人喉返神经分支的应用解剖研究

目的：了解喉返神经在喉内的分支及分布,为施行选择性喉返神经吻合术提供解剖学依据。方法：５０例正常人新鲜喉标本进行系统的显微神经解剖研究。结果：９５％喉返神经在距同侧环甲关节下方１．０－２．５ｃｍ处形成喉返神经喉外分叉点,根据分支情况可将分为三型。喉内肌除环甲状外,均由喉返神经前支支配,其中８８％的环杓后肌为喉返神经前支发出单支支配;１２％为双支支配,结论：在甲状软骨板后下部处开窗,可显露同侧喉返神     

有关喉上神经和杓间肌的解剖学研究

虽然目前已公认喉返神经分布于同侧除环甲肌以外之所有喉内肌肉,喉部粘膜感觉神经来自喉上神经之喉内支与喉返神经之分支。然而对喉上神经是否有一分支分布于杓间肌的内收肌始终存在着争论。作者首先回顾了过去有关喉部肌肉及粘膜感觉神经分布之各种意见,然后描述在6—25倍手术显微镜下对12例22侧新鲜尸检喉部标本进行的显微解剖和6例3—4个月胎儿喉组织切片的观察结果:(1)喉上神经仅有穿通支经过杓间肌分布于喉后部粘膜,并无分支终止于杓间肌。(2)喉上神经的最下支向下越过环杓后肌与喉返神经感觉支相吻合,形成Galeni攀。     

喉科学

20010838人喉返神经分支的应用解剖研究/何晓光…//临床耳鼻咽喉科杂志一2000,14(9)一387一389 目的:了解喉返神经在喉内的分支及分布,为施行选择性喉返神经吻合术提供解剖学依据。方法:对50例正常人新鲜喉标本进行系统的显微神经解剖研究。结果:95%喉返神经在距同侧环甲关节下方1.0一2.scm处形成喉返神经喉外分叉点,根据分支情况可将其分为三型。喉内肌除环甲肌外,均由喉返神经前支支配,其中88%的环构后肌为喉返神经前支发出单支支配;12%为双支支配。结论:在甲状软骨板后下处开窗,可显露同侧喉返神经前支及其喉内第一个分支一一环构后肌支(…     

选择性喉返神经吻合术治疗喉麻痹的实验研究

目的 研究不同神经源分别支配受损喉返神经内收及外展肌支的神经肌电表现。方法 将实验组犬左喉返神经完全切断，再将其外展肌支及内收肌支分别同期与同侧膈神经支及颈袢胸舌肌支吻合，吻合术后6个月分别用神经电图仪、光镜、电镜及直达喉镜等方法全面检测甲杓肌与环杓后肌神经肌电活动情况，所得数据用统计学方法进行分析。结果 吻合术后6个月，喉内收及外展肌均出现动作电位波，其甲杓肌潜伏期与术前比较无差异，甲杓肌神经传导速度已恢复正常，环杓后肌神经传导速度稍慢。结论 选择性喉返神经吻合术最大限度地从生理及解剖上避免了吻合术后喉内肌的联带运动问题，达到了预期目的。     

喉上神经与喉返神经变异吻合支1例

随机选用30具成年尸体，男27具，女3具；所有尸体均非死于头颈部疾病，头颈部及喉部外观正常、无畸形。在进行喉显微解剖研究时，发现1具男性成年尸体左侧喉返神经喉主干在位于第2气管环附近，气管食管沟处发出1神经支。该神经支向上内走行于环杓后肌表面直接与左侧喉上神经内支的下支吻合，病理切片证实为神经组织。据我们查阅的国内外文献资料，未见喉上神经内支（ISLN）与喉返神经直接吻合的描述，现报告如下。     

人喉盖仑神经吻合支新解剖分类研究

目的 进一步研究人喉盖仑(Galen)神经吻合支的解剖构成及分类。方法 用显微神经解剖方法对100例新鲜人半喉及其喉神经进行系统地研究,对其结果进行统计学分析。结果 人喉盖仑神经吻合支分为上、下两个解剖部分,上部来源于喉上神经内支的末梢支,下部来源于喉返神经后支的末梢支。在此基础上,将其解剖类型分为三型,并认为其出现率既非30％亦非60％,而是91％。结论 来源于喉返神经后支的喉内与喉上神经内支的吻合支才是盖仑神经吻合支,按其解剖构成分三型,Ⅰ型占75％,Ⅱ型占20％,Ⅲ型占5％,年龄因素不影响其出现率,左、右侧出现率无显著性差异。盖仑神经吻合支在喉神经感觉传导通路上所发挥的作用,仍有待进一步研究。     

