Chapter-62 Revisiting the Anatomy of Recurrent Laryngeal Nerve/Inferior Thyroid Artery

2013 ◽  
pp. 62-62
Author(s):  
Madan Kapre
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Laryngeal Nerve ◽  
Inferior Thyroid Artery

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 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.

scholarly journals Relationship between the recurrent laryngeal nerve and the inferior thyroid artery: a study in corpses

2000 ◽  
Vol 55 (6) ◽  
pp. 195-200 ◽  
Author(s):  
Bernardo Almeida Campos ◽  
Paulo Roberto Ferreira Henriques
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Laryngeal Nerve ◽  
Inferior Thyroid Artery ◽  
Significant Difference ◽  
Racial Variations ◽  
Anatomical Relationship ◽  
The Right ◽  
The Relationship

The anatomical relationship between the recurrent laryngeal nerve (RLN) and the inferior thyroid artery (ITA) was studied in 76 embalmed corpses, 8 females and 68 males. In both sexes, the RLN lay more frequently between branches of the ITA.; it was found in this position in 47.3% of male corpses and 42.8% of female ones. On the right, RLN was found between branches of the ITA in 49.3% of the cases, anterior to it in 38.04%, and posterior in 11.26%. On the left, the RLN lay between branches of the ITA in 44.45%, posterior to the ITA in 37.05%, and anterior to it in 18.05% of the cases. In 62.68% of the cases, the relationship found on one side did not occur again on the opposite side. There was a significant difference (p<0.05) in the distribution of the 3 types of relationships between the RLN and the ITA, on the right and on the left. Racial variations could contribute to an explanation of the differences observed by authors of different countries in the relationship between the RLN and the ITA.

Response to “Anatomic configurations of the recurrent laryngeal nerve and inferior thyroid artery”

Surgery ◽  
2007 ◽  
Vol 141 (2) ◽  
pp. 281-282 ◽  
Author(s):  
Anand K. Mishra ◽  
Amit Agarwal ◽  
C.K. Ben Selven ◽  
Arvindan Nair
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Laryngeal Nerve ◽  
Inferior Thyroid Artery

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.  

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