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Variations of the origin of superior thyroid artery and its relationship with the external branch of superior laryngeal nerve.

ABSTRACT: The superior thyroid artery, the main atrial supply of neck region, is branched from the external carotid artery as a first branch, but it may also arise from the common carotid artery and its bifurcation. The external branch of superior laryngeal nerve runs parallel to it and later crossing the artery either above or below the upper pole of the thyroid gland.This study aimed at evaluating the variations of the origin of superior thyroid artery and its relationship with the external branch of the superior laryngeal nerve.A descriptive study was conducted on 43 embalmed cadavers. The anterior triangle of the neck region was dissected bilaterally. The presence or absence of STA and its origin, branching pattern, relationship with the external branch of the superior laryngeal nerve, level of origin in relation to the lamina of the thyroid cartilage and level of carotid bifurcation were observed and recorded.The superior thyroid artery arises from the external carotid artery in 44.2%, common carotid bifurcation in 27.9% and common carotid artery in 26.7% of cadavers. In one of the cadaver, the superior thyroid artery arises from lingual artery. The origin of superior thyroid artery was significantly associated with its branching pattern and level of common carotid artery bifurcation. The mean distance from the upper pole of the thyroid gland to the level where an external branch of superior laryngeal nerve turns medially from superior thyroid artery was found to be 1.04cm.The wide range of variations of the superior thyroid artery on its origin and relationship with adjacent structures is a common phenomenon. The clinicians should be aware of those variations.

SUBMITTER: Dessie MA

PROVIDER: S-EPMC5944925 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:IntroductionUltrasound-guided internal branch of the upper laryngeal nerve block (USG-guided iSLN block) have been used to decrease the perioperative stress response of intubation. It is more likely to be successful than blindly administered superior laryngeal nerve blocks with fewer complications. Here, we evaluated the efficacy of USG-guided iSLN block to treat postoperative sore throat (postoperative sore throat, POST) after extubation.Methods100 patients, aged from 18 to 60 years old, ASA I~II who underwent general anesthesia and suffered from the moderate to severe postoperative sore throat after extubation were randomized into two groups(50 cases per group). Patients in group S received USG-guided iSLN block bilaterally (60mg of 2% lidocaine, 1.5ml each side), whereas those in group I received inhalation with 100 mg of 2% lidocaine and 1mg of budesonide suspension diluted with normal saline (oxygen flow 8 L /min, inhalation for 15 minutes). The primary outcome were VAS scores in both groups before treatment (T0), 10 min (T1), 30 min(T2), 1h(T3), 2 h(T4), 4h(T5), 8h(T6), 24h(T7), and 48h(T8) after treatment. The secondary outcome were satisfaction scores after treatment, MAP, HR, and SPO2 fromT0 to T8. The adverse reactions such as postoperative chocking or aspiration, cough, hoarseness, dyspnea were also observed in both groups.ResultsPatients in group S had significantly lower VAS score than that in group I at points of T1 ~ T6 (P < 0.01). HR of group S was lower than that of group I at points of T1 ~ T2and T4 (P < 0.05), and MAP was lower than that of group I at points of T1 ~ T3 (P < 0.05). Satisfaction scores of group S were higher than that of group I (P <0.05), In group S, 2 case (4%) needed to intravenous Flurbiprofen Injection 50 mg to relieve pain; in group I, 13 cases (26%) received Flurbiprofen Injection. 2 case of group S appeared throat numbness after treatment for 3 hours; 2 patients have difficult in expectoration after treatment recovered after 3hour. No serious adverse events were observed in both groups.ConclusionCompared with inhalation, USG-guided iSLN block may effectively relieve the postoperative sore throat after extubation under general anesthesia and provided an ideal treatment for POST in clinical work.

Project description:BackgroundTo explore whether the medial branch block of superior laryngeal nerve can reduce the stress response of patients undergoing intubation and further reduce the dosage of opioids.Methods80 patients undergoing gynecological laparoscopic surgery were selected, and randomly divided into 4 groups. All patients in the experimental groups received bilateral internal branch of superior laryngeal nerve block and transversus abdominis plane block. But the dosage of sufentanil used for anesthesia induction in the group A, B, and C was 0.4, 0.2, and 0μg/kg, respectively. Group D do not underwent supralaryngeal nerve block and the dosage of sufentanil was 0.4μg/kg. The heart rate (HR) and mean arterial pressure(MAP) were recorded at the time of entering the operating room(T1), before intubation after induction(T2), immediately after intubation(T3), 5min after intubation(T4), before extubation(T5), immediately after extubation(T6), 5min after extubation(T7). We also recorded the stay time in the recovery room, the number of cases of postoperative sore throat, the number of cases of nausea and vomiting, the first intestinal exhaust time, the length of hospital stay after operation.ResultsThe HR of group A, C and D at T3 was significantly higher than that at T2(P < 0.01), while the HR of group B had no significant change. The HR of group A, C and D at T4 was lower than that at T3(P < 0.01), while the HR of group B had no obvious change. The HR of group C and D at T3 was significantly higher than that at T1 (P < 0.01). The MAP of group A and D at T4 was significantly lower than that at T1 (P<0.001). The first postoperative intestinal exhaust time in group A, B and C was significantly shorter than that in group D. The length of hospital stay after operation in group B and C was shorter than that in group D.ConclusionsUltrasound-guided superior laryngeal nerve block combined with 0.2μg/kg sufentanil can reduce the intubation reaction, have better hemodynamic stability, reduce the first postoperative intestinal exhaust time and postoperative hospital stay, thereby accelerating the postoperative recovery of patients.

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Variations of the origin of superior thyroid artery and its relationship with the external branch of superior laryngeal nerve.

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