Variations in the Locations of the Recurrent Laryngeal Nerve in Relation to the Ligament of Berry

Abstract

Injury to the recurrent laryngeal nerve (RLN) is one of the most common iatrogenic complications of thyroid surgery. The anatomical course of the nerve also increases its susceptibility to injury and many variations have been documented in the literature. The topographical relationship of the RLN to the ligament of Berry has been extensively studied over the past decades. The consensus in the literature is divided with several authors reporting the nerve to be embedded within the ligament and others reporting a constant finding of the nerve being posterolateral to the ligament. A new operative concept has been recently introduced as a possible resolution for the conflicting reports among authors. Further investigations are needed, however, to assess its reliability and overall effects on clinical outcomes.

A Rapid and Accurate Technique for the Identification of the Recurrent Laryngeal Nerve

“…Iatrogenic RLN injury likely represents the most common cause for otolaryngologic referral. 9 It is also the main cause (82.8%) of bilateral vocal fold palsy, and most of these cases occur during revision thyroid surgery. 12 The RLN is the motor nerve supplying all of the intrinsic laryngeal muscles except the cricothyroid muscle.…”

“…4,13 During this ascending passage, the RLN will cross the inferior thyroid artery and will pass near the Berry ligament to enter the larynx. 6,9 The parathyroids also have a clear-cut location relative to the coronal plane of the RLN in the neck. The inferior glands lie ventral to the RLN, whereas the superior glands are dorsal.…”

“…6 The RLN shows a great number of topographical relations to the adjacent cervical structures because of the multiple variations in its course. 9,10 The anatomic variations may be minor in degree but are important as they may produce surgical morbidities. Therefore, surgeons should be largely aware of the variations of RLN anatomy and have a thorough knowledge of normal anatomy to ensure the integrity and safety of the RLN.…”

Tireoidectomia Total: Estudo Anatômico Do Procedimento Em Cadáver

“…15 Da mesma forma, grandes séries de conservas foram realizados com 20 estudos cadavéricos explorando as relações anatômicas desses pontos de referência, como o ligamento Berry e a artéria tireoidea superior, que estão bem próximas a glândula tireoide. 16 Outra estrutura que merece atenção é o ramo externo do nervo laríngeo superior, cujo comprometimento pode passar despercebido. A lesão deste nervo é de identificação baixa e seu dano tem alta prevalência quando é realizada a secção da artéria tireoidiana superior.…”