A Newly Identified Variation at the Entry of the Recurrent Laryngeal Nerve into the Larynx

Shao, Tanglei; Yang, Weiping; Zhang, Tao; Wang, Yan; Jin, Xiaotai; Li, Qinyu; Kuang, Jie; Qiu, Weihua; Yen, Yun

doi:10.3109/08941939.2010.509465

Cited by 20 publications

(15 citation statements)

References 23 publications

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“…A total of 53 studies ( n = 53,577 total nerves; 33,571 Right RLNs and 20,006 Left RLNs) were included: 35 intraoperative, 17 cadaveric and 1 imaging (CT) (Reed, 1943; Wade, 1955; Hunt, Poole & Reeve, 1968; Stewart, Mountain & Colcock, 1972; Skandalakis et al, 1976; Papadatos, 1978; Proye et al, 1982; Flament, Delattre & Palot, 1983; Henry et al, 1988; Menck, Grüber & Lierse, 1990; Lekacos et al, 1992; Freschi et al, 1994; Moreau et al, 1998; Sasou, Nakamura & Kurihara, 1998; Sturniolo et al, 1999; Campos & Henriques, 2000; Raffaelli, Iacobone & Henry, 2000; Watanabe et al, 2001; Watanabe et al, 2016; Monfared, Gorti & Kim, 2002; Page, Foulon & Strunski, 2003; Hermans et al, 2003; Ardito et al, 2004; Toniato et al, 2004; Spartà et al, 2004; Sciumè et al, 2005; Shindo, Wu & Park, 2005; Beneragama & Serpell, 2006; Maranillo et al, 2008; Makay et al, 2008; Serpell, Yeung & Grodski, 2009; Lee et al, 2009; Sunanda, Tilakeratne & De Silva, 2010; Shao et al, 2010; Wang et al, 2011; Kaisha, Wobenjo & Saidi, 2011; Kandil et al, 2011; Pradeep, Jayashree & Harshita, 2012; Chiang et al, 2012; Tang et al, 2012; Benouaich et al, 2012; Asgharpour et al, 2012; Silva, Siqueira & Arruda, 2013; Donatini, Carnaille & Dionigi, 2013; Satoh et al, 2013; Cai et al, 2013; Hong, Park & Yang, 2014; Yang et al, 2014; Han, Bai & Lu, 2015; Dolezel et al, 2015; Iacobone et al, 2015; Buła et al, 2015; Ngo Nyeki et al, 2015; Barczyński et al, 2015). The dates of the included studies spanned the period from 1943 to 2016.…”

Section: Resultsmentioning

confidence: 99%

The Non-Recurrent Laryngeal Nerve: a meta-analysis and clinical considerations

Henry

Sanna

Graves

et al. 2017

PeerJ

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BackgroundThe Non-Recurrent Laryngeal Nerve (NRLN) is a rare embryologically-derived variant of the Recurrent Laryngeal Nerve (RLN). The presence of an NRLN significantly increases the risk of iatrogenic injury and operative complications. Our aim was to provide a comprehensive meta-analysis of the overall prevalence of the NRLN, its origin, and its association with an aberrant subclavian artery.MethodsThrough March 2016, a database search was performed of PubMed, CNKI, ScienceDirect, EMBASE, BIOSIS, SciELO, and Web of Science. The references in the included articles were also extensively searched. At least two reviewers judged eligibility and assessed and extracted articles. MetaXL was used for analysis, with all pooled prevalence rates calculated using a random effects model. Heterogeneity among the included studies was assessed using the Chi2 test and the I2 statistic.ResultsFifty-three studies (33,571 right RLNs) reported data on the prevalence of a right NRLN. The pooled prevalence estimate was 0.7% (95% CI [0.6–0.9]). The NRLN was found to originate from the vagus nerve at or above the laryngotracheal junction in 58.3% and below it in 41.7%. A right NRLN was associated with an aberrant subclavian artery in 86.7% of cases.ConclusionThe NRLN is a rare yet very clinically relevant structure for surgeons and is associated with increased risk of iatrogenic injury, most often leading to temporary or permanent vocal cord paralysis. A thorough understanding of the prevalence, origin, and associated pathologies is vital for preventing injuries and complications.

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Section: Resultsmentioning

confidence: 99%

The Non-Recurrent Laryngeal Nerve: a meta-analysis and clinical considerations

Henry

Sanna

Graves

et al. 2017

PeerJ

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“…However, recurrent laryngeal nerves with abnormal anatomy are still susceptible to injury. Based on the literature, several variations of recurrent laryngeal nerves have been reported [1][2][3][4][5]. Similar to the non-recurrent laryngeal nerve, the variants identified in this study were all located on the right side, but not directly divided from the vagus, and divided into intracranial branches except for the tracheal, esophageal, and laryngeal branches.…”

Section: Discussionmentioning

confidence: 52%

“…Therefore, the clarification and recognition of the variation and passage of recurrent laryngeal nerves are very important for preventing postoperative complications. To date, multiple variations of the recurrent laryngeal nerve have been reported [1][2][3][4][5]. Here, we reported a new variation of the right recurrent laryngeal nerve that should be carefully considered during neck surgery.…”

mentioning

confidence: 83%

New Variation of Right Recurrent Laryngeal Nerve: Cases Report

et al. 2014

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“…Therefore, surgeons frequently encounter bifurcated nerve during thyroidectomy operations. Previous manuscripts have also reported the usualness of this variation [1, 2, 4, 5]. The incidence of bifurcated nerve has been reported between 18% and 43% [6–11].…”

Section: Discussionmentioning

confidence: 84%

Extralaryngeal Terminal Division of the Inferior Laryngeal Nerve: Anatomical Classification by a Surgical Point of View

Gürleyik

2013

Journal of Thyroid Research

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Background. Complete anatomic knowledge including all variations of the inferior laryngeal nerve (ILN) is mandatory for thyroid surgeon. Extralaryngeal terminal division (ETD) of the ILN has significant importance for the safety of thyroidectomy. Material and Methods. Surgical dissection of 200 ILNs was performed on 100 cases. The presence of ETD of the nerve was determined intraoperatively. We propose by a surgical point of view a regional (segmental) classification of ETD of the ILN along its cervical course. Results. ETD has been observed in 54/200 nerves (27%). Great majority are bifurcated nerves (trifurcation 2%). Four types of ETD are classified. In type 1 (arterial; 46.3%), ETD has occurred near inferior thyroid artery (ITA). In type 2 (postarterial; 31.5%), division has been found on postarterial segment. In type 3 (prelaryngeal; 11%), division has been located very close to laryngeal entry point. In type 4 (prearterial; 11%), ETD has occurred before the nerve crossing the ITA. Conclusions. ETD of the ILN is a common anatomical variation. The bifurcation occurs in the ILN at various distances from laryngeal entry point. The classification increasing surgeons' awareness may help to simplify identification and exposure of terminal branches. Preservation of both extralaryngeal terminal branches of the ILN has paramount importance for the safety of thyroid operations.

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A Newly Identified Variation at the Entry of the Recurrent Laryngeal Nerve into the Larynx

Abstract: This newly discovered variation of the RLN is more vulnerable to injury and should be brought to the attention of surgeons.

Cited by 20 publications

References 23 publications

The Non-Recurrent Laryngeal Nerve: a meta-analysis and clinical considerations

The Non-Recurrent Laryngeal Nerve: a meta-analysis and clinical considerations

New Variation of Right Recurrent Laryngeal Nerve: Cases Report

Extralaryngeal Terminal Division of the Inferior Laryngeal Nerve: Anatomical Classification by a Surgical Point of View

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