• Proceedings of the KOR-BRONCHOESO Conference
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• 1997.04a
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• pp.118-118
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• 1997

갑상피열근이나 피열근에 대하여 상후두신경과 반회후두신경의 이중지배(dual supply)는 오랜동안 논란이 되어왔다. 특히 피열근에 분포하는 신경은 반회후두신경의 피열분지에 의해 지배되며 또한 상후두 신경의 내지의 일부인 ramus preforantes에 의해서도 이중지배를 받는다고 알려져왔다. 그러나 한편 이러한 피열근의 운동신경지배 중 상후두신경의 역할에 대해서 적지않은 보고가 후두의 신경해부학적인 고찰 및 전기적 자극을 통한 연구에서 단지 피열근 근처에서 twig을 형성할 뿐, 직접적인 운동지배 현상은 보이지않음을 입증하여 피열근은 오직 반회후두신경에 의해서만 실질적으로 운동지배된다고 주장하였다. 저자는 양측 반회후두신경을 절단한 개 모델에서 피열근에 대하여 HRP 역행성 착색법 후 뇌간에서 살펴본 결과 후두의 운동신경원인의 핵에서 양성으로 표현되는 것을 관찰하였다. 또한 상후두신경의 내지에 대하여 운동신경섬유의 표식자로 여겨질 수 있는 Cholineacetyl transferase(CHAT) 면역염색을 시행한 결과 피열근의 운동신경에 상후두신경이 괸여함을 알 수 있었다.

• Journal of Clinical Otolaryngology Head and Neck Surgery
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• v.29 no.2
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• pp.167-172
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• 2018

• Proceedings of the KSLP Conference
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• 1996.11a
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• pp.95-95
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• 1996

후두근의 운동지배신경에 관하여 일반적으로 알려진 사실은 윤상갑상근이 상후두신경의 의지에 의하여 지배되는 것 외에는 모든 후두내근이 반회후두신경에 의하여 지배된다는 것이다. 이중에서 갑상피열근이나 피열근에 대하여 상후두신경과 반회후두신경의 이중지배(dual supply)는 오랜동안 논란이 되어왔다. 특히 피열근에 분포하는 신경은 반회후두신경의 피열분지에 의하여 지배되며 또한 상후두신경의 내지의 일부인 ramus porforantes에 의해서도 이중지배를 받는다고 알려져 왔다. 그러나 한편 이러한 피열근의 운동신경지배 중 상후두신경의 역할에 대해서 적지 않은 보고가 후두의 신경해부학적인 고찰 및 전기적 자극을 통한 연구에서 단지 피열근 근처에서 twig을 형성할 뿐, 직접적인 운동지배 현상은 보이지 않음을 입증하여 피열근은 오직 반회후두신경에 의하여 운동지배된다고 주장하였다. (중략)

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.26 no.1
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• pp.13-15
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• 2015

Intraoperative neuromonitoring of thyroid surgery has gained universal validity to help in nerve identification, safe nerve dissection, and prediction of postoperative vocal cord function. In this article, standard intraoperative neuromonitoring procedure, interpretation about loss of signal, and the indications covered by health insurance will be described.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.27 no.1
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• pp.14-17
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• 2016

Hoarseness is a postoperative complication of thyroidectomy, mostly due to damage to the recurrent laryngeal nerve (RLN). Hoarseness may also be brought about via vocal cord dysfunction (VCD) due to injury of the vocal cords from manipulations during anesthesia, as well as from psychogenic disorders and respiratory and upper-GI related infections. The clinician or surgeon should 1) document assessment of the patient's voice once a decision has been made to proceed with thyroid surgery ; 2) examine vocal fold mobility, or refer the patient to a clinician who can examine vocal fold mobility 3) examine vocal fold mobility, or refer the patient to a clinician who can examine vocal fold mobility, once a decision has been made to proceed with thyroid surgery 4) educate the patient about the potential impact of thyroid surgery on voice once a decision has been made to proceed with thyroid surgery ; 5) inform the anesthesiologist of the results of abnormal preoperative laryngeal assessment in patients who have had laryngoscopy prior to thyroid surgery ; 6) take steps to preserve the external branch of the surperior laryngeal nerve(s) when performing thyroid surgery ; 7) document whether there has been a change in voice between 2 weeks and 2 months following thyroid surgery ; 8) examine vocal fold mobility or refer the patient for examination of vocal fold mobility in patients with a change in voice following thyroid surgery ; 9) refer a patient to an otolaryngologist when abnormal vocal fold mobility is identified after thyroid surgery ; 10) counsel patients with voice change or abnormal vocal fold mobility after thyroid surgery on options for voice rehabilitation.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.21 no.1
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• pp.37-41
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• 2010

Background and Objectives : Transient minor voice changes after thyroidectomy are not infrequent complaints even in cases without any evidence of recurrent laryngeal nerve damage. However, clinical course, diagnosis and management of such voice changes are not fully understood. This study aimed to evaluate the clinical characteristics of minor voice changes after thyroidectomy. We also tried to assess the significance and feasibility of superior laryngeal nerve monitoring and to find out the optimal evaluation tools for such voice changes after thyroidectomy. Materials and Method : Nine adult patients who received total thyroidectomy without evidence of recurrent laryngeal nerve injury were enrolled for this prospective study. Voice evaluations were performed preoperatively and 3 months postoperatively ; acoustic analyses including voice range profile, aerodynamic study, stroboscopic evaluation and subjective voice assessment with questionnaires. The external branch of superior laryngeal nerve was monitored by nerve stimulator after ligation of superior thyroidal vessels. Results: Four of nine patients complained their voice change at 3 months after the surgery. Three of them reported complete recovery of their voice at 6 months after the surgery. Acoustic analysis revealed significant decrease in their phonatory range especially with high tone loss. Questionnaires related to singing was more sensitive than previously well-known "voice handicap index". Stimulation of the superior laryngeal nerve was feasible in most of the cases (94.4%), but it failed to show any correlation with minor voice changes after thyroidectomy. Conclusion : Minor voice changes were not rare events during the first 6 month after thyroidectomy. Decrease in phonatory range with high tone loss and therefore, discomfort in singing was the most common finding. Superior laryngeal monitoring was feasible but it was not a sensitive tool for the prediction of minor voice change after thyroidectomy.