Course and branches of the recurrent laryngeal nerve, inferior thyroid artery and inferior laryngeal artery

Length, width, and thickness of the recurrent laryngeal nerve and its extra-laryngeal twigs were estimated. Included is the course of the nerve to the suspensory ligament of the thyroid gland, to the inferior horn of the thyroid cartilage and to trachea and esophagus. The origin of the inferior thyroid artery, its width and course to the twigs of the recurrent laryngeal nerve were studied. The origin zone of the inferior laryngeal artery is also described. The different terms and opinions about the twigs of the truncus thyreocervicalis and the thyroid axis are discussed.     

The superior laryngeal nerve and the superior laryngeal artery

Length, diameter and anastomoses of the nervus vagus and its ganglion inferius were measured 44 halved heads. On the average, 8.65 fiber bundles of the vagus nerve leave the retro-olivary area. In the area of the jugular foramen is the near superior ganglion of the 10th cranial nerve. In this area were found 1.48 (mean value) anastomoses with the 9th cranial nerve. 11.34 mm below the margo terminalis sigmoidea branches off the ramus internus of the accessory nerve which has a length of 9.75 mm. Further anastomoses with the 10th cranial nerve were found. The inferior ganglion of the 10th nerve had a length of 25.47 mm and a diameter of 3.46 mm. Five mm below the ganglion the 10th nerve had a width of 2.9 and a thickness of 1.5 mm. The mean length of the superior sympathetic ganglion was 26.6 mm, its width 7.2 and its thickness 3.4 mm. In nearly all specimens anastomoses of the superior sympathetic ganglion with the ansa cervicalis profunda and the inferior ganglion of the 10th cranial nerve were found. The superior laryngeal nerve branches off about 36 mm below the margo terminalis sigmoidea. The width of this nerve was 1.9 mm, its thickness 0.8 mm on the right and 1.0 mm on the left side. The division in the internal and external rami was found about 21 mm below its origin. Between the n. vagus and thyreohyoid membrane the ramus internus had a length of 64 mm, the length of external ramus between the vagal nerve and the inferior pharyngeal constrictor muscle was 89 mm. Its mean length below the thyreopharyngeal part was 10.7 mm, 8.6 branchlets to the cricothyroid muscle were counted. The superior laryngeal artery had its origin in 80% of cases in the superior thyroideal artery, in 6.8% this vessel was a branch of the external carotid artery. Its average outer diameter was 1.23 mm on the right side and 1.39 mm on the left. The length of this vessel between its origin and the thyreohyoid membrane was 34 mm. In 7% on the right side and in 13% on the left, the superior laryngeal artery reached the larynx through a foramen thyreoideum. Ranges of diameters and lengths of vessels and nerves in the larynx are given.     

Microvasculature of the thyroid gland in the common tree shrew (Tupaia glis): microvascular corrosion cast/scanning electron microscopy study.

A thyroid vascular cast of the common tree shrew (Tupaia glis) was obtained by injection of Batson's No. 17 plastic mixture into the ascending aorta. The cast was studied under the scanning electron microscope. It was found that each half of the gland is supplied by a large superior and a rather small inferior thyroid artery. After plunging into the gland, the arteries divide into smaller branches that are the interlobular, intralobular and follicular arteries (afferent vessels). The basket-like capillaries arising from the follicular arteries and encapsulating thyroid follicles are of large diameter and are arranged in a single layer. The follicular side of the capillary casts was observed to contain numerous small and some large projecting knobs compatible with the presence of fenestrations in the endothelial cells. On the other hand, endothelial nuclear imprints were found mainly on the stromal surface of the follicular capillary casts. Transfollicular capillaries connecting the adjacent follicular capillary networks were also observed. Blood from the follicular capillaries either drains into the follicular veins (efferent vessels) or abruptly drains into the intralobular veins before proceeding to intralobular and interlobular veins, respectively. The interlobular veins are collected into a few small superior, a few larger middle and a few even larger inferior thyroid veins. These veins drain directly into the laryngeal vein lying adjacent to the deep surface of the thyroid gland before joining the jugular vein. Venous valves were identified outside the thyroid gland. In addition, the glomerular capillary island of the parathyroid gland was often seen at the cranioanterolateral and sometimes at the cranioposterolateral aspect of the thyroid gland.     

