Motor and sensory branching of the recurrent laryngeal nerve in thyroid surgery

Kandil, Emad; Abdelghani, Samy; Friedlander, Paul L.; Alrasheedi, Saud; Tufano, Ralph P.; Bellows, Charles F.; Slakey, Douglas P.

doi:10.1016/j.surg.2011.09.002

Cited by 49 publications

(65 citation statements)

References 23 publications

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“…This high value may be related to our use of a thyroid pillow to extend the neck, leading to nerve stretching due to the position. The branchings within 5 mm that were not evaluated as real branchings in the study by Kandil et al (13,14) may have been evaluated as branching due to neck extension in our study. There is no data regarding the position of the patient in other studies.…”

Section: Discussionmentioning

confidence: 88%

“…Katz (11) reported the rate of extralaryngeal branching as 58% in his study, in which he accepted branches before the 5 mm distance to the NEP. In the past ten years, the branching rate has been reported as 24%-43% in studies in which branchings were accepted if the RLNs were branched 5 mm or more below the NEP (12)(13)(14)21). We determined the branching rate to be 47.8%, with 43.9% on the right and 51.9% on the left, in our study.…”

Section: Discussionmentioning

confidence: 94%

“…If a branched nerve is not detected, one of the identified branches can be considered as the main trunk. This situation may lead to inadvertent injury due to traction and division of the other branch (14). The most frequent cause of RLN paralysis is traction trauma.…”

Section: Discussionmentioning

confidence: 99%

“…Nerves with only posterior branches to the esophagus were not considered to be branching nerves. Nerves with two branches that both entered the larynx under the cricopharyngeal muscle were considered to be branching nerves (13,14). It was found that some branching nerves bifurcated again from the anterior or posterior branches after the first bifurcation and entered the larynx as trifurcated nerves.…”

Section: Surgical Techniquementioning

confidence: 99%

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Extralaryngeal division of the recurrent laryngeal nerve: A common and asymmetric anatomical variant

et al. 2017

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Results: A total of 161 recurrent laryngeal nerves were examined (82 right, 79 left). Overall, 77 (47.8%) of 161 recurrent laryngeal nerves were bifurcated before entering the larynx. There were 36 (43.9%) branching nerves on the right and 41 (51.9%) branching nerves on the left, and there was no significant difference between the sides in terms of branching (p=0.471). Among 67 patients who underwent bilateral exploration, 28.4% were found to have bilateral branching, 40.3% had unilateral branching, and the remaining 31.3% had no branching. The median branching distance was 15 mm (5-60mm). Conclusion:Extralaryngeal division of recurrent laryngeal nerve is a common and asymmetric anatomical variant. These variations can be easily recognized if the recurrent laryngeal nerve is identified at the level of the inferior thyroid artery and then dissected totally to the entry point of the larynx. Inadvertent division of a branch may lead to vocal cord palsy postoperatively, even when the surgeon believes the integrity of the nerve has been preserved.

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Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Section: Surgical Techniquementioning

confidence: 99%

See 2 more Smart Citations

Extralaryngeal division of the recurrent laryngeal nerve: A common and asymmetric anatomical variant

et al. 2017

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“…-The authors stated that 'before entering the larynx, the RLN divided into anterior and posterior branches in 147/160 sides,… the later innervating the posterior cricoarytenoid and thyroarytenoid muscles'. It is stated in the textbook [2] and the article [1] that 'the anterior branch is mainly motor…, and the posterior branch is mainly sensory. Actually, we have expected to learn how the authors identify the posterior one innervates, the muscles mentioned above.…”

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confidence: 99%