scholarly journals A STUDY OF RELATION OF RECURRENT LARYNGEAL NERVE TO INFERIOR THYROID ARTERY AND THYROID GLAND

2017 ◽  
Vol 4 (56) ◽  
pp. 3406-3409
Author(s):  
Kumari T.K ◽  
Sajey P.S ◽  
Romi S
Keyword(s):  
Thyroid Gland ◽  
Recurrent Laryngeal Nerve ◽  
Laryngeal Nerve ◽  
Inferior Thyroid Artery

scholarly journals Variations in the origin of inferior thyroid artery and relation of the artery with recurrent laryngeal nerve

2013 ◽  
Vol 02 (01) ◽  
pp. 011-015 ◽  
Author(s):  
S. P. Chandrakala ◽  
Mamatha Y. ◽  
K. O. Thejaswini
Keyword(s):  
Thyroid Gland ◽  
Physical Examination ◽  
Recurrent Laryngeal Nerve ◽  
Thyroid Surgery ◽  
Laryngeal Nerve ◽  
Inferior Thyroid Artery ◽  
Arterial Supply ◽  
Major Surgery ◽  
Human Cadavers ◽  
Relationship Of

Abstract Background and aim : Thyroid surgery being a major surgery & quite often performed, a thorough knowledge of variations in arterial supply is very essential for surgeons to prevent alarming number of table deaths in patients with thyroid disease due to excessive and uncontrollable bleeding . It also helps the physicians for proper physical examination and treatment of the patient and to the anatomists for learning the variant patterns. Materials & methods: Fifty five adult human cadavers(45 males,10 females)aged between 25 to 50 years and 25 foetuses (18 female,7 male) aged between 24 to 34 weeks were studied by gross dissection. Results: The inferior thyroid artery was found to be absent in 5% of cases. The level of branching of inferior thyroid artery was also studied where in 23.1 % of cases the artery divides before piercing the surgical capsule of thyroid gland and in 76.97%, it divided after piercing the surgical capsule.The relationship of the artery to the recurrent laryngeal nerve was also studied where in 52.6% of cases, either the artery or its branches were anterior to the nerve, in 26.3% of cases the artery or its branches were posterior to the recurrent laryngeal nerve and in 21.1 % of cases the nerve was intermingled with the branches of artery. Conclusion: From the present study it is concluded that the knowledge of variation of the arterial supply can be used during thyroidectomy where in ligation of all the thyroid vessels is highly essential to ensure proper homeostasis.

scholarly journals Anatomical Variations of the Recurrent Laryngeal Nerve and Implications for Injury Prevention during Surgical Procedures of the Neck

Diagnostics ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. 670
Author(s):  
Alison M. Thomas ◽  
Daniel K. Fahim ◽  
Jickssa M. Gemechu
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Surgical Procedures ◽  
Anatomical Variations ◽  
Laryngeal Nerve ◽  
Inferior Thyroid Artery ◽  
Branching Pattern ◽  
The Right ◽  
Relationship Of ◽  
Intrinsic Laryngeal Muscles ◽  
Formalin Fixed

Accurate knowledge of anatomical variations of the recurrent laryngeal nerve (RLN) provides information to prevent inadvertent intraoperative injury and ultimately guide best clinical and surgical practices. The present study aims to assess the potential anatomical variability of RLN pertaining to its course, branching pattern, and relationship to the inferior thyroid artery, which makes it vulnerable during surgical procedures of the neck. Fifty-five formalin-fixed cadavers were carefully dissected and examined, with the course of the RLN carefully evaluated and documented bilaterally. Our findings indicate that extra-laryngeal branches coming off the RLN on both the right and left side innervate the esophagus, trachea, and mainly intrinsic laryngeal muscles. On the right side, 89.1% of the cadavers demonstrated 2–5 extra-laryngeal branches. On the left, 74.6% of the cadavers demonstrated 2–3 extra-laryngeal branches. In relation to the inferior thyroid artery (ITA), 67.9% of right RLNs were located anteriorly, while 32.1% were located posteriorly. On the other hand, 32.1% of left RLNs were anterior to the ITA, while 67.9% were related posteriorly. On both sides, 3–5% of RLN crossed in between the branches of the ITA. Anatomical consideration of the variations in the course, branching pattern, and relationship of the RLNs is essential to minimize complications associated with surgical procedures of the neck, especially thyroidectomy and anterior cervical discectomy and fusion (ACDF) surgery. The information gained in this study emphasizes the need to preferentially utilize left-sided approaches for ACDF surgery whenever possible.

Neuromonitoring of the recurrent laryngeal nerve in thyroid gland surgery – results and experiences

2021 ◽  
Vol 70 (2) ◽  
pp. 89-96
Author(s):  
Jiří Hložek ◽  
Jan Rotnágl ◽  
Jaromír Astl
Keyword(s):  
Thyroid Gland ◽  
Recurrent Laryngeal Nerve ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Laryngeal Nerve ◽  
Operative Strategy ◽  
Predictive Values ◽  
Group A ◽  
Group B ◽  
Neural Monitoring

