Anatomical Variations of the Recurrent Laryngeal Nerve During Thyroid Surgery and the Dangers of Nerve Injury

Objective: To describe the anatomic relationship of the recurrent laryngeal nerve and the inferior thyroid artery in adult cadavers in the Philippines and to compare the proportions of these anatomic relationships with those reported in the foreign literature. Methods: Study design: Descriptive, cross-sectional Setting: University of the Philippines College of Medicine Anatomy Laboratory Subjects: Fifty-four (54) preserved cadavers (108 sides) dissected within a period from June 2008 to Aug 2010. The anatomy and position of both the right and the left recurrent laryngeal nerves (RLN) and inferior thyroid arteries (ITA) were noted. The RLN was further classified into 2 variations: non-branching or branching prior to insertion at the cricothyroid joint, under the inferior constrictor muscle. The ITA was also classified into non-branching and branching. The results were compared to two foreign studies using a Z-test for two proportions. Results: Fifty four (54) cadavers (108) sides were dissected. Among the cadavers, both the recurrent laryngeal nerves and inferior thyroid arteries had a maximum of two branches although both the RLNs and ITAs for both the right and left sides were mostly non-branching. The right side of one cadaver was noted to have both a branching RLN and a branching ITA. There were no non-recurrent laryngeal nerves seen among the 54 cadavers. For both left and right sides, the RLN was mostly dorsal to the ITA. Branching RLNs was mostly dorsal to a non-branching ITAs. Most of the non-branching RLNs were dorsal to the ITAs. Non-branching RLNs were usually dorsal to the ITA. The local patterns of the course of the RLN in relation to the ITA approximates those of Chinese where there is predominance of the RLN dorsal to the ITA but differs from those of Brazilians where the RLN is usually between ITA branches. Conclusion: There are multiple anatomical variations with regards to the relationship of the RLN and the ITA. The anatomic variation among Asians may be different from Brazilians. The surgeon’s knowledge of the possible various configurations of the RLN and ITA should be able to help in identification and preservation of the RLN and prevention of complications in thyroid surgery. Keywords: recurrent laryngeal nerve, inferior thyroid artery, thyroid surgery, Filipino cadavers, anatomical variations

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Intraoperative neuromonitoring versus visual nerve identification for prevention of recurrent laryngeal nerve injury in adults undergoing thyroid surgery

Cochrane Database of Systematic Reviews ◽

10.1002/14651858.cd012483 ◽

2016 ◽

Cited By ~ 1

Author(s):

Roberto Cirocchi ◽

Vito D'Andrea ◽

Alberto Arezzo ◽

Iosief Abraha ◽

Roberto Passera ◽

...

Keyword(s):

Recurrent Laryngeal Nerve ◽

Nerve Injury ◽

Thyroid Surgery ◽

Recurrent Laryngeal Nerve Injury ◽

Intraoperative Neuromonitoring ◽

Laryngeal Nerve ◽

Laryngeal Nerve Injury ◽

Nerve Identification

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

Surgical Science ◽

10.4236/ss.2019.101002 ◽

2019 ◽

Vol 10 (01) ◽

pp. 11-15

Author(s):

Fatogoma Issa Koné ◽

Siaka Soumaoro ◽

Naouma Cissé ◽

N’faly Konaté ◽

Kassim Diarra ◽

...

Keyword(s):

Recurrent Laryngeal Nerve ◽

Thyroid Surgery ◽

Anatomical Variations ◽

Laryngeal Nerve

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Thyroidectomy: post-operative complications and management

International Surgery Journal ◽

10.18203/2349-2902.isj20191887 ◽

2019 ◽

Vol 6 (5) ◽

pp. 1659

Author(s):

Nikhil Soni ◽

Bapuji Shravan Gedam ◽

Murtaza Akhtar

Keyword(s):

Recurrent Laryngeal Nerve ◽

Nerve Injury ◽

Thyroid Surgery ◽

Laryngeal Nerve ◽

Common Finding ◽

Care Hospital ◽

Operative Complications ◽

Laryngeal Nerve Injury ◽

Thyroid Swelling ◽

Post Operative Complications

Background: Thyroidectomy is a surgical procedure indicated as elective treatment for symptomatic thyroid swellings or neoplasms. Today most of the complications of thyroid surgery are related to either metabolic derangements or injury to the recurrent laryngeal nerve injury. Other complications include superior laryngeal nerve injury, infection, airway compromise, and bleeding. Hence, before any thyroid surgery patient must be precisely informed the possible complications and their remedies. The present study aims to evaluate post-operative complications after thyroid surgery.Methods: In a tertiary care hospital based longitudinal study patients presenting with clinically and sonographically diagnosed thyroid swelling who underwent surgical intervention were enrolled in the study. These patients were evaluated for thyroid profile test, fine needle aspiration cytology (FNAC), pre-operative and post-operative indirect laryngoscopy, serum calcium level and histopathology. Intra operative and post-operative assessment was done for bleeding, hematoma, and surgical site infection.Results: A total of 53 patients were enrolled. Thyroid swelling was more common in females (F: M =5.6:1) mostly presenting in 3rd and 4th decades with mean age of 38.1 years. Hemithyroidectomy was the most common procedure performed (63.6%) followed by total (27.3%) and near total thyroidectomies (5.5%). On histopathological examination most common finding was nodular goiter (49.1%) followed by multinodular goiter (28.3%), follicular adenoma (16.9%) and malignancies (5.7%). The post-operative complications after thyroidectomies were hypocalcemia (16.9%), recurrent laryngeal nerve (RLN) injury (5.7%), and surgical site infection (1.9%).Conclusions: Careful evaluation of post thyroidectomy complications will help in reducing these complications and patient’s safety.

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