Araştırma Çıktıları | WoS | Scopus | TR-Dizin | PubMed
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Publication Metadata only Complication Risk in Secondary Thyroid Surgery(YERKURE TANITIM YAYINCILIK HIZMETLERI AS, 2018) Aygun, Nurcihan; Besler, Evren; Yetkin, Gurkan; Mihmanli, Mehmet; Isgor, Adnan; Uludag, Mehmet; University of Health Sciences Turkey; Bahcesehir UniversityPublication Metadata only Extralaryngeal division of the recurrent laryngeal nerve: A common and asymmetric anatomical variant(AVES, 2017) Uludag, Mehmet; Yetkin, Gurkan; Sen Oran, Ebru; Aygun, Nurcihan; Celayir, Fevzi; Isgor, Adnan; Istanbul Sisli Hamidiye Etfal Training & Research Hospital; Bakirkoy Dr. Sadi Konuk Research & Training Hospital; Bahcesehir UniversityObjective: Recognition of extralaryngeal branching of the recurrent laryngeal nerve is crucial because prevention of vocal cord paralysis requires preservation of all branches of the recurrent laryngeal nerve. We assessed the prevalence of extralaryngeal branching of the recurrent laryngeal nerve and the median branching distance from the point of bifurcation to the entry point of the nerve into the larynx. Material and Methods: Prospective operative data on recurrent laryngeal nerve branching were collected from 94 patients who underwent thyroid or parathyroid surgery between September 2011 and May 2012. Results: A total of 161 recurrent laryngeal nerves were examined (82 right, 79 left). Overall, 77 (47.8%) of 161 recurrent laryngeal nerves were bifurcated before entering the larynx. There were 36 (43.9%) branching nerves on the right and 41 (51.9%) branching nerves on the left, and there was no significant difference between the sides in terms of branching (p=0.471). Among 67 patients who underwent bilateral exploration, 28.4% were found to have bilateral branching, 40.3% had unilateral branching, and the remaining 31.3% had no branching. The median branching distance was 15 mm (5-60mm). Conclusion: Extralaryngeal division of recurrent laryngeal nerve is a common and asymmetric anatomical variant. These variations can be easily recognized if the recurrent laryngeal nerve is identified at the level of the inferior thyroid artery and then dissected totally to the entry point of the larynx. Inadvertent division of a branch may lead to vocal cord palsy postoperatively, even when the surgeon believes the integrity of the nerve has been preserved.Publication Metadata only A palsied recurrent laryngeal nerve should be explored and evaluated by intraoperative neuromonitoring during secondary thyroidectomy: report of two cases(SPRINGER, 2015) Uludag, Mehmet; Yetkin, Gurkan; Oran, Ebru S.; Aygun, Nurcihan; Celayir, Fevzi; Kartal, Abdulcabbar; Isgor, Adnan; Istanbul Sisli Hamidiye Etfal Training & Research Hospital; Bahcesehir UniversityIntroduction: Our aim was to evaluate the findings of intraoperative nerve monitoring (IONM) in two cases with preoperative vocal cord palsy. Case 1: a 61-year-old female with recurrent goiter underwent secondary thyroidectomy. The preoperative evaluation of the vocal cords revealed right vocal cord paralyses without atrophy. The right recurrent laryngeal nerve (RLN) was found to be anatomically intact and preserved. The electrical responses of the vocal cords were elicited via IONM. Case 2: a 26-year-old male, who presented with preoperative right vocal cord palsy with atrophy, underwent completion thyroidectomy secondary to papillary carcinoma. The right RLN was explored and found to be tied and interrupted. There was no signal from the RLN with IONM. Conclusion: Even in cases with vocal cord palsy detected preoperatively, the nerve should be explored intraoperatively, and should never be sacrificed before an evaluation by nerve monitoring. A palsied RLN which has electrical activity should be protected to maintain the vocal cord's neural tone and to prevent its atrophy.Publication Metadata only A Closer Look at the Recurrent Laryngeal Nerve Focusing on Branches & Diameters: A