Paresis of the recurrent laryngeal nerve (RLN) is one of the serious complications of thyroid and parathyroid gland surgery. The intraoperative neural monitoring (IONM) enables to verify the functionality of RLN. The aim of this study is to compare the incidence of postoperative RLN palsy in patients who underwent surgery with and without the use of IONM RLN and to evaluate the positive and negative predictive values, sensitivity, specifi city and accuracy of the method. Methods: Retrospective analysis of thyroid gland surgeries performed within the period from 1. 7. 2016 to 1. 7. 2018. A total of 467 operations were performed (780 nerves exposed). One hundred and thirty procedures (215 nerves) were carried out without IONM (group A). In total, 337 procedures (565 nerves) were performed with IONM (group B). Results: In group A, unilateral postoperative RLN paresis occurred in 7 cases (3.26%); 6 of them were temporary (2.79%) and 1 was permanent (0.47%). In group B, unilateral postoperative RLN paresis occurred in 33 cases (5.84%); 32 of them were temporary (5.66%) and 1 was permanent (0.18%). The incidence of postoperative RLN paresis related to the use of IONM was not considered statistically signifi cant. (Chi-square test: P = 0.146; Fisher‘s exact test: P = 0.2015, P = 0.4715). The sensitivity, specifi city, positive predictive value, negative predictive value and accuracy were 78.79%, 99.25%, 86.67%, 98.69%, and 98.05%, respectively. There was no case of bilateral postoperative RLN paresis. Conclusion: There was no statistically significant diff erence in the incidence of postoperative RLN palsy in patients who underwent surgery with IONM compared to the group without IONM. The high negative predictive value, specifi city and accuracy indicate high reliability of the method. The IONM provides the surgeon with valuable information regarding the functional status of the nerve. This knowledge allows for changing the operative strategy during the procedure. Keywords: intraoperative neural monitoring – IONM – recurrent laryngeal nerve injury – recurrent laryngeal nerve – thyroid surgery

scholarly journals Two Concomitant Right Nonrecurrent Laryngeal Nerves Encountered During Thyroidectomy (Type 4 Course): Reported for the First Time

2020 ◽  
pp. 014556132091898
Author(s):  
Ayad Ahmad Mohammed ◽  
Sardar Hassan Arif
Keyword(s):  
Vagus Nerve ◽  
Recurrent Laryngeal Nerve ◽  
Neck Surgery ◽  
Laryngeal Nerve ◽  
Inferior Thyroid Artery ◽  
Thyroid Function Tests ◽  
Ligamentum Arteriosum ◽  
Laryngeal Nerves ◽  
Thyroid Lobectomy ◽  
The Right

Introduction: The recurrent laryngeal nerve gains its name because after branching from the vagus nerve, it turns superiorly (recur) around the subclavian artery on the right and around the ligamentum arteriosum on the left, the nonrecurrent nerve has a straight direct course to the larynx and doesn’t follow this course. It presents mostly on the right side. The presence of this variation places the nerve at higher risk of injury during neck surgery especially thyroid operations. Case Presentation: A 45-year-old lady presented with painless thyroid enlargement for 1 year. Thyroid examination showed a 3-cm firm nodule at the right thyroid lobe with normal thyroid function tests. Right thyroid lobectomy was done and the histopathology showed a benign follicular lesion. During surgery, we discovered 2 nonrecurrent laryngeal nerves at the right side which were arising from the vagus nerve and both were entering the larynx. Conclusion: Failure in identification of the nerve or overlooking the possibility of the non-recurrent laryngeal nerve may result in a serious sequelae of nerve damage, ipsilateral injury may lead to permanent hoarseness and bilateral injury may result in severe dyspnea or aphonia. Currently, there are 3 types of nonrecurrent laryngeal nerve courses. Type 1 passes near to the superior thyroid vessels. Type 2 (2A) passes parallel to the inferior thyroid artery and has a transverse course above it. Type 3 (2B) passes parallel to the inferior thyroid artery and transversely between branches of or under the inferior thyroid artery, we can add to this classification type 4, which are 2 nonrecurrent laryngeal nerves (double nerves) passing above and parallel to the inferior thyroid artery.

scholarly journals The Identification of Recurrent Laryngeal Nerve by Injection of Blue Dye into the Inferior Thyroid Artery in Elusive Locations

2013 ◽  
Vol 2013 ◽  
pp. 1-3 ◽  
Author(s):  
Gulcin Hepgul ◽  
Meltem Kucukyilmaz ◽  
Oguz Koc ◽  
Yigit Duzkoylu ◽  
Yavuz Selim Sari ◽  
...  
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Potential Risk ◽  
Gold Standard ◽  
Laryngeal Nerve ◽  
Inferior Thyroid Artery ◽  
Surrounding Tissue ◽  
Blue Dye ◽  
Thyroid Lobe ◽  
Tracheoesophageal Groove ◽  
Nerve Localization

Introduction. Thyroidectomy creates a potential risk for all parathyroid glands and the recurrent laryngeal nerve (RLN). The identification and dissection of the RLN is the gold standard for preserving its function. In some cases, it may be quite difficult to identify the nerve localization. In such elusive locations, we aimed to identify RLNs using peroperative injection of a blue dye into the inferior thyroid artery.Materials and Methods. This study included 10 selected patients whose RLN identification had been difficult peroperatively during the period from April 2008 to June 2009. When the RLNs became elusive in location, the branches of the inferior thyroid artery (ITA) on the capsule of the thyroid lobe were isolated, and then 0.5 mL isosulphan blue dye was injected into the artery.Results. RLN was carefully dissected in the tracheoesophageal groove. RLN was clearly visualized, in all patients. All RLNs were identified along their course in the dyed surrounding tissue. No RLN palsy was encountered.Conclusion. The injection of blue dye into the ITA branches can be used as an alternate method in case of difficulty in identification of RLNs.

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