![]() ![]() 2 For simplicity, we will refer to the communicating nerve of Galen and all other possible communicating nerves between branches of the vagus simply as communicating nerves, since their identification and isolation intraoperatively is variable.Ĭephalic to the RLN and iSLN off of the vagus nerve lies the pharyngeal plexus, which provides variable sensory and motor innervation to the pharynx with contributions from the glossopharyngeal nerve. Anatomical studies in human cadaveric larynges have shown the presence of the classic nerve of Galen (NG) anastomosis between the iSLN and RLN to be present 100% of the time, in addition to other anastomotic patterns in the larynx between the RLN, iSLN, and external SLN (eSLN). In addition to the GCR arc, the iSLN and RLN have variable interconnecting neural pathways that bypass the brainstem. This classic pathway involves ascending the iSLN to the vagus to the nucleus tractus solitaries to the nucleus ambiguus and then descending down the vagus to the RLN. The GCR is composed of the internal branch of the superior laryngeal nerve (iSLN) and the recurrent laryngeal nerve (RLN), providing the afferent and efferent pathways, respectively. The importance of the GCR cannot be overstated owing to its critical role in airway protection. Almost 2000 years later, our laboratory continues to search for various innervation patterns to the larynx with a focus on helping to augment the glottic closure reflex (GCR). ![]() 1 He showed in likely the first laryngeal experiment in the porcine model that transection of the nerve would cease the animal’s squealing. Laryngeal physiology has come a long way since Galen in the 2nd century AD noted the “reversivi” or recurrent laryngeal nerves and performed his famous experiments in front of the Roman Elders. We also noted a variable direct pattern of innervation to the TA. In 3 of 7 subjects, a short latency response (mean 3.05 milliseconds) was identified, which disappeared in 1 subject each by eSLN, RLN, and NG transection.Ĭonclusions and Relevance We identified the specific neural pathway involved in the PP’s GCR-like pathway. In 3 of 7 subjects, a long latency response (mean, 14.62 milliseconds) was identified, which was eliminated only after transection of the RLN. Results Stimulation of the PP evoked a response from the TA muscle in 6 of 7 subject animals. Main Outcomes and Measures Confirmation of TA muscle contraction by EMG. Subsequently, the external branch of the superior laryngeal nerve (eSLN), communicating nerve of Galen (NG), and the recurrent laryngeal nerve (RLN) were sequentially transected to help elucidate the path of neural conduction. Interventions Contraction of the TA was detected with electromyography (EMG) during electrical stimulation of the PP in 7 porcine necks. Objective To identify the specific neural pathways involved in the glottic closure reflex (GCR)-like pathway of the PP and other pathways to the thyroarytenoid (TA) muscle in the porcine model.ĭesign, Setting, and Animal Subjects Animal experimental study from September 2013 to June 2014 conducted in a tertiary academic medical center on male Yorkshire pigs. Importance There continues to be a paucity of data regarding the pharyngeal plexus (PP) and its interconnectivity with the laryngeal nerves and function. Shared Decision Making and Communication.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience.Challenges in Clinical Electrocardiography. ![]()
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