The effect of lesions of the dorsal acoustic stria on the levels of glutamic acid decarboxylase and GABA transaminase in the inferior colliculus and cochlear nucleus of the guinea-pig

The levels of glutamic acid decarboxylase (GAD) and γ-amino butyric acid-α-oxoglutarate transaminase (GABA-T) have been investigated in the cochlear nucleus and inferior colliculus of the guinea-pig after hemilateral section of the dorsal acoustic stria. Animals were cerebellectomised and the stria on one side cut. Eleven days later the animals were killed and GAD and GABA-T assayed in the respective nuclei. There was no change in the enzyme levels of the inferior colliculi showing no direct GABA-ergic fibres ascending through the stria and terminating in the inferior colliculi. The levels of both GAD and GABA-T in the cochlear nucleus on the operated side decreased significantly. It is concluded that about 30% of the GAD containing terminals in the cochlear nucleus arise from fibres descending through the dorsal acoustic stria. The bulk of the GABA-ergic transmission in the cochlear nucleus is assumed to involve an intrinsic system of short axoned neurones, the majority of which have their nerve endings in the dorsal part of the nucleus.     

The superior thyroid artery perforator flap: anatomical study and clinical series

The redundant tissues of the anterior neck are well suited as a donor site for fasciocutaneous flaps in head and neck reconstruction, with similar skin quality and numerous underlying perforators. However, historic cadaveric research has limited the use of this as a donor site for the design of long and/or large flaps for fear of vascular compromise. The authors undertook an anatomical study to identify the vascular basis for such flaps and have modified previous designs to offer the versatile and reliable superior thyroid artery perforator (STAP) flap. Forty-five consecutive computed tomographic angiograms of the neck were reviewed, assessing the vascular supply of the anterior skin of the neck. Based on these findings, eight consecutive patients underwent head and neck reconstruction using a flap based on the dominant perforator of the region. In all cases, a perforator larger than 0.5 mm was identified within a 2-cm radius of the midpoint of the sternocleidomastoid muscle at its anterior border. This perforator was seen to emerge through the investing layer of deep cervical fascia as a fasciocutaneous perforator and to perforate the platysma on its ipsilateral side of the neck, proximal to the midline. This was seen to be a superior thyroid artery perforator in 89 of 90 sides and an inferior thyroid artery perforator in one case. Eight consecutive patients underwent preoperative imaging and successful flap planning and execution based on this dominant perforator. The superior thyroid artery perforator (STAP) flap demonstrates reliable vascular anatomy and is well suited to reconstruction of a broad range of head and neck defects. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.     

A bilateral maxillofacial trunk in man: an extraordinary anomaly of the carotid system of arteries.

In a Caucasian male, the maxillary artery (M) bilaterally arose with the facial artery anteromedially from the external carotid artery. On the right side, the M entered the infratemporal fossa between the neck of the mandible and the medial pterygoid muscle, whereas the left M pierced the medial pterygoid muscle, first being covered by the muscle and the angle of the mandible. On both sides, the M ran deep to the inferior head of the lateral pterygoid muscle and the buccal nerve. The right M lay deep to the inferior alveolar, but superficial to the lingual nerve, whereas the left inferior alveolar and lingual nerves had formed two roots, thus encircling the left M. The ascending palatine artery was replaced on both sides by palatine branches of the ascending pharyngeal artery. Since a bilaterial maxillofacial trunk with topographical relations as described herein has not been previously reported in man, the embryology and comparative anatomy of this variation are discussed.     

The blood supply of the cervical esophagus.]

