el-Guindy A, Abdel-Aziz M
Department of Otolaryngology, Tanta Faculty of Medicine, Egypt.
J Laryngol Otol. 2000 Apr;114(4):268-73. doi: 10.1258/0022215001905535.
Iatrogenic lesions of the superior laryngeal nerve (SLN) are much more common than is generally recognized. Since injury to this nerve may cause transient or even persistent changes either in quality of voice or in deglutition, an attempt should be made to localize and identify the nerve during surgery. This study included 74 patients who underwent surgical dissection near the thyroid apex in the neck. Effective prevention of SLN injury during surgery was achieved by anatomical localization of the nerve in the viscerovertebral angle and its functional identification with the nerve stimulator. Post-operative analysis consisted of subjective interview, rigid laryngoscopy, acoustic analysis, laryngeal videostroboscopy and cricothyroid electromyography. Four patients complained of post-operative voice changes; two were diagnosed as SLN injury (2.4 per cent), one as reflux laryngitis and the fourth as intubation granuloma. Surgical access to the SLN in the periapical area may be achieved through mobilization of the viscerovertebral angle. The use of a nerve stimulator during difficult situations should keep SLN injury at a minimum.
喉上神经（SLN）的医源性损伤比人们普遍认为的更为常见。由于该神经损伤可能导致声音质量或吞咽功能出现短暂甚至持续的变化，因此手术过程中应尝试对该神经进行定位和识别。本研究纳入了74例在颈部甲状腺尖附近接受手术解剖的患者。通过在脏椎角对神经进行解剖定位并使用神经刺激器对其进行功能识别，实现了手术期间对喉上神经损伤的有效预防。术后分析包括主观访谈、硬质喉镜检查、声学分析、喉动态镜检查和环甲肌肌电图检查。4例患者术后出现声音改变；2例被诊断为喉上神经损伤（2.4%），1例为反流性喉炎，第4例为插管肉芽肿。通过脏椎角的松动可实现根尖周围区域喉上神经的手术入路。在困难情况下使用神经刺激器应将喉上神经损伤降至最低。
