Rheumatoid arthritis (RA) is a chronic inflammatory disease that affects the synovial membrane, causing joint damage and bone destruction. Symptoms of cricoid arytenoid joint (CJ) arthritis often include a voice change and a feeling of fullness in the throat and pharynx. In some cases, bilateral CJ invasion may require an emergency tracheostomy due to acute airway closure. This report describes a 45-year-old man who suffers from voice changes and aspiration due to a vocal cord palsy caused by RA, along with bilateral CJ invasion. One month after receiving drug treatment for rheumatoid arthritis, the patient regained normal voice.

Intraoperative Neuromonitoring (IONM) using endotracheal tube with surface electrodes has gain acceptance as an adjunct tool to preserve the recurrent laryngeal nerve in thyroid surgery. The electromyographic (EMG) tube based IONM has many advantages and is well validated, but it also has some disadvantages. This article is written to review alternative techniques for IONM in thyroid surgery except EMG tube.

The non-recurrent laryngeal nerve is a rare neurological disorder associated with the underdeveloped subclavian artery. During thyroidectomy, this abnormal nerve can be inadvertently damaged, causing permanent vocal cord paralysis. However, preoperative diagnosis of the abnormal subclavian artery can predict the presence of non-relapsed laryngeal nerve. We report a case of right recurrent laryngeal nerve-related thyroid surgery that was not noticed preoperatively on a CT scan of the neck but was accidentally encountered during thyroidectomy. Preoperative CT scan showed an abnormal right subclavian artery in the posterior esophagus, but was unnoticed. A female patient underwent total thyroidectomy with central compartment node autopsy for thyroid cancer. The recurrent laryngeal nerve on the left side was identified, as well as the non-relapsed laryngeal nerve on the right side. Postoperatively, the patient had normal vocal cord function. By identifying the abnormal right recurrent laryngeal nerve with a CT scan of the neck, it is possible to predict the right recurrent laryngeal nerve preoperatively, which may help prevent vocal cord paralysis.

Intraoperative neuromonitoring (IONM) has been introduced as a promising technology that can help minimize recurrent nerve injury. The IONM can identify anatomical variations and unusual nerve routes, which are associated with increased risks of injury if they are not identified. The IONM helps predict postoperative nerve function. Moreover, by detecting nerve injury intraoperatively, it allows a surgeon to stage bilateral surgery to avoid bilateral vocal cord paralysis and tracheotomy. This review summarizes definition of electrophysiologic adverse signal including loss of signal, and their incorporation into the staged bilateral thyroidectomy process.

Routine visual identification of the recurrent laryngeal nerve (RLN) is the gold standard of care during thyroidectomy because it is associated with low rates of RLN palsy. Over the last two decades, intraoperative neuromonitoring (IONM), which allows for assessment of the RLN’s functional integrity during the operation, has been widely used for risk minimization in thyroid surgery as a valuable adjunct to visual nerve identification. Currently, one of the most important trends in IONM is the real-time monitoring of the vagus nerve (VN) to prevent iatrogenic injury of RLN. Continuous IONM (C-IONM) seems to be superior to intermittent IONM (I-IONM) because it enhances standardization by permanent VN stimulation and provides entire and constant RLN function monitoring during thyroidectomy procedures. In this article, we provide a comprehensive review of the C-IONM technique.

Background and Objectives The prevalence of intraoperative neuromonitoring (IONM) has not been reported. Thus, we evaluated the prevalence of three kinds of IONM in the Korean population using data from the Korean National Health Insurance Service (KNHIS). Materials and Methods Using the data of the Healthcare Big Data Hub by KNHIS, the annual prevalence of intraoperative neurophysiologic monitoring at one site/≥ 2 or more sites (IONM one/two) from 2010 through 2020 and intraoperative laryngeal nerve monitoring in thyroid and parathyroid surgery (IOLNM) from 2017 through 2020 were measured. Results The number of IOLNMs increased from 2,872 in 2017 to 5,427 in 2020. The number of IONMs increased from 1,521 in 2010 to 2,144 in 2020. The number of IONM two continuously increased from 4,689 in 2010 to 16,450 in 2020. Conclusion As expected, the prevalence of IONM is increasing overall. This study provides the exact change in the prevalence of IONM in a Korean population using real-world data.

