Split vagus nerve and recurrent laryngeal nerve abductor anastomosis

1. Neck trauma or thyroid surgery damage the recurrent laryngeal nerve, and people with breathing difficulties. 2. The distal end of the recurrent laryngeal nerve can be found in the operation and the proximal end of the recurrent laryngeal nerve can not be found or the defect is too much. Treatment of diseases: open neck injury Indication 1. Neck trauma or thyroid surgery damage the recurrent laryngeal nerve, and people with breathing difficulties. 2. The distal end of the recurrent laryngeal nerve can be found in the operation and the proximal end of the recurrent laryngeal nerve can not be found or the defect is too much. Contraindications 1. The sacral cartilage joint is stiff or fixed or the intercondylar area has fibrous scar adhesion. 2. The patient's general condition is too poor to tolerate the operator. 3. If the two ends of the recurrent laryngeal nerve can be found and have sufficient length, it is estimated that no tension after anastomosis should first use the recurrent laryngeal nerve end anastomosis. Surgical procedure Tracheotomy First, tracheotomy was performed under local anesthesia. The third to fifth rings of the trachea were dissected, and an anesthesia cannula with a balloon was inserted to start general anesthesia. 2. Patient position and incision Take the supine position, the head is biased to the opposite side, so that the neck of the operation side is straight. If the thyroid surgery injury should be cut along the original surgical incision. If there is no incision in the neck, the lower edge of the flat annular cartilage is made into a transverse incision. The skin, subcutaneous tissue and platysma are cut open, and the flaps are lifted up and down respectively. An incision can also be made at the leading edge of the sternocleidomastoid muscle. 3. Explore the recurrent laryngeal nerve Find the distal end of the recurrent laryngeal nerve and follow it to the larynx. The recurrent laryngeal nerve is located on the posterior medial side of the annulus. The anterior medial thyroid cartilage is divided into two anterior and posterior medial larynx. The anterior branch enters the larynx to support the larynx adductor muscle, and the posterior branch enters the posterior iliac crest muscle, and the vocal cord abduction. Find the posterior branch of the recurrent laryngeal nerve. 4. Open the vagus nerve The vagus nerve trunk is found posterior to the common carotid artery and the internal jugular vein. The medial part of the vagus nerve trunk is the bundle of recurrent laryngeal nerve fibers, which is injected into the nerve sheath with 1% procaine to separate the nerve fibers from the sheath. Under the operating microscope, the nerve sheath is cut longitudinally, and the splanchnic nerve trunk outside the recurrent laryngeal nerve bundle inside the vagus nerve trunk is identified, and the laryngeal nerve bundle is sharply separated, and the laryngeal nerve bundle is cut at an appropriate length to bring it closer. The abduction of the lateral and recurrent laryngeal nerves was tension-free sutured with a 10-0 atraumatic suture, and the vagus nerve sheath was closed. 5. Suture the incision layer by layer.