正常喉诱发电位特点的研究

目的 分析正常喉肌诱发电位特点,得出其参数正常参考值范围,以利于喉神经功能的评估.方法 检测36例健康受试者72侧喉诱发电位反应,刺激相应喉返神经、喉上神经内、外支及迷走神经,检测诱发肌电反应潜伏期、时程、波幅(电位).结果 甲杓肌喉返神经诱发肌电潜伏期正常参考值(-x±2s,以下同)为(1.13～2.25)ms,迷走神经诱发肌电潜伏期(2.57～5.85)ms,迷走神经与喉返神经潜伏期相比差异有统计学意义(P＜0.01);其中右侧迷走神经诱发肌电潜伏期(2.01～4.53)ms,左侧迷走神经(3.70～6.98)ms,双侧比较差异有统计学意义(P＜0.01),左侧明显较右侧长.诱发肌电时程和波幅各神经亦略有差异,时程差异较小,波幅值变化较大.刺激喉上神经(外支)在环甲肌可直接引出诱发电位,其波形和潜伏期与喉返神经诱发电位大致相同,刺激喉上神经(内支)在甲杓肌、环杓侧肌和环杓后肌可引出反射性感觉诱发电位前波R1和迟发波R2.结论 喉各支配神经诱发电位特点各不相同;神经诱发电位的潜伏期相对时程和波幅来说,是更重要的评估参数.     

喉功能保留外科相关的喉功能解剖

目的 了解喉功能的解剖学基础,为喉癌、下咽癌手术保留喉功能提供解剖依据.方法 对4例成年男性尸体喉部的环杓关节相关肌肉、神经及血管进行解剖观察,根据肌肉的起止点与肌纤维方向分析各肌肉的作用.结果 甲杓肌位于喉腔内,环杓后肌、环杓侧肌、杓横肌及杓斜肌位于喉软骨支架的后外周面;在相关肌肉的作用下,以环杓关节面为核心,杓状软骨可以完成旋转与滑动运动;环杓后肌与环杓侧肌可以开大、缩小声门,对保证正常的喉功能有更重要的作用;喉返神经于气管食管沟内自下而上支配环杓后肌、环杓侧肌、杓横机、杓斜肌及甲杓肌等肌肉;喉下动脉自甲状腺下动脉发出后走行于环杓后肌的背侧,供血于环杓关节相关组织.结论 一侧完整的环杓关节及功能正常的环杓后肌与环杓侧肌是保留喉功能喉部分切除术的最基本条件.     

环杓关节在延期喉内肌神经再支配后的变化

目的：观察环杓关节在延期喉内肌神经再支配后的变化及对杓状软骨运动的影响。方法：在喉返神经切断后，将犬分为两组：实验组（６、８、１０、１２和１８个月后行延期神经再支配）和对照组（相同时间无神经再支配），观察其杓状软骨运动及环杓关节组织学变化。结果：１２个月以内行喉内肌神经再支配后环杓关节纤维化有不同程度的逆转，而１８个月行喉内肌神经再支配后环杓关节纤维化不可逆。结论：越早行喉内肌神经再支配对环杓关节     

喉科学

20011402人喉盖仑神经吻合支新解剖分类研究/何晓光…//听力学及言语疾病杂志一2001,9(1)一24一26 目的:进一步研究人喉盖仑(Galen)神经吻合支的解剖构成及分类。方法:用显微神经解剖方法对100例新鲜人半喉及其喉神经进行系统地研究,对其结果进行统计学分析。结果:人喉盖仑神经吻合支分为上、下两个解剖部分,上部来源于喉上神经内支的末梢支,下部来源于喉返神经后支的末梢支。在此基础上,将其解剖类型分为三型,并认为其出现率既非30%亦非60%,而是91%。结论:来源于喉返神经后支的喉内与喉上神经内支的吻合支才是盖仑神经吻合支,按其解剖构成…     

The innervation of the human posterior cricoarytenoid muscle: Evidence for at least two neuromuscular compartments

Recent work has demonstrated that the dog posterior cricoarytenoid (PCA) muscle is composed of three neuromuscular compartments: a vertical, an oblique, and a horizontal. In this study, the human PCA muscle was examined for evidence of neural compartments. Fifteen human PCA muscles were processed by Sihler's stain, which renders the muscle translucent while counterstaining the nerve supply. The results clearly show that in all specimens the nerve supply of the human PCA muscle is separated into at least two main branches: one supplies the horizontal compartment and a second further subdivides to innervate both the vertical and oblique compartments. In 10 of the specimens, these nerve branches arose as separate branches from the recurrent laryngeal nerve. In all specimens, the nerve branch to the horizontal compartment was either combined or connected with the nerve branch to the interarytenoid muscle. The results suggest that the different compartments of the PCA muscle have distinct functions. In addition, the strong connections with the interarytenoid nerve complicate reinnervation procedures to reanimate a paralyzed or transplanted larynx.     

