Injury to the external branch of the superior laryngeal nerve (EBSLN) can occur during superior pole dissection in thyroid surgery; the EBSLN injury rate is reported as high as 28 % (Cernea et al., Head Neck 14:380–383, 1992). Injury to the EBSLN leads to variable symptoms that may be overlooked, but that can be significant, especially to professional speakers and singers. Intraoperative nerve monitoring (IONM) is employed widely to aid in nerve identification. We report on normative electroneuromyography (EMG) data on EBSLN-IONM and cricothyroid muscle (CTM) twitch response during stimulation as an aid to EBSLN identification.

Surgical hypoparathyroidism (HYPOPARA) is due to insufficient production of parathyroid hormone (PTH) occurring after thyroid, parathyroid, or other neck surgery. It is due to damage or removal of parathyroid tissue. Surgical HYPOPARA can be divided in two main categories:•Following total or subtotal thyroidectomy•Following parathyroid surgery, which can consist of the removal of a single parathyroid adenoma or removal of several affected glands (multiglandular disease) in either primary (PHPT) or secondary (SHPT) hyperparathyroidism.Postsurgical HPT can be transient (t-HYPOPARA) or permanent (p-HYPOPARA). T-HYPOPARA usually resolves within a few weeks, but may persist up to 6 months after surgery. If HYPOPARA persists beyond 6 months, the condition is best referred to as permanent hypoparathyroidism (p-HYPOPARA).

Objectives/HypothesisTo report normative electromyography (EMG) data on the external branch of the superior laryngeal nerve (EBSLN) and to compare this to analogous data of the recurrent laryngeal nerve (RLN) and vagus nerve (VN) during intraoperative neural monitoring (IONM) using both the standard monopolar stimulator probe and a novel bipolar stimulator probe.Study DesignProspective multiple tertiary care center study.MethodA prospective study of EBSLN, RLN and VN EMG data in 22 thyroid surgeries was performed. Subjects with preoperative vocal fold paralysis were excluded. Postoperative laryngoscopy was normal in all subjects. Normative EMG data were acquired using both a standard monopolar and a novel bipolar stimulator probe, as well as a novel endotracheal tube. Cricothyroid muscle (CTM) twitch response during EBSLN stimulation was analyzed.ResultsIn 100% of cases, EBSLN was identified and quantifiable EMG response was observed. EMG amplitude did not change despite extensive nerve dissection and multiple nerve stimulations. EBSLN amplitude was similar for left and right sides for patients under age 50 and aged 50 or older, for both genders, and with monopolar and bipolar stimulators.ConclusionsIntraoperative neural monitoring may be used to safely assist in EBSLN identification during thyroid surgery in 100% of patients. A novel endotracheal tube allows for quantifiable EBSLN EMG activity in 100% of cases. Monopolar and bipolar stimulator probes produce similar EMG data.Level of Evidence4. Laryngoscope, 124:1035–1041, 2014

OBJECTIVE:To elucidate electrophysiologic responses of the recurrent laryngeal nerves that were preoperatively paralyzed or invaded by malignancy and to use this information as an added functional parameter for intraoperative management of recurrent laryngeal nerves with malignant invasion.STUDY DESIGN:Case series with chart review.SETTINGS:Academic, tertiary care center.SUBJECTS AND METHODS:All consecutive neck surgeries with nerve monitoring performed by senior author (GWR) between December 1995 and January 2007 were reviewed after obtaining Institutional Review Board approval from Massachusetts Eye and Ear Infirmary Human Subjects Committee and the Partners Human Research Committee. Electrophysiologic parameters in all cases with preoperative vocal cord paralysis/paresis, and the recurrent laryngeal nerve invasion by cancer, were studied.RESULTS:Of the 1138 surgeries performed, 25 patients (2.1%) had preoperative vocal cord dysfunction. In patients with preoperative vocal cord dysfunction, recognizable recurrent laryngeal nerve electrophysiologic activity was preserved in over 50% of cases. Malignant invasion of the recurrent laryngeal nerve was found in 22 patients (1.9%). Neural invasion of the recurrent laryngeal nerve was associated with preoperative vocal cord paralysis in only 50% of these patients. In nerves invaded by malignancy, 60% maintained recognizable electrophysiologic activity, which was more commonly present and robust when vocal cord function was preserved.CONCLUSION:Knowledge of electrophysiologic intraoperative neural monitoring provides additional functional information and, along with preoperative vocal cord function information, aids in constructing decision algorithms regarding intraoperative management of the recurrent laryngeal nerve, in prognosticating postoperative outcomes, and in patient counseling regarding postoperative expectations.

The LaryngoscopeVolume 121, Issue S5 p. S273-S273 Triological Society's 2011 Annual Meeting BRAFV600E is associated with increased uPA levels in papillary thyroid cancer E. Ashlie Darr, E. Ashlie Darr New York Eye and Ear Infirmary, New York, NYSearch for more papers by this authorTheodore S. Nowicki, Theodore S. Nowicki New York Medical College, Valhalla,NYSearch for more papers by this authorMelanie E. MacEwan, Melanie E. MacEwan New York Medical College, Valhalla,NYSearch for more papers by this authorJulie Dunbar, Julie Dunbar New York Medical College, Valhalla,NYSearch for more papers by this authorCodrin Iacob, Codrin Iacob New York Eye and Ear Infirmary, New York, NYSearch for more papers by this authorJan Geliebter, Jan Geliebter New York Medical College, Valhalla,NYSearch for more papers by this author E. Ashlie Darr, E. Ashlie Darr New York Eye and Ear Infirmary, New York, NYSearch for more papers by this authorTheodore S. Nowicki, Theodore S. Nowicki New York Medical College, Valhalla,NYSearch for more papers by this authorMelanie E. MacEwan, Melanie E. MacEwan New York Medical College, Valhalla,NYSearch for more papers by this authorJulie Dunbar, Julie Dunbar New York Medical College, Valhalla,NYSearch for more papers by this authorCodrin Iacob, Codrin Iacob New York Eye and Ear Infirmary, New York, NYSearch for more papers by this authorJan Geliebter, Jan Geliebter New York Medical College, Valhalla,NYSearch for more papers by this author First published: 15 August 2011 https://doi.org/10.1002/lary.22229AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume121, IssueS5Supplement: Poster Presentations from the Triological Society's 2011 Annual Meeting2011Pages S273-S273 RelatedInformation

