scholarly journals The Recurrent Laryngeal Nerve in Relation to the Inferior Thyroid Artery in Adult Filipino Cadavers

2011 ◽  
Vol 26 (2) ◽  
pp. 13-17 ◽  
Author(s):  
Jacob S. Matubis ◽  
Karen June P. Dumlao ◽  
Ryner Jose C. Carrillo
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Thyroid Surgery ◽  
Anatomical Variations ◽  
The Philippines ◽  
Laryngeal Nerve ◽  
Inferior Thyroid Artery ◽  
Laryngeal Nerves ◽  
Recurrent Laryngeal Nerves ◽  
The Right ◽  
Relationship Of

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

Non-recurrent laryngeal nerve related to thyroid surgery: report of three cases

2007 ◽  
Vol 122 (7) ◽  
pp. 757-761 ◽  
Author(s):  
C Page ◽  
P Monet ◽  
J Peltier ◽  
B Bonnaire ◽  
V Strunski
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Subclavian Artery ◽  
Thyroid Surgery ◽  
Anatomical Variation ◽  
Anatomical Variations ◽  
Laryngeal Nerve ◽  
Frequency Of Occurrence ◽  
Laryngeal Nerves ◽  
Recurrent Laryngeal Nerves ◽  
The Right

AbstractPurpose of the study:We aimed to highlight a rare anatomical variation involving the recurrent laryngeal nerve, and to emphasise its implications for thyroid surgery.Materials and methods:Over a period of 13 years, 993 patients underwent thyroid surgery; 1557 recurrent laryngeal nerves (887 on the right side) were exposed.Results:Three non-recurrent laryngeal nerves were found on the right side, associated with a retro-oesophageal subclavian artery. One case was suspected before surgery.Discussion:Several variations in the path and branches of the recurrent laryngeal nerve have been reported in the literature. The frequency of occurrence of a non-recurrent laryngeal nerve is about 1 per cent, for patients undergoing thyroid surgery. Other surgically relevant anatomical variations of the recurrent laryngeal nerve include associations with the inferior thyroid artery and the presence of nerve branches.Conclusion:The recurrent laryngeal nerve must be carefully dissected and totally exposed during thyroid surgery in order to best preserve its function. Moreover, the thyroid surgeon must be aware of the existence of anatomical variations, which are not as rare as one may think.

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.

scholarly journals Identifying Recurrent Laryngeal Nerve in Thyroid Surgery Using Relationship with Superior Parathyroid Gland and Tubercle of Zuckerkandl

2015 ◽  
Vol 23 (3) ◽  
pp. 99-103
Author(s):  
Somesh Mozumder ◽  
Shirish Dubey ◽  
Aniruddha Dam ◽  
Anup Kumar Bhowmick
Keyword(s):  
Prospective Study ◽  
Recurrent Laryngeal Nerve ◽  
Parathyroid Gland ◽  
Thyroid Surgery ◽  
Intimate Relationship ◽  
Laryngeal Nerve ◽  
Laryngeal Nerves ◽  
Recurrent Laryngeal Nerves ◽  
A Prospective Study ◽  
Relationship Of

Introduction: Recurrent laryngeal nerves (RLN) are particularly prone to injury during thyroid surgeries due to its intimate relationship and proximity with the gland. Zuckerkandl’s tubercle (ZT) helps in preserving RLN intra operative. Material and Methods: A prospective study for identifying RLN in thyroid surgery using relationship with superior parathyroid gland and tubercle of Zuckerkandl was conducted on 50 thyroidectomy patients between August 2013 and February 2014. Results: In all cases ZT was identified. Temporary paralysis of RLN was seen in 3 (6%) cases and permanent paralysis in 2 (4%) of cases. Discussion: The site of greatest risk during thyroidectomy to the RLN is in the last 2-3 cm extralaryngeal course of the nerve. Relationship of recurrent laryngeal nerve with superior parathyroid gland and tubercle of Zukerkandl (ZT) is known. Conclusion: Use of ZT and superior parathyroids as a landmark allows safe dissection of RLN.

scholarly journals Anatomical Variations in Recurrent Laryngeal Nerves in Thyroid Surgery

2020 ◽  
pp. 014556132092756 ◽  
Author(s):  
Chuanchang Yin ◽  
Bin Song ◽  
Xiaoyan Wang
Keyword(s):  
Thyroid Surgery ◽  
Vocal Cord Paralysis ◽  
Anatomical Variation ◽  
Anatomical Variations ◽  
Laryngeal Nerve ◽  
Laryngeal Nerves ◽  
Original Direction ◽  
Nonrecurrent Laryngeal Nerve ◽  
Recurrent Laryngeal Nerves ◽  
The Right

