Surgical anatomy of the recurrent laryngeal nerve; a cross-sectional descriptive study

Abstract

Abstractescribe the relationship of the recurrent laryngeal nerve (RLN) to the inferior thyroid artery and the ligament of Berry and to study its trajectory patients who underwent total thyroidectomy and six who underwent thyroid lobectomy were included. 46 RLNs including 24 right and 22 left, were studied. The relationship of the nerve to the inferior thyroid artery, ligament of Berry and its course between these two structures were recorded after the surgery. Data were tabulated and analyzed using spread sheet application.instances (61%; 80% of left and 50% of right), the nerve was posterior to the inferior thyroid artery while in 11 occasions (24%; 33% of right and 15% of left) the nerve traveled through the branches of the inferior thyroid artery. In four instances, (9%) the nerve was anterior to the inferior thyroid artery. In one instance, a single right non-recurrent laryngeal nerve (2%) was detected. The left inferior thyroid artery was absent in two patients. In 25 instances (54%), the nerve was in contact with the Berry's ligament while in 17 (37%) occasions the nerve traveled in between the ligament and tracheo-oesophagial groove (TO groove) and in 3 instances (7%), the nerve traveled through the ligament. The observed right non-recurrent nerve (2%) was superior to the ligament. The trajectory of the RLN from the inferior thyroid artery level to the ligament of Berry fell into eight categories. In 70% instances, RLN (77% of left and 63% of right) was in the tracheo-oesophageal groove at the inferior thyroid artery level.RLN is usually posterior to the inferior thyroid artery. Relationship between right RLN and the inferior thyroid artery is more variable than that between the left RLN and inferior thyroid artery. RLN is commonly in contact with the ligament of Berry. Most of the time (79%) the left RLN was found to be in the TO groove, deep to the inferior thyroid artery while the right RLN showed a more variable position. The trajectory of the nerve from the inferior thyroid artery level to the level of ligament of Berry was highly variable. Occasionally, the presence of the right non recurrent laryngeal nerve should be expected.

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

“…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.…”

Variable relationship of the recurrent laryngeal nerve to the inferior thyroid artery: A meta‐analysis and surgical implications

“…The characteristics of the studies included in the meta‐analysis are summarized in Table , which shows the prevalence of each type of RLN to ITA relationship. A total of 79 studies ( n = 14,269 nerves) were included, among which 18 were intraoperative, 60 were cadaveric, and 1 included both intraoperative and cadaveric groups. Among the intraoperative studies, 5 were prospective and 14 were retrospective.…”

Peer Review #3 of "The Non-Recurrent Laryngeal Nerve: a meta-analysis and clinical considerations (v0.2)"

“…The characteristics of the studies included in the meta-analysis are summarized in (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, 2001Watanabe et al, , 2016aMonfared, 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;…”