofascial pain syndromes (MPS) of the upper and lower extremities. Like the heart to the circulation system, the legs and arms are our body’s organs of action. Because a majority of our pain clients are presenting with problems in the low back and neck regions, therapists, I’ve noticed, are often focused on only treating these regions. In this unit, you will become more familiar with the many common pain diagnoses of the legs and arms frequently unrecognized as originating from trigger points (TrPs). We will consider the holding patterns down below which are affecting the alignment up above. We may be treating condition specific, but we will also be looking at the entire structure as well. Specifically, by the end of your online studies, you will have a greater understanding of tennis and golfer’s elbow, carpel tunnel syndrome, heal spurs, plantar fasciitis, shin splints, and runner’s and jumper’s knees to innumerate just a few diagnoses we will encounter. Before we get started, let’s do a little housekeeping. If you haven’t already listened to the free introductory lecture, it is available at www.AskCathyCohen.com. Though I try reviewing one or two basic concepts of myofascial pain syndromes with each module, by listening to the intro lecture and filling in its study guide, you’ll maximize your learning. What also helps is setting aside four 60 to 90 minute slots in your appointment book to complete this unit. -
Cervical Spine and Cervicothoracic Junction Alexander R
46 Cervical Spine and Cervicothoracic Junction Alexander R. Riccio, Tyler J. Kenning, John W. German SUMMARY OF KEY POINTS the approximate cervical spinal levels for the purposes of the skin incision. These include the hyoid bone (C3), thyroid • Understanding the anatomy of the cervical spine and cartilage (C4-5), cricoid cartilage (C6), and carotid tubercle neck is of the utmost importance for the surgeon (C6). These landmarks, however, may not be universally reli- operating in this region. able because, depending on a patient’s body habitus, they may be difficult to palpate reliably; moreover, the relationships are • The anatomy of this region can be classified from only an estimate and variability exists. superficial to deep and further analyzed by system, The most prominent structure of the upper dorsal surface including muscle, bone, nerves, vasculature, and soft of the nuchal region is the inion, or occipital protuberance. tissue. This may be palpated in the midline and is a part of the • Regarding the nerves in the neck, more focused occipital bone. The spinous processes of the cervical vertebrae consideration is taken for surgical purposes when may then be followed caudally to the vertebral prominence, discussing the laryngeal nerve as a result of the variably corresponding to the spinous process of C6, C7 (most potential morbidity associated with iatrogenic injury common), or T1. to this nerve. The prominent surface structure of the ventral neck is the • The vertebral artery is discussed in specific detail as laryngeal prominence, which is produced by the underlying well due to its clinical importance and proximity to thyroid cartilage. -
A Comprehensive Review of Anatomy and Regional Anesthesia Techniques of Clavicle Surgeries
vv ISSN: 2641-3116 DOI: https://dx.doi.org/10.17352/ojor CLINICAL GROUP Received: 31 March, 2021 Research Article Accepted: 07 April, 2021 Published: 10 April, 2021 *Corresponding author: Dr. Kartik Sonawane, Uncovering secrets of the Junior Consultant, Department of Anesthesiol- ogy, Ganga Medical Centre & Hospitals, Pvt. Ltd. Coimbatore, Tamil Nadu, India, E-mail: beauty bone: A comprehensive Keywords: Clavicle fractures; Floating shoulder sur- gery; Clavicle surgery; Clavicle anesthesia; Procedure review of anatomy and specific anesthesia; Clavicular block regional anesthesia techniques https://www.peertechzpublications.com of clavicle surgeries Kartik Sonawane1*, Hrudini Dixit2, J.Balavenkatasubramanian3 and Palanichamy Gurumoorthi4 1Junior Consultant, Department of Anesthesiology, Ganga Medical Centre & Hospitals, Pvt. Ltd., Coimbatore, Tamil Nadu, India 2Fellow in Regional Anesthesia, Department of Anesthesiology, Ganga Medical Centre & Hospitals, Pvt. Ltd., Coimbatore, Tamil Nadu, India 3Senior Consultant, Department of Anesthesiology, Ganga Medical Centre & Hospitals, Pvt. Ltd., Coimbatore, Tamil Nadu, India 4Consultant, Department of Anesthesiology, Ganga Medical Centre & Hospitals, Pvt. Ltd., Coimbatore, Tamil Nadu, India Abstract The clavicle is the most frequently fractured bone in humans. General anesthesia with or without Regional Anesthesia (RA) is most frequently used for clavicle surgeries due to its complex innervation. Many RA techniques, alone or in combination, have been used for clavicle surgeries. These include interscalene block, cervical plexus (superficial and deep) blocks, SCUT (supraclavicular nerve + selective upper trunk) block, and pectoral nerve blocks (PEC I and PEC II). The clavipectoral fascial plane block is also a safe and simple option and replaces most other RA techniques due to its lack of side effects like phrenic nerve palsy or motor block of the upper limb.