Objective: To study terminal bifurcation of recurrent laryngeal nerves (RLNs) with original direction to larynx entry and to decrease the risk of vocal cord paralysis in thyroid patients. Methods: The RLNs of 294 patients (482 sides) were dissected according to the branches into the larynx, and the original direction of each RLN trunk in thyroid surgery was recorded. Results: (1) About 30.9% of the RLNs gave off multiple branches into the larynx. (2) Two and 3 branches of RLNs into the larynx were found in 25.5% and 5.4% of the cases, respectively. (3) In 0.4% or 2 cases, the RLN trunk combined with the inferior branch of the vagus nerve. (4) Nonrecurrent laryngeal nerve appeared in 2 cases. (5) On the left side, 68.0%, 25.6%, and 6.4% of cases were found with 1, 2, and 3 bifurcations of RLN to larynx entry, respectively. On the right side, 69.8%, 25.8%, and 4.4% cases were identified with 1, 2, and 3 bifurcations of RLN to larynx entry, respectively. (6) The combining dissection approach was proved as successful and safe for protecting the RLN with no permanent RLN paresis. Conclusions: Because of the anatomical variation in RLNs with extralaryngeal bifurcation, it is necessary to increase the awareness of surgeons about these variations so as to protect bifurcated nerves in 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.

Characteristic travelling patterns of non-recurrent laryngeal nerves

2014 ◽  
Vol 128 (6) ◽  
pp. 534-539 ◽  
Author(s):  
K H Hong ◽  
H T Park ◽  
Y S Yang
Keyword(s):  
Computed Tomography ◽  
Recurrent Laryngeal Nerve ◽  
Subclavian Artery ◽  
Vocal Fold ◽  
Laryngeal Nerve ◽  
New Classification ◽  
Laryngeal Nerves ◽  
Brachiocephalic Trunk ◽  
Recurrent Laryngeal Nerves ◽  
The Right

AbstractBackground:The non-recurrent laryngeal nerve is subject to potential injury during thyroid surgery. Intra-operative identification and preservation of this nerve can be challenging. Its presence is associated with an aberrant subclavian artery and the developmental absence of the brachiocephalic trunk. This study aimed to evaluate the incidence of non-recurrent laryngeal nerves and present a new classification system for the course of these nerves.Methods:Non-recurrent laryngeal nerves were identified on the right side in 15 patients who underwent thyroidectomy. The incidence of non-recurrent laryngeal nerves (during thyroidectomy) and aberrant subclavian arteries (using neck computed tomography) was evaluated, and the course of the nerves was classified according to their travelling patterns.Results:The overall incidence of non-recurrent laryngeal nerves was 0.68 per cent. The travelling patterns of the nerves could be classified as: descending (33 per cent), vertical (27 per cent), ascending (20 per cent) or V-shaped (20 per cent).Conclusion:Clinicians need to be aware of these variations to avoid non-recurrent laryngeal nerve damage. A retroesophageal subclavian artery (on neck computed tomography) virtually assures a non-recurrent laryngeal nerve. This information is important for preventing vocal fold paralysis. Following a review of non-recurrent laryngeal nerve travelling patterns, a new classification was devised.

scholarly journals Clinical impacts of the Sudanese anatomical variations in a relation of the recurrent laryngeal nerve to the inferior thyroid artery

2020 ◽  
Vol 8 (2) ◽  
pp. 25
Author(s):  
Mohamed Elghazali Elhasan ◽  
Wael Mohialddin Doush
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Anatomical Variations ◽  
Cross Sectional Study ◽  
Laryngeal Nerve ◽  
Inferior Thyroid Artery ◽  
Parathyroid Glands ◽  
Main Trunk ◽  
Cross Sectional ◽  
Relationship Of ◽  
The Relationship