In accordance with former authors the arteries for the cervical esophagus originate mainly from the inferior thyroid artery. In a few cases additional vessels originated directly from the subclavian artery. After a variable course they approach the esophagus in a purely transverse direction. The uppermost vessels originating from the inferior thyroid artery may send branches to the posterior wall of the trachea and also supply the anterior wall of the esophagus. The surgical separation of the two organs is dangerous for the esophagus.     

Effects of mandibular distraction osteogenesis on the inferior alveolar nerve: an experimental study in monkeys

A series of experimental studies were performed in monkeys to study the effect of mandibular distraction osteogenesis on the inferior alveolar nerve at different times before and after distraction. A mandible osteotomy was performed and distraction was carried out unilaterally in 10 young rhesus monkeys and bilaterally in six. The intact nerves on the contralateral side of the 10 monkeys were used for the control. Care was taken to avoid destroying the integrity of the inferior alveolar nerve during the surgical procedure. After a 5-day latency period, the distraction device was activated at a rate of 0.5 mm twice each day for 15 days. Sensory nerve action potential testing was applied before and 1 day after the operation, at completion of distraction, and at 2, 4, 6, 9, and 12 weeks of fixation. Necropsy was performed at the completion of distraction and 2, 4, 6, and 12 weeks of fixation. The mental nerves were taken, sectioned, and stained with lead citrate and uranyl acetate, and examined with a transmission electron microscope. The inferior alveolar nerves in the distraction gap were obtained, and paraffin slides were made and stained with hematoxylin and eosin, Luxol fast blue, and Bodian methods. The authors found that immediately after the mandible osteotomy, most nerves showed signs of slight acute injury; the latency was increased by 5.553 percent, and the amplitude was decreased to 1808 microV. This might be caused by the surgical procedure or by compressions produced by swelling tissues around the nerves. When distraction was completed, the latency was prolonged for an average of 22.18 percent, and the amplitude average had attenuated to 28.54 percent (804 microV) of the preoperative value on the distracted side. Most nerve fibers exhibited signs of degeneration, such as myelin disruption, swelling of cell organs greatly increased in axoplasm, axon tearing, and myelin fragments engulfed by macrophages. These were nerve reactions to the tensions produced by mandible lengthening. As time elapsed, the nerve's action potential recovered gradually because of its repairing ability, the latency shortened, amplitude increased, Schwann cells proliferated and formed new myelin sheaths, and the tearing axons reconnected. After 12 weeks of consolidation, there was still a latency of 12.384 percent prolongation because of the prolonged conduction distance, and the average amplitude was restored to 2786 microV, the approximate preoperative value. The nerve seemed to be repaired completely; its myelin thickness, axon diameter, and ultrastructure were all similar to those of the control. It was concluded that mandibular distraction osteogenesis can produce some degree of harmful effects on the function and structure of inferior alveolar nerves, but it is reversible and relatively slight. Along with the regeneration of the nerve's myelin and axon, the nerve function can gradually rehabilitate to a normal level.     

The innervation of the thyroid gland of the sand rat (Psammomys obesus)

It has been reported on the occurence of vegetative neurons in the stroma of the sand rat (Psammomys obesus) thyroid gland. The cells show all the typical signs of autonomic nerve cells. In contrast to neurons appearing in the pancreas of the sand rat, the neurons in the thyroid gland occur in most cases as singular neurons. The importance of the sympathetic innervation for the thyroid function has been discussed and the close relationship between thyroid hormone secretion and biogenic amines localized in the thyroid mast cells has been described as well.     

Neural tumours of the neck presenting as thyroid nodules: a report of three cases