Intraoperative neuromonitoring (IONM) during thyroid surgery may be beneficial to identify and preserve the recurrent laryngeal nerve or the external branch of superior laryngeal nerve. However, false positive or false negative outcomes during IONM has been considered as limitations and lead to failure of successful IONM. To minimize such failures, experts in IONM during thyroid surgery have suggested to follow the standardized procedure of IONM, which begins and ends with supra-threshold vagal stimulation. In this article, tips to follow the procedure will be introduced with review of related studies.

Schwannoma is a benign peripheral nerve sheath tumor. Although rarely found in the oral cavity, it is most commonly found on the tongue, followed by the palate, palate, buccal mucosa, and mandible. Because schwannoma of the base of the tongue is so rare, it is often not included in the differential diagnosis immediately, delaying identification and treatment. We report a case of schwannoma at the base of the tongue misdiagnosed as lingual thyroid, along with a literature review. A 28-year-old man presented with a tongue mass, which was first discovered a month ago. The preoperative diagnosis was lingual thyroid gland on physical findings and computed tomography findings. The permanent pathological report of the mass was schwannoma. After surgery, the patient had no problems with tongue function and wound healing.

The external branch of the superior laryngeal nerve (EBSLN) innervates the cricothyroid muscle (CTM) and plays a major role in producing high-frequency voice. The EBSLN usually travels along with the superior thyroid vessels and crosses them above the superior thyroid pole. However, anatomical variants exist, and some EBSLNs are more intimately associated with the superior pole of the thyroid, placing the nerve at high risk for injury during thyroid and parathyroid surgeries. Several classification schemes have been introduced in order to categorize EBSLNs according to their anatomy and risk for injury, including the Cernea Classification scheme. As with the recurrent laryngeal nerve (RLN), visual identification of the nerve is the gold standard for preventing EBSLN injury. However, despite sparse published evidence, intraoperative neuromonitoring (IONM) has surfaced as a valuable adjunct to visual inspection in identifying and preserving the EBSLN, especially for the nerves that are not readily visible. This review discusses the significance of EBSLN, the current evidence for use of IONM, and the techniques for neuromonitoring of EBSLN.

Legal and ethical guidelines direct health care professionals to perform their duties in a manner acceptable to society. Intraoperative neuromonitoring (IONM) is not a prerequisite for registration, such as permission and certification. Because patients receiving IONM are particularly vulnerable and need additional protection, it is important to explore the ethical and legal aspects of these practices. Therefore, we would like to examine the ethical aspects of neuromonitoring.

Implant overdenture treatment planning should be carried out meticulously to ensure positive treatment outcomes over several years. Various factors, namely the number of implants to be placed, their length and diameter, type of abutment, nature of the residual edentulous ridge, available bone density, interarch distance, jaw relation, mouth opening, soft tissue architecture, design of the prosthesis, including the type of teeth and their size, and type of attachment to be used should all be taken into consideration while planning the treatment. The maintenance phase of the implant therapy includes the implant, prosthesis, and attachments. The treatment connects the dentist, patient, and hygienist triad. The dentist with the support of the hygienist should provide detailed explanations regarding the treatment and motivate the patient, and the patient, in turn, should sincerely follow the protocol for maintenance as explained by the dentist. The patient should also come back for periodic recall visits as scheduled by the prosthodontist/implantologist. This overview covers the evolving and changing aspects of mandibular implant overdenture treatment and maintenance.

Nowadays, laparoscopic adrenalectomy has been the gold standard treatment for benign surgical adrenal disease. Traditionally, the transperitoneal approach was most widely used for laparoscopic adrenalectomy. Recently, the posterior retroperitoneoscopic adrenalectomy (PRA) was introduced and it showed several benefits over the traditional approach, such as less complications and pain, and a shorter operative time and hospitalization. The number of surgeons capable of performing PRA is steadily increasing world-wide. The initial surgical step in this procedure is the identification and exposure of the upper part of kidney, which is the only visible landmark in the fat-abundant retroperitoneal space. Therefore, PRA in a renal agenesis (RA) patient is challenging for the surgeon due to the absence of surgical landmarks. In this article, we describe our experience of performing a PRA on the RA patient. The patient was a 62-year-old female, who had hypertension for 20 years. Blood examination revealed a high renin-aldosterone ratio, and computed tomography scan and adrenal venous sampling confirmed a 2.4 cm left adrenal aldosterone-producing adenoma. PRA was safely performed using three trochars. The total operation time was 55 minutes, and there were no complications.