Background: Until recently, the knowledge of the anatomical variations in the relationship between the recurrent laryngeal nerve (RLN) and the inferior thyroid artery (ITA) combined with visual intraoperative RLN identification are essential for the protection of these life-important structures during surgical exposure and the mobilization of thyroid and parathyroid glands. This leads to the proper treatment of patients and improvement of the surgical techniques.Aim: To describe anatomical variations in the relationship of the recurrent laryngeal nerve to the inferior thyroid artery in the Sudanese population.Patients and methods: Following ethical committee approval, an observational descriptive prospective cross-sectional study in the period between March 2019 and February 2020, for anatomical variations in the relation of the recurrent laryngeal nerve to the inferior thyroid artery in seventy-two cervical sides of thirty-six well-dissected embalmed Sudanese cadavers. The RLN was investigated in three positions: posterior to the ITA main trunk, anterior to the ITA main trunk and between the ITA branches. Then, the results were analyzed according to the gender, age and dissection side.Results: We found that the anatomical variations were more frequent in males (97.2%) than females (2.8%). The age of these variations ranged between 31–45 years which represents (61.1%). On the right side of the neck, the commonest position of the RLN is posterior to the ITA (63.9%) followed by in decreasing order of frequency, the RLNs run between the ITA branches (30.6%) and anterior to the ITA (5.6%). On the left side of the neck, the commonest position of the RLN is posterior to the ITA (69.4%). It passed between the ITA branches in (30.6%) of specimens. There was no anterior location of the RLN to the ITA. Variations in a relationship of the RLN to the ITA on one side is significantly different from the opposite side.Conclusions: Although the risk of potential damage to the RLN during surgical neck procedures involving the thyroid gland and parathyroid glands is well recognized, pre-operative detailed surgeon’s knowledge for these frequent anatomical variations and the usage of the ITA as an anatomical landmark for intraoperative RLN recognition is important. This will lead to a reduction of iatrogenic RLN injury prevalence. Future studies are recommended to compare the findings on this cadaveric study with a larger sample size in the long-term period.  

Thyroid tubercle of Zuckerkandl: anatomical and surgical experience from 79 thyroidectomies

2008 ◽  
Vol 123 (7) ◽  
pp. 768-771 ◽  
Author(s):  
C Page ◽  
P Cuvelier ◽  
A Biet ◽  
P Boute ◽  
M Laude ◽  
...  
Keyword(s):  
Thyroid Gland ◽  
Recurrent Laryngeal Nerve ◽  
Thyroid Surgery ◽  
Anatomical Variation ◽  
Lateral Lobe ◽  
Anatomical Variations ◽  
Anatomical Landmark ◽  
Laryngeal Nerve ◽  
Surgical Experience ◽  
The Right

AbstractObjective:To highlight a poorly known anatomical variation of the lateral lobe of the thyroid gland, which can be useful in identifying the recurrent laryngeal nerve during thyroid surgery.Materials and methods:We performed a three-year prospective study of 79 thyroid surgery patients. Great attention was paid to anatomical variations of the thyroid gland (i.e. the presence or absence of a distinct tubercle of Zuckerkandl), the recurrent laryngeal nerve and the location of the parathyroid glands.Results:A total of 71 right lobectomies and 74 left lobectomies were performed. Five tubercles of Zuckerkandl were identified (7.04 per cent of cases) and were useful in detecting the recurrent laryngeal nerve (but only on the right side).Conclusion:The tubercle of Zuckerkandl is a poorly known and variable anatomical feature of the thyroid gland which may not, in fact, be so rare. It arises for embryological reasons, and it can be a reliable anatomical landmark for identifying the recurrent laryngeal nerve during thyroid surgery. It should be included in the Nomina Anatomica as the ‘processus posterior glandulae thyroideae’ described by Zuckerkandl.

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 Surgical anatomy of recurrent laryngeal nerve during thyroid and laryngeal surgeries

2017 ◽  
Vol 5 (1) ◽  
pp. 2-4
Author(s):  
Trideep Pantha ◽  
N.N. Mathur ◽  
S. Bhandary
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Average Diameter ◽  
Neck Surgery ◽  
Surgical Anatomy ◽  
Laryngeal Nerve ◽  
Inferior Thyroid Artery ◽  
The Right ◽  
Relationship Of ◽  
Crossing Point ◽  
Anatomic Relationship

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 Methods: Descriptive prospetive study was conducted in the department of Otorhinolaryngology and Head and Neck surgery in BPKIHS, Dharan, between July 2008- June 2009 including all patients undergoing thyroidectomy and total laryngectomy during the study period.Result: RLN frequently passed behind the inferior thyroid artery and occupied the tracheo-oesophageal groove in the left side than on the right. The average diameter of the nerve was 1.88 mm and the nerve commonly terminated as a single trunk.Conclusion: The nerves were commonly found deep to the ITA (96.2% on left side and 88% on right). The segment of RLN vulnerable to surgical injury between the crossing point of ITA to its entry in the larynx was found to be 3.13 cm (SD=0.29cm). The average thickness of the nerve was 1.68mm however the thickness increased as the surgery progressed and at the end of surgery. All the RLNs on the left side were found completely within the TOG while some variations were seen on the right side.

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