OBJECTIVES: Neural tumours of the neck may at times secondarily involve the thyroid and manifest clinically as thyroid nodules. On cytological evaluation these nodules may be confused with other spindle lesions of the thyroid. We report two cases of schwannoma and one case of a malignant peripheral nerve sheath tumour (MPNST) of the neck, which presented as thyroid nodules and evaluate the role of cytology in identifying these tumours. METHODS: The thyroid nodules in all the three cases were sampled by the non-aspiration technique using a 23-gauge needle. Both alcohol-fixed and air-dried smears were prepared and stained by the Papanicolaou and May-Grünwald-Giemsa stains. Cytology smears and histology sections from the resected specimens were reviewed, and the findings noted. RESULTS: Both the cases of schwannoma were correctly identified on cytology while the case of MPNST could only be typed as a spindle cell tumour. However, on cytology it was not possible to state whether the tumours were thyroidal or extrathyroidal in origin. CONCLUSIONS: Schwannomas of the neck are easily identifiable on cytology compared with MPNST. However, cytology alone is not helpful in identifying the origin of these tumours. As primary neural tumours of the thyroid are rare, the possibility of a soft tissue neural tumour extending into the thyroid should always be ruled out while evaluating these cases.     

The human maxillary artery reinvestigated: I. Topographical relations in the infratemporal fossa.

The topographical relations of the human maxillary artery (IM) in the infratemporal fossa were studied in 102 individuals of both sexes. In the majority of the cases (55.4%), the artery was found in a lateral position to the lower head of the lateral pterygoid muscle (LPTER). In most of these specimens, the IM ran also lateral to the inferior alveolar, lingual and buccal nerves (type LA, 37.2%), whereas in 16.1% only the buccal nerve crossed the IM laterally (type LB). In 4.6%, the artery occupied a medial position to the LPTER. With respect to the branches of the mandibular nerve, an IM, passing deep to the LPTER, was lying either lateral to its main sensory branches (type MA, 1.9%) or coursing lateral to the inferior alveolar and lingual nerves, but medial to the buccal nerve (type MB, 23.8%). In 4.9%, the artery, running medial to the LPTER and the buccal nerve, was found to pierce the inferior alveolar nerve (type MC). In 7.4%, the IM was running medial to both the inferior alveolar and buccal nerves, but lateral to the lingual nerve (type MD), and in 3.9% the IM passed deep to all the branches of the mandibular nerve (type ME). Besides those common anatomical patterns, seven specimens showed different variations of the mandibular nerve. In about one third of the individuals, an asymmetric position of the IM to the LPTER (LM or ML) was present. None of the four cephalometric parameters and the two cephalic indices recorded in 55 individuals showed a significant correlation to the actual position of the IM (lateral or medial).     

Kaposi's sarcoma of the thyroid gland in an HIV-negative woman: a case report

BACKGROUND: Kaposi's sarcoma (KS) is a neoplastic disease that affects primarily the skin, but visceral involvement is not uncommon. Most of the cases are seen in AIDS patients and transplant recipients; however, rare HIV-negative cases have also been reported. Involvement of the thyroid is exceedingly rare, with only a fw cases reported, all of them associated with AIDS. CASE: A 45-year-old, black, Haitian woman presented with a slowly enlarging left side of the thyroid. Computed tomography showed multiple thyroid nodules, and there was no uptake of iodine on the nuclear scan. Fine needle aspiration of the lesion was performed. The smears were composed of spindle and plasmacytoid cells, which raised the possibility of medullary carcinoma. The patient underwent left hemithyroidectomy. Histologic examination showed KS in the thyroid. CONCLUSION: We present the first case of KS of the thyroid in a HIV-negative patient. Familiarity with the cytologic features can be useful in making the diagnosis.     

甲状腺全切除术与半切除术治疗甲状腺癌的临床效果分析

目的:比较甲状腺全切除术与半切除术治疗甲状腺癌的临床效果。方法:选取我院收治的90例甲状腺癌患者,对所有患者行甲状腺全切除术或近全切除术,同时应用I131以及甲状腺激素抑制治疗作为辅助治疗,并对所有患者进行随访。结果:两组患者的术中出血量、喉返神经显露率比较差异无统计学意义(P0.05),观察组的手术切口以及手术时间均明显长于对照组(P0.01),甲状旁腺显露率高于对照组(P0.01)。两组患者暂时性、永久性喉返神经损伤,暂时性、永久性甲状旁腺功能低下发生率比较差异无统计学意义(P0.05)。复发率为13.33%(6/45),观察组无复发,两组患者术后复发率比较差异具有统计学意义(P0.05)。结论:甲状腺全切除术治疗甲状腺癌的效果优于半切除术,且能够有效降低术后复发率。     

