The autonomic innervation of the human vocal cord: Neuropeptides

Basterra, J; Dilly, P. N.; Martorell, Miguel

doi:10.1288/00005537-198903000-00010

Cited by 12 publications

(12 citation statements)

References 16 publications

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“…In humans, Basterra et al (1989) demonstrated the presence of vasoactive intestinal polypeptide and neuropeptide P around the glands and vessels of the vocal cords. As those neuropeptides have been closely related to adrenergic and cholinergic endings, the authors inferred that they may modify the caliber and turgescence of the vocal cords, causing variations in the voice during emotional stress and singing.…”

Section: Discussionmentioning

confidence: 99%

Sympathetic fiber origin of the superior laryngeal nerve and its branches: An anatomic study

Furlan

2002

Clinical Anatomy

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An anatomic study of 50 fresh adult human cadavers was carried out to classify the nervous anastomoses between the ipsilateral cervical sympathetic chain (CSC)/superior cervical sympathetic ganglion (SCSG) and the superior laryngeal nerve with its branches (SLNwb). Following the pattern of a prospective randomized study, the necks were dissected bilaterally to identify the SLNwb, CSC and SCSG. The nervous connections between the CSC/SCSG and the SLNwb were grouped according to Sun and Chang's (1991, Surg. Radiol. Anat. 13:175-180) types as well as according to a new classification, tie, based on the location and number of connections between the CSC/SCSG and the SLNwb. Connections between the CSC/SCSG and the SLNwb were found in 95 of 100 dissections. According to our tie classification, the results demonstrated that the e(n) was the most frequent tie group in the sample (59%), followed by t(n) (15%), i(n)e(n) (11%), t(n)e(n) (8%), no nervous anastomosis (5%), and i(n) (2%), where t, i, e represent nervous connections between the CSC/SCSG and the trunk, external branch, and internal branch of the SLN, respectively, and n represents the number of connections. Therefore, the nervous communications between the CSC/SCSG and the SLNwb were frequent and could easily be classified by the origin and number of nervous connections. Although their physiologic role remains unclear, the SLNwb may be an important pathway for nerve fibers from the CSC/SCSG to reach the larynx.

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Section: Discussionmentioning

confidence: 99%

Sympathetic fiber origin of the superior laryngeal nerve and its branches: An anatomic study

Furlan

2002

Clinical Anatomy

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“…Laryngospasm, hypertension, and cardiac arrhythmias commonly result from inadequate blockade of the sympathetic nervous system during instrumentation of the airway and point to the influence of adrenergic innervation in addition to the cholinergically mediated innervation of laryngeal musculature. Specifically, noradrenergic nerve fibers directly innervate the intrinsic muscles of the larynx via laryngeal nerves in animals and humans and are contributed to vagal nerves via the superior cervical and middle cervical ganglia (Hisa, 1982;Hisa et al, 1982;Basterra et al, 1989;Yoshida et al, 1992). It is also important to note that prior to intubation or laryngeal mask placement anesthesiologists will administer opioids along with sedative hypnotics (such as propofol) to blunt the sympathetic activation that occurs with instrumentation of the airway.…”

Section: Neurochemistry and Neuroanatomy In Wcsmentioning

confidence: 99%

“…The effect can be benign or produce life-threatening laryngospasm. It occurs immediately after injection of fentanyl and can occur at low doses, but seems to share a similar underlying mechanism with the severe laryngospasm seen in WCS since both seem to be managed successfully with a-adrenergic and anticholinergic agents (Basterra et al, 1989;Yoshida et al, 1992;Lin et al, 2004;Horng et al, 2010;El Baissari et al, 2014).…”

Section: Neurochemistry and Neuroanatomy In Wcsmentioning

confidence: 99%

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Noradrenergic Mechanisms in Fentanyl-Mediated Rapid Death Explain Failure of Naloxone in the Opioid Crisis

