Superior approach to the inferior laryngeal nerve in thyroid surgery: anatomy, surgical technique and indications

Page, C.; Peltier, Johann; Charlet, L; M, Laude; Strunski, V.

doi:10.1007/s00276-006-0141-9

Cited by 23 publications

(31 citation statements)

References 13 publications

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“…Therefore avoiding morbidity is of paramount importance. Complication rates vary from 0 to 50% [1,2]. The main concern is with regards to safety of the RLN and parathyroid glands.…”

Section: Introductionmentioning

confidence: 99%

“…The main concern is with regards to safety of the RLN and parathyroid glands. Literature has excellent description of various landmarks and approaches to thyroid surgery with their pros and cons [1,[3][4][5][6]. While the incidence of injury to RLN is relatively low, in enthusiasm to safeguard the nerve, the blood supply to parathyroid is damaged resulting in its dysfunction [2,7].…”

Section: Introductionmentioning

confidence: 99%

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The Tubercle of Zuckerkandl : An Important Landmark Revisited

Irawati

Vaish

Chaukar

et al. 2015

Indian J Surg Oncol

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To study the incidence of the tubercle of Zuckerkandl (ZT) among Indian patients subjected to thyroid surgery at a tertiary care cancer centre and its relevance in localization of recurrent laryngeal nerve (RLN). Prospective study on 144 patients (48 males, 96 females) undergoing thyroidectomy (35 hemithyroidectomies, 109 total thyroidectomies) from September 1st 2010 - February 28th 2013. 144 specimen/253 lobes (129 right, 124 left) were evaluated. Findings were recorded by the same team to ensure consistency. Presence, shape, grade (Pelizzo's) of ZT and relationship to RLN were documented. ZT was identified in 90.5 % (n = 229), commoner on the right (n = 120) than on left (n = 109). ZT was Grade 0 in 9.5 %, Grade I in 28.9 %, Grade II in 50.5 % and Grade III in 11 % of cases. In all patients ZT was unilobed. Recurrent laryngeal nerve (RLN) was consistent in position and was posterior to ZT in all cases. There were no branches of the RLN above the ZT. The ZT is a useful guide in locating RLN. Surgeon should be aware about the incidence, shape, grade and relation to RLN which is different in the Indian population as compared to what has been reported globally.

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“…Therefore avoiding morbidity is of paramount importance. Complication rates vary from 0 to 50% [1,2]. The main concern is with regards to safety of the RLN and parathyroid glands.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Tubercle of Zuckerkandl : An Important Landmark Revisited

Irawati

Vaish

Chaukar

et al. 2015

Indian J Surg Oncol

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“…Traditionally, the technique of identifying the RLN at its crossing with the inferior thyroid artery has been used by the many surgeons. Although this technique is relatively simple and reliable in the majority of cases, occasional anatomic variations of both the artery and nerve [ 3 4 ], and in those particular cases where the access to the inferior pole of the thyroid is difficult [ 5 ], may be problematic. Regarding the relationship of the RLN to the ligament of Berry, there are controversies in the literature.…”

Section: Discussionmentioning

confidence: 99%

“…In another textbook, when searching for the nerve at its usual cross point with the inferior thyroid artery is difficult or impossible, it is very useful to find the RLN at its LEP, which requires previous dissection of the upper pole, or an “inside-out” approach, after division of the isthmus [ 11 ]. Furthermore Page et al [ 5 ] reported 25 patients with cervicothoracic goiter who underwent total thyroidectomy, and in their study, early division of the isthmus was performed when possible to facilitate the operation. As in the previous study, this ‘medial to lateral dissection’ was usually reserved only for especially difficult cases.…”

Section: Discussionmentioning

confidence: 99%

Safety of medial dissection of the thyroid gland along the trachea based on anatomic constancy of the laryngeal entry point of the recurrent laryngeal nerve

et al. 2018

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PurposeThe purpose of this study was to determine the extent of safety of medial dissection of the thyroid gland along the trachea. Medial to lateral dissection of the thyroid gland along the trachea after early division of the isthmus has been known to be a useful technique in thyroid surgery, especially for difficult cases, but the risk of injury of the recurrent laryngeal nerve (RLN) has constrained thyroid surgeons from utilizing this technique to its full extent.MethodsDistances of the laryngeal entry point (LEP) of 134 RLNs of 71 patients from the midline of the trachea, and some other anatomical distances, were measured intraoperatively. The relationships of the intraoperatively measured data with circumferences of the cartilaginous portion of the trachea (CCT) around LEP measured preoperatively by CT scan were evaluated.ResultsLEP was always located within 2 mm vertically from the horizontally extended line of the inferior border of the cricoid cartilage and was the closest point from the midline in the whole course of the RLN. The distance between LEP and the midline was very closely correlated with CCT measured on preoperative CT scan, and it can be accurately calculated with a regression equation; Distance between LEP and the midline = (0.42 × CCT) + (1.2 × sex) + 3.2 (mm) (sex: female=0, male=1; R2 = 0.85).ConclusionEarly division of the isthmus and dissecting the thyroid off the trachea to the calculated extent is a safe and effective procedure.

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“…Surgical Science, 10, 11-15. [3]. These are the extra laryngeal divisions of the nerve, the link of the nerve to the inferior thyroid artery and the recurrent non-recurrent nerve.…”

Section: Introductionmentioning

confidence: 99%

Anatomical Variations of Recurrent Laryngeal Nerve: The Danger in Thyroid Surgery

Koné¹,

Soumaoro²,

Cissé³

et al. 2019

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Objectives: We report two types of anatomical variations of the recurrent laryngeal nerve in two patients. Through these two patients we wanted to highlight our surgical approach of the recurrent nerve in an unusual position and to describe the surgical implication of these almost rare variations. Case report: patient aged 28 and 58 admitted for goiter. They underwent a right lobisthmectomy. Both recurrences were approached retrograde. The anatomical variations of the nerve concerned the non-recurrent laryngeal nerve in the first patient. In the second patient there were three anatomical variations, namely an extra laryngeal bifurcation of the nerve, a pre-vascular position of the nerve and a branch connecting the vagus nerve and the recurrent nerve. No recurrence nerve injury was noted. Conclusion: The anatomical variations of the nerve are numerous. A careful dissection is a guarantee of a good prognosis.

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Superior approach to the inferior laryngeal nerve in thyroid surgery: anatomy, surgical technique and indications

Cited by 23 publications

References 13 publications

The Tubercle of Zuckerkandl : An Important Landmark Revisited

The Tubercle of Zuckerkandl : An Important Landmark Revisited

Safety of medial dissection of the thyroid gland along the trachea based on anatomic constancy of the laryngeal entry point of the recurrent laryngeal nerve

Anatomical Variations of Recurrent Laryngeal Nerve: The Danger in Thyroid Surgery

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