Revisited anatomy of the recurrent laryngeal nerves

Ardito, G; Revelli, Luca; D’Alatri, Lucia; Lerro, Valentina; Guidi, Maria Lavinia; Ardito, Francesco

doi:10.1016/j.amjsurg.2003.11.001

Cited by 143 publications

(141 citation statements)

References 7 publications

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“…Extralaryngeal branching is often seen as bifurcation, and the rate of branching greater than bifurcation is reported to be 1.4%-7.3% in the literature (3,20,23). The branching rate for more than two branches is 3.1%, similar to the literature.…”

Section: Discussionsupporting

confidence: 75%

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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: Discussionsupporting

confidence: 75%

“…The rates of extralaryngeal branching were reported as 64.5% and 72%, respectively, in studies by Cernea et al (3) and Ardito et al (20) in which more than 2000 RLNs were evaluated. All the branches of the RLN entering the larynx were evaluated in these studies.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2017

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“…Due to the exposure restriction of the incision and the concern of damage to the variants, no further tracking of the finial innervations of these variants was made. However, we hypothesize that the intracranial branches may have some unknown functions, which challenge the current concept of complete nerve exposure during thyroid surgery in order to avoid accidental injury to the recurrent laryngeal nerve [6]. Our experience is that intraoperative exposure of the recurrent laryngeal nerve has no effect on postoperative phonation if complete isolation of the recurrent laryngeal nerve or excessive dissection of the laryngeal entry of the recurrent larynx nerve does not occur [7].…”

Section: Discussionmentioning

confidence: 99%

New Variation of Right Recurrent Laryngeal Nerve: Cases Report

et al. 2014

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“…In the present study the bifurcations occurred within the distal 2cm of the nerve. Ardito et al 3 , in their study found that the distance of bifurcation from the inferior border of the cricoid cartilage ranged from 0.3 to 4.5 cm. Similarly He et al 14 found that in most cases, the recurrent laryngeal nerve diverged at 1.0-2.5 cm below the cricothyroid articulation.…”

Section: Discussionmentioning

confidence: 99%

Surgical anatomy of recurrent laryngeal nerve during thyroid and laryngeal surgeries

Pantha

Mathur

Bhandary

2017

Nepalese J ENT Head Neck Surg

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INTRODUCTION:A correct knowledge of variations in regional neurovascular anatomy is essential for preventing complications during surgery in neck. The most important anatomic structures during thyroidectomy include the arteries and veins of thyroid gland, the position of the parathyroid glands and the position of the laryngeal nerves. Recurrent Laryngeal Nerve (RLN) is a branch of vagus nerve. The right RLN arises from the vagus nerve in the superior part of the thorax crosses the undersurface of the right subclavian artery and ascends in the neck and the left RLN hooks around the arch of aorta and ascends more vertically in the neck before reaching its point of penetration in the larynx. RLN palsy is a serious iatrogenic complication of the thyroid surgery which can cause hoarseness and breathing difficulties. Moreover, this palsy can be responsible for major psychological and social disturbance for the patients. The route of the RLN is not always consistent but it must be identified and dissected completely in the thyroid region during the surgery, in order to preserve it from iatrogenic injury. 1 The reported incidence of vocal cord paralysis has fallen over the last several decades due to improved experience of surgeons and better knowledge of anatomical details of the RLN. Still the incidence of postoperative vocal cord paresis or paralysis in recent large series is reported up to 5% for temporary and 0.5% for permanent paralysis. 2 Identification of the RLN early during thyroid surgery is important so as to avoid its inadvertent injury. This study was conducted with the objective of identifying the variations in RLN and its relation to the surrounding structures in patients undergoing thyroid and the laryngeal surgeries as this is the key in avoiding iatrogenic RLN injuries. MATERIALS AND METHODS:This is a descriptive prospective study conducted in the department of Otorhinolaryngology and Head and Neck surgery in BPKIHS, Dharan, between July 2008-June 2009. All patients undergoing thyroidectomy and total laryngectomy were included where the RLN could be traced to the extent technically possible by operating surgeon without jeopardizing the nerve and the intra-operative observations were noted. For measuring the thickness of the nerve it was compared with the thickness of electrical copper wire ranging in thickness from 10 to 20 gauges and its exact diameter was measured in mm with micrometer screw gauge. Prior ethical clearance was obtained from the institute's ethical committee. All photographic records were taken by Cannon Power Shot A620 7.1 mega pixels digital camera from an angle of about 45° to the body and a distance of 15 cm without using any zoom. Analysis of the data was done using appropriate statistical method (SPSS 14 for windows). Objective:To determine the anatomic relationship of recurrent laryngeal nerve with inferior thyroid artery, tracheo-oesophageal groove and Berry's ligament and to determine the thickness and terminal branching pattern of recurrent laryngeal nerve. Material and Meth...

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Revisited anatomy of the recurrent laryngeal nerves

Cited by 143 publications

References 7 publications

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

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

New Variation of Right Recurrent Laryngeal Nerve: Cases Report

Surgical anatomy of recurrent laryngeal nerve during thyroid and laryngeal surgeries

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