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Surgical anatomy of the internal branch of the superior laryngeal nerve.

ABSTRACT: The internal branch of the superior laryngeal nerve (ibSLN) may be injured during anterior approaches to the cervical spine, resulting in loss of laryngeal cough reflex, and, in turn, the risk of aspiration pneumonia. Such a risk dictates the knowledge regarding anatomical details of this nerve. In this study, 24 ibSLN of 12 formaldehyde fixed adult male cadavers were used. Linear and angular parameters were measured using a Vernier caliper, with a sensitivity of 0.1 mm, and a 1 degrees goniometer. The diameter and the length of the ibSLN were measured as 2.1+/-0.2 mm and 57.2+/-7.7 mm, respectively. The ibSLN originates from the vagus nerve at the C1 level in 5 cases (20.83%), at the C2 level in 14 cases (58.34%), and at the C2-3 intervertebral disc level in 5 cases (20.83%) of the specimens. The distance between the origin of ibSLN and the bifurcation of carotid artery was 35.2+/-12.9 mm. The distance between the ibSLN and midline was 24.2+/-3.3 mm, 20.2+/-3.6 mm, and 15.9+/-4.3 mm at the level of C2-3, C3-4, and at the C4-5 intervertebral disc level, respectively. The angles of ibSLN were mean 19.6+/-2.6 degrees medially with sagittal plane, and 23.6+/-2.6 degrees anteriorly with coronal plane. At the area between the thyroid cartilage and the hyoid bone the ibSLN is the only nerve which traverses lateral to medial. It is accompanied by the superior laryngeal artery, a branch of the superior thyroid artery. The ibSLN is under the risk of injury as a result of cutting or compression of the blades of the retractor at this level. The morphometric data regarding the ibSLN, information regarding the distances between the nerve, and the other consistent structures may help us identify this nerve, and to avoid the nerve injury.

SUBMITTER: Kiray A

PROVIDER: S-EPMC2438561 | biostudies-other | 2006 Sep

REPOSITORIES: biostudies-other

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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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Surgical anatomy of the internal branch of the superior laryngeal nerve.

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