Racial variation in the surgical anatomy of the recurrent laryngeal nerve in patients undergoing thyroid/parathyroid surgery

Functional laryngeal reinnervation depends upon the precise reinnervation of the laryngeal abductor and adductor muscle groups. While simple end-to-end anastomosis of the recurrent laryngeal nerve (RLN) main trunk results in synkinesis, functional reinnervation can be achieved by selective anastomosis of the abductor and adductor RLN divisions. Few previous studies have examined the intralaryngeal anatomy of the RLN to ascertain the characteristics that may lend themselves to laryngeal reinnervation. Ten human larynges without known laryngeal disorders were obtained from human cadavers for RLN microdissection. The bilateral intralaryngeal RLN branching patterns were determined, and the diameters and lengths of the abductor and adductor divisions were measured. The mean diameters of the abductor and adductor divisions were 0.8 and 0.7 mm, while their mean lengths were 5.7 and 6.1 mm, respectively. The abductor division usually consisted of one branch to the posterior cricoarytenoid muscle; however, in cases in which multiple branches were seen, at least one dominant branch could usually be identified. We conclude that the abductor and adductor divisions of the human RLN can be readily identified by an extralaryngeal approach. Several key landmarks aid in the identification of the branches to individual muscles. These data also indicate the feasibility of selective laryngeal reinnervation in patients who might be candidates for laryngeal transplantation after total laryngectomy.

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Intraoperative Monitoring of the Recurrent Laryngeal Nerve during Thyroidectomy: A Standardized Approach (Part 1)

World Journal of Endocrine Surgery ◽

10.5005/jp-journals-10002-1079 ◽

2011 ◽

Vol 3 (3) ◽

pp. 144-150 ◽

Cited By ~ 7

Author(s):

Henning Dralle ◽

Antonio Sitges-Serra ◽

Peter Angelos ◽

Manuel C Durán Poveda ◽

Gianlorenzo Dionigi ◽

...

Keyword(s):

Recurrent Laryngeal Nerve ◽

Thyroid Surgery ◽

Superior Laryngeal Nerve ◽

Surgical Anatomy ◽

Laryngeal Nerve ◽

Nerve Monitoring ◽

Visual Identification ◽

Current State ◽

Monitoring Procedure ◽

Intraoperative Nerve Monitoring

ABSTRACT One of the most feared complications in thyroid surgery is injury to the superior laryngeal nerve or recurrent laryngeal nerve. Neural identification during surgery is insufficient to assess nerve injury. Intraoperative nerve monitoring of the vagal nerve and recurrent laryngeal nerve during thyroid surgery is a new adjunct designed to allow better identification of nerves at risk and therefore reduce complications related to their injury. This new working tool does not substitute adequate surgical technique but merely provides the surgeon with an adjunct to routine visual identification and functional assessment. The use of nerve monitoring requires standardization of the monitoring procedure. Pursuant to this, we will discuss in two related articles the current state of the art standardized technique of nerve monitoring in thyroid surgery. The aim of part 1 is to provide a concise overview of nerve monitoring in thyroid surgery and its effectiveness. This will include a brief review of the surgical anatomy of the recurrent laryngeal nerve and the key landmarks used to identify the nerve during surgery. Part 2 will describe how to perform the standardized nerve monitoring in a step by step fashion during thyroid surgery which will diminish variable results and misleading information associated with a nonstandardized nerve monitoring procedure.

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RECURRENT LARYNGEAL NERVE PALSY AT THYROID AND PARATHYROID SURGERY

The journal of the Japanese Practical Surgeon Society ◽

10.3919/ringe1963.53.1516 ◽

1992 ◽

Vol 53 (7) ◽

pp. 1516-1521

Author(s):

Yoshiharu KANAJI ◽

Yoshihide FUJIMOTO ◽

Yukio ITO ◽

Takao OBARA

Keyword(s):

Recurrent Laryngeal Nerve ◽

Nerve Palsy ◽

Recurrent Laryngeal Nerve Palsy ◽

Laryngeal Nerve ◽

Parathyroid Surgery ◽

Laryngeal Nerve Palsy

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Beahrs’ Triangle: The Surgical Anatomy

World Journal of Endocrine Surgery ◽

10.5005/jp-journals-10002-1206 ◽

2017 ◽

Vol 9 (1) ◽

pp. 35-35

Author(s):

Vikas Jain

Keyword(s):

Recurrent Laryngeal Nerve ◽

Vocal Cord ◽

Nerve Injury ◽

Vocal Cord Paralysis ◽

Recurrent Laryngeal Nerve Injury ◽

Surgical Anatomy ◽

Laryngeal Nerve ◽

Laryngeal Nerve Injury

ABSTRACT Thyroidectomy is a commonly performing surgery worldwide with known complications of recurrent laryngeal nerve injury (RLN) and vocal cord paralysis. To avoid RLN palsy, various methods of RLN identification have been defined, one of which is called as defining Beahrs’ triangle. How to cite this article Jain V. Beahrs’ Triangle: The Surgical Anatomy. World J Endoc Surg 2017;9(1):35.

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