Topographic anatomy of the external branch of the superior laryngeal nerve. Its importance in head and neck surgery

The authors have studied the anatomy of the external branch of the superior laryngeal nerve in its entirety on 40 fresh cadavers, and they have drawn the following conclusions: the nerve ramifies from the vagus immediately below the nodose ganglion or in the ganglion itself. The nerve splits into two branches approximately 1.5 cm below the ganglion nodosum. In four cases, both branches originated from the vagus itself. In one case, anastomosis of the external branch of the superior laryngeal nerve with the recurrent nerve was found. The external branch of the superior laryngeal nerve is not usually severed at supraglottic laryngectomy but the nerve is at risk during neck dissections, resection of Zenker's diverticula and thyroidectomy. An accurate knowledge of its course should reduce the incidence of injury to the branches of the superior laryngeal nerve during surgery.     

The supraglottic nerve supply: an anatomic study with clinical implications

OBJECTIVES: To describe the course of the superior laryngeal nerve (SLN) and its branches, in particular, with regard to supraglottic motor and sensory functions. METHODS: In 30 normal human hemilarynges, the SLN with its internal (intSLN) and external branch (extSLN) were dissected under microsurgical conditions and marked with acrylic dye. All anatomic structures of the larynges (muscles, cartilages, and ligaments) were dissected in detail. RESULTS: The intSLN subdivides into three branches. The superior branch (I) runs to the lingual (extralaryngeal) part of the epiglottis and sends small fibers through the epiglottic foramina to the laryngeal surface. The middle branch (II) runs through the aryepiglottic fold into the ventricular fold, and the inferior branch (III) to the piriform sinus and to the postcricoid region, forming various anastomoses (e.g., ansa galeni) with the recurrent laryngeal nerve (RLN). The extSLN runs to the cricothyroid muscle (CT) and sends a branch through the CT along the lower rim of the thyroid cartilage into the larynx and up to the ventricular fold. This ventricular branch is a potential candidate for the innervation of the ventricular muscle (VM). CONCLUSIONS: Our results may contribute to a better understanding of supraglottic actions that provide primary functions of the larynx (such as swallowing, coughing, and breathing). An enhanced knowledge of neurolaryngology also provides a basis for interpreting disorders or paralyzes following surgical treatments (e.g., thyroid surgery, partial laryngectomy) and helps to lower the risks.     

Motor Innervation of the Guinea Pig Interarytenoid Muscle: Reinnervation Process Following Unilateral Denervation

The authors investigated the process of denervation and reinnervation of the interarytenoid (IA) muscle in the guinea pig using transmission electron microscopy and glycogen depletion technique after unilateral transection of the recurrent laryngeal nerve (RLN) and superior laryngeal nerve to clarify the innervation pattern of the unpaired IA muscle. Anastomosis between the bilateral arytenoid branches was confirmed in the belly of the IA muscle. Five weeks after transection, all of the IA muscle fibers appeared to have been reinnervated by the contralateral RLN. As the arytenoid branch of the RLN runs together with that of the contralateral RLN in a single intramuscular nerve funiculus, it is possible that collateral sprouting branches grow and extend into the adjacent denervated Schwann's sheaths. The authors conclude that the unpaired IA muscle, as a whole, receives specific motor nerve supply from the bilateral RLNs, although each muscle fiber is innervated unilaterally.     

Variability in nerve patterns of the adductor muscle group supplied by the recurrent laryngeal nerve

INTRODUCTION: Accurate knowledge of the nerve supply of each individual muscle is needed to achieve a successful selective reinnervation of the larynx. The aim of the present work was to study the nerve supply of the adductor laryngeal muscles supplied by the recurrent laryngeal nerve. STUDY DESIGN: Morphologic study of human larynges. METHODS: The muscular nerve supply was studied in a total sample of 75 human larynges obtained from necropsies (47 males and 28 females, age range from 41-95 years) and examined by careful dissection using a surgical microscope. RESULTS: The arytenoid muscle received one branch from each recurrent nerve. In 88% of cases, this branch arose in a common trunk with the upper branch of the posterior cricoarytenoid muscle. In 8% of cases, the nerve for the arytenoid muscle also had a branch going to the lateral cricoarytenoid muscle. The arytenoid muscle also received from one to three pairs of branches from the posterior division of the internal laryngeal nerve; these were interconnected ipsi- and contralaterally and were also connected to the two branches coming from the recurrent laryngeal nerve. The lateral cricoarytenoid muscle received from one to six branches from the recurrent nerve, but in 5.8% of cases, it also received a twig from a connecting branch between the recurrent nerve and the external (5.6%) or the internal laryngeal nerves (0.2%). The thyroarytenoid muscle received from one to four branches from the recurrent nerve, but in 5.6% of cases, it also received a twig from a connecting branch between the recurrent nerve with the external (4.6%) or the internal (1%) laryngeal nerves. CONCLUSION: No abductor or adductor division of the recurrent laryngeal nerve was found in the present study. In 88% of cases, the nerve supply to the arytenoid muscle (adductor) and the posterior cricoarytenoid muscle (abductor) arose from a common trunk, which in 8% of cases, also had a branch to the lateral cricoarytenoid muscle. Furthermore, the high incidence of branches innervating the adductor muscles from connections between the recurrent laryngeal nerve and the internal and external laryngeal nerves led us to reconsider the contribution of these nerves in the supply to this muscle group.