The effects of unilateral and bilateral neurectomy of inferior alveolar nerves on the frequency of PCNA-positive keratinocytes in basal layer of gingival epithelium in Lewis rats

The aim of our study was to establish the role of sensory denervation on gingival epithelium proliferation. We investigated the effect of unilateral (right side) and bilateral neurectomy of inferior alveolar nerve on PCNA-positive (PCNA+) cell frequences in the basal layer of gingival epithelium in male Lewis rats. The samples were taken in each group both from left and right side of gingiva, and the PCNA+ cells were counted separately in the epithelium from both sides in all groups. The results of our study indicate that the proliferation of gingival epithelium, expressed as percentage of PCNA+ nuclei of basal layer keratinocytes of gingival squamous epithelium, is better correlated with the trauma than with denervation.     

Human Vagus Nerve Branching in the Cervical Region

BackgroundVagus nerve stimulation is increasingly applied to treat epilepsy, psychiatric conditions and potentially chronic heart failure. After implanting vagus nerve electrodes to the cervical vagus nerve, side effects such as voice alterations and dyspnea or missing therapeutic effects are observed at different frequencies. Cervical vagus nerve branching might partly be responsible for these effects. However, vagus nerve branching has not yet been described in the context of vagus nerve stimulation.ResultsCervical vagus nerve branching was observed in 29% of all cases (26% unilaterally, 3% bilaterally) and proven histologically in all cases. Right-sided branching (22%) was more common than left-sided branching (12%) and occurred on the level of the fourth and fifth vertebra on the left and on the level of the second to fifth vertebra on the right side. Vagus nerves without branching were significantly larger than vagus nerves with branches, concerning their diameters (4.79 mm vs. 3.78 mm) and cross-sections (7.24 mm² vs. 5.28 mm²).DiscussionCervical vagus nerve branching is considerably more frequent than described previously. The side-dependent differences of vagus nerve branching may be linked to the asymmetric effects of the vagus nerve. Cervical vagus nerve branching should be taken into account when identifying main trunk of the vagus nerve for implanting electrodes to minimize potential side effects or lacking therapeutic benefits of vagus nerve stimulation.     

Lateralized memory storage and crossed inhibition during odor processing by Limax

After odor conditioning intact Limax maximus and injecting LY into their haemocoel, labeled groups of neurons are found in either the right or left procerebral lobe but never in both procerebral lobes. This suggests that a competitive interaction occurs between right and left odor processing pathways of which the procerebral lobe is a part. We use the nerve discharge in the external peritentacular nerve evoked by applying a puff of conditioned odor to the nose to document crossed inhibition between left and right odor processing pathways. Responses in the external peritentacular nerve evoked by stimulating one superior nose with a conditioned odor are strongly lateralized as responses occur only on the stimulated side. Stimulating both superior noses simultaneously with the same conditioned odor yields responses in both external peritentacular nerves that resemble the sum of responses to unilateral stimulation. Simultaneously stimulating both superior noses, each with a different conditioned odor, leads to strong inhibition of both external peritentacular nerve responses. The crossed inhibition is also evident if both superior and inferior noses on the same side are stimulated simultaneously. A lateral inhibitory mechanism, situated postsynaptic to odor recognition, appears to inhibit external peritentacular nerve responses if the two noses receive conflicting sensory inputs. Accepted: 14 December 1999     

甲状腺再次手术治疗的临床分析

目的:探讨甲状腺再次手术的原因、手术方式的选择和手术效果以及患者的预后情况。方法:统计哈尔滨医科大学附属第二医院普外科2001年1月到2015年9月期间收治的1600例初次行甲状腺手术的患者,回顾分析其中175例再次行甲状腺手术患者的临床资料。结果:甲状腺再次手术采用双侧甲状腺次全切除术为92例,单侧甲状腺次全切除术为72例,甲状腺癌根治术为11例。甲状腺再次手术患者术后出现甲状腺功能减退、气管和喉返神经损伤、出血以及缺钙引起的手足抽搦等概率高,与首次手术比较差异有统计学意义(P0.05)。术后1年内对再次手术的患者进行随访,其中复发12例(病理确诊为甲状腺癌3例,结节性甲状腺肿9例),其他类型甲状腺疾病无复发。结论:甲状腺再次手术较初次手术难度较大,术中及术后并发症较多,再次手术应谨慎选择术式及术中精细操作。     