Prospective Cohort Study(TAYLOR & FRANCIS INC, 2016) Uludag, Mehmet; Yazici, Pinar; Aygun, Nurcihan; Citgez, Bulent; Yetkin, Gurkan; Mihmanli, Mehmet; Isgor, Adnan; Istanbul Sisli Hamidiye Etfal Training & Research Hospital; Bahcesehir UniversityAim: We aimed to investigate the anatomical characteristics of the recurrent laryngeal nerve (RLN) highlighting on its diameter and branching pattern. Materials and Methods: We prospectively collected 215 patients (178 female, 37 male) who underwent thyroid/parathyroid surgery during over a 2-year period. Apart from demographic features and surgical data, diameter of RLNs, and their branches and as well as branching distance (distance between the point of bifurcation and the laryngeal entry of RLN) were recorded. Results: In 215 patients, 378 RLNs were assessed and 42% (n = 159) bifurcated RLNs were observed. The bifurcation rate was similar on the right and left side(s) of the neck (40% and 44%, respectively, p = 0.47). In those, who underwent bilateral exploration, in the case of bifurcation on the first side of the neck, the possibility of contralateral bifurcation was approximately 50%, whereas this rate was found to be only 30% in those with nonbranching RLNs. Mean branching distance was 18 +/- 9mm, and it was similar on the right and left sides (17 and 19mm, respectively). Approximately 80% of bifurcations were observed within 5-24mm of the RLN. Mean diameter of the anterior branches was found to be significantly larger compared to posterior branches (1.09 +/- 0.35 and 0.82 +/- 0.36mm, respectively, p < 0.01).Conclusions: There is great variability in RLN branching. We observed that approximately two out of three bifurcations were unilateral and anterior branches were thicker compared to posterior branches. These findings should be taken into consideration to avoid any damage to the RLN during thyroid and parathyroid surgery.Publication Metadata only Contribution of intraoperative neural monitoring to preservation of the external branch of the superior laryngeal nerve: a randomized prospective clinical trial(SPRINGER, 2017) Uludag, Mehmet; Aygun, Nurcihan; Kartal, Kinyas; Citgez, Bulent; Besler, Evren; Yetkin, Gurkan; Kaya, Cemal; Ozsahin, Hamdi; Mihmanli, Mehmet; Isgor, Adnan; Istanbul Sisli Hamidiye Etfal Training & Research Hospital; Bahcesehir UniversityPurpose The purpose of this study was to evaluate the effect of intraoperative neuromonitoring (IONM) on the injury rate of the external branch of the superior laryngeal nerve (EBSLN) during thyroidectomy. Methods A total of 133 consenting patients (98 female, 35 male, mean age, 45.6 +/- 11.7 years) undergoing thyroidectomy were randomly assigned to 2 groups. In group 1 (n = 65 patients, 105 nerves), superior thyroid pole dissection was performed with no attempt to identify the EBSLN, in group 2 (n = 68 patients, 106 nerves), IONM was used to identify the EBSLN during surgery. EBSLN function was evaluated by intraoperative electromyography of the cricothyroid muscle. The EBSLN Voice Impairment Index-5 (VII-5) was conducted preoperatively and at 1, 3, and 6 months postoperatively. The primary outcome was the prevalence of EBSLN injury. The secondary outcomes were the identification rate of the EBSLN using IONM and changes in postoperative voice performance. Results EBSLN injury was detected in eight (12.3%) patients and nine (8.6%) nerves in group 1 and in one (1.5%) patient and one (0.9%) nerve in group 2 (patients, p = 0.015, nerves, p = 0.010). IONM contributed significantly to visual (p < 0.001) and functional (p < 0.001) nerve identification in group 2. The VII-5 indicated more voice changes in group 1 than 2 at 1, 3, and 6 months postoperatively (p = 0.012, p = 0.015, and p = 0.02, respectively). Conclusion IONM contributes to visual and functional identification of the EBSLN and decreases the rate of EBSLN injury during superior pole dissection. Routine use of IONM to identify the EBSLN will minimize the risk of injury during thyroidectomy.