The brachial plexus which innervates the upper limb has afferent from cervical and thoracic part of spinal cord. Due to its proximity other important vascular nervous structures, is mainly responsible for post block complications like temporary paralysis phrenic, recurrent laryngeal nerves or Horner's syndrome .

From a surgical viewpoint there are several critical anatomic structures that lie in close proximity to the thyroid gland. These critical structures include the recurrent laryngeal nerves, the superior laryngeal nerves, and the parathyroid glands. Successful thyroid surgery depends on the technical skill of the surgeon to identify and preserve these vital structures.

Neuropathies involving the brachial plexus, phrenic, recurrent laryngeal, and saphenous nerves, as well as the sympathetic chain are complications of cardiac surgery. The reported frequency of nerve injuries varies from 1.5% to 24% for the brachial plexus and 10% to 60",,6 for the phrenic nerve (1-5). Neuropathies of the recurrent laryngeal, lower limb (saphenous) nerves, and the sympathetic ch...

The receptor sites and nerve pathways involved in the reflex production of laryngospasm have been investigated in the cat. The trigeminal nerves and the internal branch of the superior laryngeal nerves were shown to provide an afferent pathway for the reflex when the nasopharynx and larynx were exposed to ether vapour. Evidence was obtained suggesting that the recurrent laryngeal nerves may for...

Hitherto voice changes have been regarded as an infrequent complication of thyroidectomy and damage to the recurrent laryngeal nerve has been given as their major cause. Voice function was assessed in 325 patients after thyroidectomy. Permanent changes occurred in 35 (25%) after subtotal thyroidectomy and in 19 (11%) after lobectomy. The commonest cause of voice change appeared to be injury to ...

PURPOSE OF REVIEW Laryngeal nerve injury, resulting in speech and swallowing dysfunction, is a feared complication of thyroid operations. Routine visualization of the recurrent laryngeal nerve (RLN) has decreased the likelihood of nerve injury, and intraoperative nerve monitoring has been applied in the hope of further enhancing safety. RECENT FINDINGS There is conflicting evidence about the ...

FIG. i.-Drawing of the appearance at operation. The right lobe of the thyroid is freed and rotated forwards after division of the superior pole. The anomalous nerve is seen passing from beneath the carotid sheath towards the trachea.

One of the most important and feared complications of thyroid and parathyroid surgery is injury to the recurrent laryngeal nerve. The main reason for this type of injury is anatomical variations. Currently, nerve monitoring is being widely used to reduce complications due to the high variation rate. However, it is not being used extensively in our country, due to cost related issues. In this ca...

In recent years, intraoperative neural monitoring (IONM) has gained widespread acceptance as an adjunct to the gold standard of visual nerve identification and it can be used identify both recurrent laryngeal (RLN) external branch superior (EBSLN). At present, three types IONM are performed: RLN intermittent neuromonitoring (i-IONM); continuous (c-IONM); EBSLN. i-IONM remains most employed meth...