高频超声与喉镜检查对甲状腺癌侵犯喉返神经的术前评价价值分析

目的:比较高频超声与喉镜检查对甲状腺癌侵犯喉返神经(recurrent laryngeal nerve,RLN)的术前评价价值。方法:选择2012年2月到2019年8月在本院进行诊治的甲状腺癌患者207例,采用高频超声与喉镜进行术前评估侵犯喉返神经情况,记录超声特征并判断诊断价值(以病理检查作为金标准)。结果:在207例甲状腺癌患者中,术后病理学证实喉返神经侵犯52例(侵犯组),转移率为25.1%。侵犯组的性别、年龄、发病位置、体重指数、病程等与非侵犯组患者对比差异无统计学意义(P0.05)。侵犯组超声显示病灶形态、内部回声、边界、钙化、晕环等特征与非侵犯组对比差异有统计学意义(P0.05),主要表现为侵犯组的病灶形态不规则、无晕环、无钙化、边界不清晰、内部高超声均显著高于非侵犯组(P0.05)。侵犯组的峰值强度(Peak intensity,PI)值高于非侵犯组患者(P0.05),两组达峰时间(Peak time,TP)与AUC值对比差异无统计学意义(P0.05)。在207例患者中,高频超声判断为喉返神经侵犯43例,喉镜判断为喉返神经侵犯39例,高频超声与喉镜检查对甲状腺癌侵犯喉返神经的术前诊断敏感性为97.7%和97.4%,特异性为93.9%和91.7%,高频超声诊断的敏感性和特异性比喉镜检查稍优。ROC曲线显示高频超声诊断的AUC为0.903,喉镜检查的AUC为0.860。结论:高频超声与喉镜检查对甲状腺癌侵犯喉返神经的术前评价的应用价值相当,均有很高的敏感性与特异性,能准确反映患者侵犯喉返神经的情况。     

METASTATIC CARCINOMA OF THE THYROID GLAND AS THE INITIAL MANIFESTATION OF THE DISEASE

During the past 38 years, 260 patients with thyroid carcinoma have been operated upon at the University of California Hospital. In 26 of these patients the first symptom was a mass distant from the thyroid gland, and the gland was considered normal on clinical examination.In all but three of the 26 cases a small carcinoma of the thyroid gland was observed at operation or in pathological examination.Radical neck dissection with either total lobectomy or total thyroidectomy would seem to be the operation of choice in the treatment of these patients.The ultimate prognosis, even in the presence of metastases, is relatively good.Primary carcinoma of the thyroid gland should be considered in the presence of tumors of the side of the neck even in the absence of palpable nodules in the gland itself.     

Inferior alveolar nerve reconstruction with a polyglycolic acid bioabsorbable nerve conduit.

A custom-designed polyglycolic acid (PGA) bioabsorbable nerve conduit was used to reconstruct a 25-mm defect in the right inferior alveolar nerve. The initial nerve injury, following a dental extraction, resulted in loss of lower lip sensation and severe facial pain. Sixteen months after tooth extraction, with no improvement in symptomatology, the alveolar canal was enlarged in diameter by means of mandibular osteotomy to accommodate a 2-mm-diameter polyglycolic acid tube. The proximal end of the inferior alveolar nerve was sutured into the polyglycolic acid tube. The mental nerve was sutured into the distal end of the tube. Pain of neural origin was relieved in the early postoperative period. Two years following nerve reconstruction, pain relief remains excellent and perception of pressure and vibration is similar to the thresholds for these perceptions on the contralateral lip.