Torralva

Janowsky

2019

The Journal of Pharmacology and Experimental Therapeutics

116

112

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In December 2018, the Centers for Disease Control declared fentanyl the deadliest drug in America. Opioid overdose is the single greatest cause of death in the United States adult population (ages 18-50), and fentanyl and its analogs [fentanyl/ fentanyl analogs (F/FAs)] are currently involved in .50% of these deaths. Anesthesiologists in the United States were introduced to fentanyl in the early 1970s when it revolutionized surgical anesthesia by combining profound analgesia with hemodynamic stability. However, they quickly had to master its unique side effect. F/FAs can produce profound rigidity in the diaphragm, chest wall and upper airway within an extremely narrow dosing range. This clinical effect was called wooden chest syndrome (WCS) by anesthesiologists and is not commonly known outside of anesthesiology or to clinicians or researchers in addiction research/medicine. WCS is almost routinely fatal without expert airway management. This review provides relevant clinical human pharmacology and animal data demonstrating that the significant increase in the number of F/FA-induced deaths may involve a-adrenergic and cholinergic receptor-mediated mechanical failure of the respiratory and cardiovascular systems with rapid development of rigidity and airway closure. Although morphine and its prodrug, heroin, can cause mild rigidity in abdominal muscles at high doses, neither presents with the distinct and rapid respiratory failure seen with F/FA-induced WCS, separating F/FA overdose from the slower onset of respiratory depression caused by morphine-derived alkaloids. This distinction has significant consequences for the design and implementation of new pharmacologic strategies to effectively prevent F/FA-induced death. SIGNIFICANCE STATEMENT Deaths from fentanyl and F/FAs are increasing in spite of availability and awareness of the opioid reversal drug naloxone. This article reviews literature suggesting that naloxone may be ineffective against centrally mediated noradrenergic and cholinergic effects of F/FAs, which clinically manifest as severe muscle rigidity and airway compromise (e.g., wooden chest syndrome) that is rapid and distinct from respiratory depression seen with morphine-derived alkaloids. A physiologic model is proposed and implications for new drug development and treatment are discussed.

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“…The issue of whether the SN is involved in vocal cord mobility is very important for surgeons during head and neck surgery. In experimental studies it has been suggested that possible roles of the SN in vocal cord function are the regulation of glandular secretion and vasculization (Basterra et al 1989), but the SN has not yet been found to control movement of the vocal cords. The accurate role of sympathetic fibers of the AN has not yet been clarified.…”

Section: Discussionmentioning

confidence: 99%

Nonrecurrent Inferior Laryngeal Nerve Without Vascular Anomaly as a Genuine Entity

Tateda

Hasegawa

Sagai

et al. 2008

Tohoku J. Exp. Med.

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Inferior laryngeal nerve (ILN), which usually arises from vagus nerve, runs recurrent course and is called recurrent ILN (RILN). Intimate knowledge of normal and anatomic variants of the ILN reduces the risk of nerve injury and vocal cord paralysis in thyroid and parathyroid surgery. The nonrecurrent ILN (NRILN) is a rare nerve anomaly that is associated with a right aberrant subclavian artery. We encountered 2 patients with NRILN during thyroid surgery. Patient 1, a 57-year-old woman, had mediastinal thyroid tumor without vascular anomaly. Patient 2, a 47-year-old woman with a history of esophageal foreign body (fish bone), was suspected to have NRILN with vascular anomaly before surgery, as judged by preoperative enhanced CT. In the patient 1, we verified laryngeal mobility function of the NRILN by nerve stimulation, and confirmed the absence of RILN in usual recurrent course. The findings in the patient 1 indicate that NRILN without subclavian artery anomaly is a genuine entity. In both patients we performed thyroid surgery safely and fast by expectation and identification of NRILN by use of nerve stimulator. In conclusion, we confirm the existence of NRILN without vascular anomaly and show effectiveness of preoperative enhanced CT and valuable use of nerve stimulator for nerve preservation in the patients with NRILN.Nonrecurrent inferior laryngeal nerve; aberrant subclavian artery; esophageal foreign body; nerve stimulator; CT. Inferior laryngeal nerve (ILN) palsy is a major problem in thyroid and parathyroid surgery. Intimate knowledge of normal and anatomic variants of the ILN reduces the risk of nerve injury and vocal cord paralysis. It is generally accepted that the nonrecurrent inferior laryngeal nerve (NRILN) is a well-known but relatively rare anatomic variant. The prevalence of NRILN is less than 1% based on surgical reports (Henry et al. 1988;Proye et al. 1991;Avisse et al. 1998;Devèze et al. 2003; Toniate et al. 2004) and 1-2% based on anatomical reports (Avisse et al. 1998). The NRILN usually arises on the right side of the neck and is associated with malformation of the aortic arch and aberrant subclavian artery. In NRILN, there are several unsolved problems,

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The autonomic innervation of the human vocal cord: Neuropeptides

Cited by 12 publications

References 16 publications

Sympathetic fiber origin of the superior laryngeal nerve and its branches: An anatomic study

Sympathetic fiber origin of the superior laryngeal nerve and its branches: An anatomic study

Noradrenergic Mechanisms in Fentanyl-Mediated Rapid Death Explain Failure of Naloxone in the Opioid Crisis

Nonrecurrent Inferior Laryngeal Nerve Without Vascular Anomaly as a Genuine Entity

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