• Journal of Chest Surgery
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• v.50 no.5
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• pp.391-394
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• 2017

Recurrent laryngeal nerve injury can develop following cervical or thoracic surgery; however, few reports have described intraoperative recurrent laryngeal nerve monitoring. Consensus regarding the use of this technique during thoracic surgery is lacking. We used intraoperative recurrent laryngeal nerve monitoring in a patient with contralateral vocal cord paralysis who was scheduled for completion pneumonectomy. This case serves as an example of intraoperative recurrent laryngeal nerve monitoring during thoracic surgery and supports this indication for its use.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.27 no.2
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• pp.130-133
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• 2016

Rheumatoid arthritis (RA) is a connective tissue disease involving the larynx in 30 % of the patients. Foreign body sensation, hoarseness, and cough are common symptoms in laryngeal involvement. An urgent tracheostomy is required when acute airway obstruction occurs in case of bilateral vocal fold paralysis. The most common cause of bilateral vocal fold paralysis in RA patients is a cricoarytenoid joint arthritis. Laryngeal nerve degeneration is rare cause of bilateral vocal fold paralysis in RA patients. In this case report, an emergent tracheostomy was performed on a 64-years-old male patient with acute dyspnea, and concurrent involvement of RA on laryngeal nerve and cricoarytenoid joint was revealed by laryngeal electromyography and histopathology. The vocal fold mobility was restored after 3-months medical treatment.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.7 no.1
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• pp.5-10
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• 1996

From October 1991 to June 1995, 4 medialization thyroplasties and I arytenoid adduction were simultaneously performed with the thyroid surgery when the unilateral recurrent laryngeal nerve was paralyzed before or during thyroidectomy. Four cases were papillary carcinoma with direct invasion to the unilateral recurrent laryngeal nerve, and one case was huge adenomatous goiter and the recurrent laryngeal nerve was incidentaly cut. Hoarseness was present preoperatively with mean duration of 15 months and aspiration was also present in three cases. After phonosurgery, voice was improved in 4 out of 5 cases and aspiration subsided in 2 out of 3 cases. In one case, hoarseness continued after total thyroidectomy and thyroplasty type I and the arytenoid adduction with planned due to posterior glottic gap of 2mm. We suggest that the thyroplasty type I or arytenoid adduction are primary phonosurgical procedures which ran be performed concomitantly with neck surgeries in the patients with paralysis of the unilateral recurrent laryngeal or vagus nerve damage during neck surgeries.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.10 no.2
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• pp.130-134
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• 1999

Background and Objectives : Vocal fold paralysis is an unusual complication following endotracheal intubation. We experienced five cases and analyzed their causes and preventions. Materials and Methods : We reviewed 5 cases of vocal fold paralysis following general anesthesia with endotracheal intubation at Ewha Womans University Hospital from September 1997 to May 1999 retrospectively. Results : Four cases were unilateral vocal fold paralysis(3 cases were left side, 1 case was right side) and a case was bilateral vocal fold paralysis. Conclusion : Vocal fold paralysis following endotracheal intubation is the result of recurrent laryngeal nerve damage. This damage can occur as the result of compressing the anterior branch of recurrent laryngeal nerve between an inflated endotracheal tube cuff and thyroid cartilage. Prevention of this complication lies in eliminating the use of endotracheal tubes with cuff inflated unevenly, desisting from the practice of deliberately placing the cuff within the larynx, and filling the cuff with a sample of the inspired mixture of gases.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.11 no.2
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• pp.188-191
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• 2000

In thyroid and parathyroid surgery, damage to the recurrent laryngeal nerve(RLN) is the most common iatrogenic cause of vocal cord paralysis. Identification and preservation of the BLNs and meticulous technique can siginificantly decrease the incidence of this complication. We experienced one case of NRRLN in a patient with the parathyroid adenoma. During the dissection, there was no branch to be considered as RLN in tracheoesophageal groove. While searching for the RLN, We found a white structure coursing horizontally at the level of cricoid cartilage directly arising from the vagus nerve in the carotid sheath. That structure was nonrecurrent recurrent laryngeal nerve(NRRLN) and NRRLNs are exceedingly rare. Awareness of the possibility of NRRLN will prevent the surgeon from accidentally severing one if it is encountered during surgery.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.31 no.1
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• pp.1-6
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• 2020

In unilateral vocal fold paralysis (UVFP) patients, we try to improve their symptoms such as hoarseness or aspiration by restoring nerve functions or medialization laryngoplasty (ML), etc. Until now, ML (thyroplasty and/or arytenoid adduction) is considered as gold standard of treatment for UVFP. However, if recurrent laryngeal nerve (RLN) is damaged and use of RLN is feasible during operation, laryngeal reinnervation (LR) would be a good option. Anastomosis with ansa cervicalis to RLN is most common reinnervation method. Delayed LR may be considered in young patients when the RLN denervation period is not long (less than 2 years) for the treatment of surgery-related UVFP. Injection laryngoplasty and laryngeal framework surgery showed great voice outcomes in UVFP. Combination therapy (neuromuscular pedicle innervation with ML) also showed good post-operative voice outcomes even in longer periods (over 2 years). In pediatric patients, LR would be considered as a good treatment option because all procedures need to general anesthesia.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.30 no.2
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• pp.139-141
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• 2019

