The recurrent laryngeal nerve and the inferior thyroid artery—anatomical variations during surgery

Makay, Özer; İçöz, Gökhan; Yılmaz, Mustafa; Akyıldız, Mahir; Yetkin, Enis

doi:10.1007/s00423-008-0320-8

Cited by 64 publications

(67 citation statements)

References 27 publications

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“…Our study showed 4 (80%) of the bifurcated nerves to be in the left sided and 1 on the right side. Similar results were seen in the study by Makay et al 11 where bifurcation of the nerve was mostly observed on the left side. However Casella et al 13 found 36 of 195 (18.5%) nerves showing extra-laryngeal branching of which 27 (25.5%) were right and 9 left sided (p = 0.0088).…”

Section: Discussionsupporting

confidence: 91%

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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Section: Discussionsupporting

confidence: 91%

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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“…Thyroid surgery requires a thorough knowledge of the RLN and its anatomical variations. This is of utmost importance, since it is well known that variations of the RLN are prone to iatrogenic injuries [12]. Giving more researches on these variations is essential to prevent damage to the nerve.…”

Section: Discussionmentioning

confidence: 99%

An applied anatomical study on the recurrent laryngeal nerve and inferior thyroid artery

et al. 2011

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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: 80%

“…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: 93%

New Variation of Right Recurrent Laryngeal Nerve: Cases Report

et al. 2014

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The recurrent laryngeal nerve and the inferior thyroid artery—anatomical variations during surgery

Abstract: To avoid the risk of nerve damage during thyroid surgery, a good knowledge of the variations of the inferior laryngeal nerve is essential. This is important to achieve an undisturbed quality of life for the thyroid patient.

Cited by 64 publications

References 27 publications

Surgical anatomy of recurrent laryngeal nerve during thyroid and laryngeal surgeries

Surgical anatomy of recurrent laryngeal nerve during thyroid and laryngeal surgeries

An applied anatomical study on the recurrent laryngeal nerve and inferior thyroid artery

New Variation of Right Recurrent Laryngeal Nerve: Cases Report

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