Abstract Of the 44,670 new cases of thyroid cancer predicted for this year in the US by the American Cancer Society, 80% will be papillary thyroid carcinoma (PTC). PTC typically arises from a gain-of-function mutation in the RET, RAS, or BRAF genes which make up a linear signaling cascade for ERK activation in over 90% of PTC cases. PTCs possessing the BRAFV600E mutation have been associated with greater local invasion and regional metastatic potential. Urokinase plasminogen activator (uPA) has been shown to be an important mediator of invasion and metastasis in several cancers. To determine the extent to which BRAFV600E mutation status predicts up-regulation of the uPA in PTC, a study using patient thyroid tissue samples obtained over a 6-year period at a single tertiary care center was undertaken. DNA and RNA were obtained from patient PTC and matched, normal thyroid tissue samples using the Trizol method. BRAFV600E mutational status of the DNA was determined using the TaqMan SNP genotyping assay, while RNA was analyzed for differences in uPA transcription levels (relative to matched, normal thyroid tissue) by qRT-PCR. Fifty-four percent of the PTC samples possessed the BRAFV600E mutation. PTC samples bearing the BRAFV600E mutation displayed significantly higher uPA RNA levels (relative to matched control tissue) than those samples with wild-type BRAF (5.883 vs. 1.27-fold, p<0.05, Wilcoxon signed-rank test). Additionally, uPA RNA levels were significantly higher in patients with nodal metastasis (p<0.05). These data provide new evidence of the roles of BRAFV600E and uPA in PTC invasive pathology and demonstrate for the first time that BRAFV600E status is able to predict higher uPA levels in PTC. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 1063. doi:10.1158/1538-7445.AM2011-1063

OBJECTIVE:To investigate the expression of connexin 43 (Cx43) in benign vs malignant thyroid tissue for potential use as a diagnostic marker.DESIGN:Retrospective study.SUBJECTS:Thyroid specimens were obtained from 50 patients who underwent partial or total thyroidectomy at the New York Eye and Ear Infirmary, New York, New York, between 1999 and 2007. They included goiter (n = 5), follicular adenoma (n = 15), follicular carcinoma (n = 17), papillary thyroid carcinoma (PTC) (n = 7) and the follicular variant of PTC (n = 6).INTERVENTIONS:Tissue sections (5 μm) were immunohistochemically stained for Cx43 with the avidin-biotin-peroxidase method using an automated stainer. The Cx43 membrane staining pattern was evaluated.RESULTS:Twenty-three of 30 cancer specimens (77%) revealed a loss of Cx43 plaque staining at the cellular membrane compared with only 3 of 20 benign specimens (15%). Among the malignant specimens, loss of Cx43 plaque staining was observed in 11 of 17 follicular carcinomas (65%), 5 of 6 follicular variants of PTC (83%), and 7 of 7 PTCs (100%). In contrast, only 3 of 15 adenomas (20%) and 0 of 5 goiter samples demonstrated loss of Cx43 plaque staining at the cell membrane.CONCLUSION:Our data provide evidence that the absence of Cx43 plaque staining is associated with thyroid cancer and thus holds potential clinical utility as a marker for malignant disease.

The LaryngoscopeVolume 120, Issue S3 p. S29-S29 Poster Presentations from the 2010 Triological Society Combined Section Meetings Chondrosarcoma of the larynx and trachea: A report of two rare cases E. Ashlie Darr MD, New York Eye & Ear InfirmarySearch for more papers by this authorBruce M. Wenig MD, Beth Israel Medical Center, New York, NYSearch for more papers by this authorMark L. Urken MD, Beth Israel Medical Center, New York, NYSearch for more papers by this author E. Ashlie Darr MD, New York Eye & Ear InfirmarySearch for more papers by this authorBruce M. Wenig MD, Beth Israel Medical Center, New York, NYSearch for more papers by this authorMark L. Urken MD, Beth Israel Medical Center, New York, NYSearch for more papers by this author First published: 14 December 2010 https://doi.org/10.1002/lary.21207AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume120, IssueS3Supplement: Poster Presentations from the Triological Society's 2010 Annual MeetingOctober 2010Pages S29-S29 RelatedInformation

ObjectiveTo investigate the spectrum of disease presentation and clinical management of primary external auditory canal cholesteatoma (EACC).Study DesignCase series with chart review.SettingSpecialty teaching hospital.Subjects and MethodsTen cases of primary EACC were identified in nine patients treated over 14 years (1995‐2009). Cases were reviewed with regard to demographics, presentation, physical examination, CT findings, and clinical management.ResultsThe most common symptoms were otalgia and hearing loss, followed by otorrhea and tinnitus. Erosion was present in the mastoid air cells in seven patients, middle ear in six, temporomandibular joint in two, otic capsule in two, and fallopian canal in one patient. Eight of nine patients were managed with serial debridement.ConclusionsEACC is associated with adjacent bony erosion, most often involving the inferior EAC. Despite the potentially destructive nature of these lesions, most cases can be successfully managed with serial debridement.