The causes of vocal cord paralysis include iatrogenic injury during thyroid or cervical surgery, heart and chest surgery, and tumorous lesion such as laryngeal cancer and lung cancer. In addition to these common causes, rarely, cardiovascular disease can also cause vocal fold paralysis. A disease known as Cardiovocal syndrome, or Ortner's syndrome, causes left vocal fold paralysis when the left recurrent laryngeal nerve is compressed by the pulmonary artery and aorta, which is occurred by pulmonary hypertension from heart disease. We report for the first case in Korea the diagnosis of vocal fold paralysis caused by Ortner's syndrome.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.10 no.1
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• pp.30-36
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• 1999

Background and Objectives : Laryngeal Evoked Electromyography(EEMG) is a objective, quantitative technique to determine innervation status of larynx. The possible applications of this technique are to confirm the etiology of impaired vocal fold motion and monitor perioperative vagus nerve trauma. The purpose of this study is to develop a novel method for determining the amount of reinnervation of recurrent laryngeal nerve with accurate, inexpensive, and minimally invasive technique in human. Materials and Methods : Laryngeal EEMG was performed for 16 adults with intact vocal folds motion and 2 patients diagnosed as unilateral vocal fold paralysis. for the purpose of searching what is the optimal and noninvasive technique for laryngeal EEMG, we used 2 types of stimulation configurations(transcutaneous vs percutaneous) and 2 types of recording configurations(intramuscular vs. surface). Results and Conclusions : Percutaneous needle stimulation and surface recording of laryngeal EEMG was reliable and comparable to standard needle stimulation and invasive intramuscular needle recording. But the laryngeal EEMG by the surface recording and transcutaneous surface stimulation was not reliable and repeatable. Therefore we recommended that laryngeal EEMG by surface recording and percutaneous needle stimulation would be minimally invasive, reliable technique to know the status of reinnervation in e patients with vocal fold paralysis.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.11 no.2
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• pp.178-184
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• 2000

Laryngeal evoked EMG is the objective and quantitative method to measure the innervation of laryngeal muscle. If there is a mobility disorder of vocal cords, the cause and location of neural lesion co be understood by the laryngeal evoked EMG and if there is a vocal cord paralysis, the degree of recovery and the policy of treatment can be determined by it. Recently, the studies of reinnervation after recurrent laryngeal nerve injury have been actively carried out. Laryngeal evoked EMC is useful to these studies. The aim of study is to know whether noninvasive methods for stimulating the recurrent laryngeal nerve and for recording of compound action potential(CAP) using surface electrode are as useful as the invasive method using needle electrode. We obtained EMG of laryngeal muscle by various stimulating and recording methods : 1) Direct nerve stimulation by placing nerve cuff electrode made out of silastic tube and platinum wire and recording by insertion of hook wire electrode into posterior cricoarytenoid(PCA) and thyroarytenoid(TA) muscles, respectively. 2) Recording of compound action potential by surface electrode after stimulation of recurrent laryngeal nerve by the insertion of 27 gauge of needle electrode. 3) Recording of compound action potential by surface electrode after stimulating the recurrent laryngeal nerve by transcutaneous blunt rod electrode at tracheoesophageal groove. The amplitude, duration and latency of the CAP evoked by recurrent laryngeal nerve stimulation were compared among the three groups. The amplitude of CAP was smallest in the group recorded from posterior cricoarytenoid and hyroarytenoid muscle, and that recorded by surface electrode after stimulation by needle electrode was largest. The difference in amplitude between the group by hook wire recording and the two groups by surface electrode recording was significant statistically. There is no significant difference in duration and latency among three groups. Since the waveform of CAP from all three methods has similar duration, latency, we concluded that noninvasive method is a useful as invasive methods.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.16 no.1
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• pp.81-84
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• 2005

Vagus nerve palsy caused by herpes virus infection is rare. Here, the author presents a 65-year-old woman with acute onset of right side otalgia and sore throat, followed by delayed vocal fold paralysis on the same side. Vesicles were also found on the posterior wall of ear canal but the tympanic membrane was not involved. Laryngoscopy revealed multiple ulcerative lesions on the pharyngeal and laryngeal mucosa exclusively on the right side. One month later, she noticed dyshonia which turned out right vocal fold paralysis. Skull base to upper chest CT did not reveal local lesion. Three months after finishing the acyclovir, her symptoms were almost gone and vocal fold movement has almost completely improved. Vagus nerve involvement of herpes infection should be considered as a differential diagnosis for patients with herpes zoster oticus with sore throat.