Journal of Korean Neurosurgical Society

  • 제48권5호
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  • Pages.406-411
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  • 2010
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  • 2005-3711(pISSN)
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  • 1598-7876(eISSN)
대한신경외과학회 (The Korean Neurosurgical Society)
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Hypopharyngeal Wall Exposure within the Surgical Field : The Role of Axial Rotation of the Thyroid Cartilage during Anterior Cervical Surgery

  • Choi, Byung-Kwan (Department of Neurosurgery, School of Medicine, Pusan National University) ;
  • Cho, Won-Ho (Department of Neurosurgery, School of Medicine, Pusan National University) ;
  • Choi, Chang-Hwa (Department of Neurosurgery, School of Medicine, Pusan National University) ;
  • Song, Geun-Sung (Department of Neurosurgery, School of Medicine, Pusan National University) ;
  • Kim, Choon-Grak (Department of Statistics, Pusan National University) ;
  • Kim, Hak-Jin (Department of Radiology, School of Medicine, Pusan National University)
  • 투고 : 2010.03.30
  • 심사 : 2010.11.26
  • 발행 : 2010.11.28
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초록

Objective : Esophageal/hypopharyngeal injury can be a disastrous complication of anterior cervical surgery. The amount of hypopharyngeal wall exposure within the surgical field has not been studied. The objective of this study is to evaluate the chance of hypopharyngeal wall exposure by measuring the amount of axial rotation of the thyroid cartilage (ARTC) and posterior projection of the hypopharynx (PPH). Methods : The study was prospectively designed using intraoperative ultrasonography. We measured the amount of ARTC in 27 cases. The amount of posterior projection of the hypopharynx (PPH) also was measured on pre-operative CT and compared at three different levels; the superior border of the thyroid cartilage (SBTC), cricoarytenoid joint and tip of inferior horn of the thyroid cartilage (TIHTC). The presence of air density was also checked on the same levels. Results : The angle of ARTC ranged from $-6.9^{\circ}$ to $29.7^{\circ}$, with no statistical difference between the upper and lower cervical group. The amount of PPH was increased caudally. Air densities were observed in 26 cases at the SBTC, but none at the TIHTC. Conclusion : Within the confines of the thyroid cartilage, surgeons are required to pay more attention to the status of hypopharynx/esophagus near the inferior horn of the thyroid cartilage. The hypopharynx/esophagus at the TIHTC is more likely to be exposed than at the upper and middle part of the thyroid cartilage, which may increase the risk of injury by pressure. Surgeons should be aware of the fact that the visceral component at C6-T1 surgeries also rotates as much as when the thyroid cartilage is engaged with a retractor. The esophagus at lower cervical levels warrants more careful retraction because it is not protected by the thyroid cartilage.

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참고문헌

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피인용 문헌

  1. Does a Medial Retraction Blade Transmit Direct Pressure to Pharyngeal/Esophageal Wall During Anterior Cervical Surgery? vol.40, pp.1, 2010, https://doi.org/10.1097/brs.0000000000000649
  2. Cadaveric Analysis of Posterior Pharyngoesophageal Wall Thickness: Implications for Anterior Cervical Spine Surgery vol.41, pp.5, 2010, https://doi.org/10.1097/brs.0000000000001217
  3. Normal radiological anatomy of thyroid cartilage in 600 Chinese individuals: implications for anterior cervical spine surgery vol.13, pp.None, 2010, https://doi.org/10.1186/s13018-018-0728-y
  4. The Presence of Thyroid Cartilage at the Surgical Level Reduces Early Dysphagia after Single-Level Anterior Cervical Surgery: A Retrospective Study vol.33, pp.4, 2010, https://doi.org/10.1080/08941939.2018.1520939