scholarly journals Incidence and Surgical Importance of Zuckerkandl’s Tubercle of the Thyroid and Its Relations with Recurrent Laryngeal Nerve

ISRN Surgery ◽  
2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Emin Gurleyik ◽  
Gunay Gurleyik
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Total Thyroidectomy ◽  
Surgical Procedures ◽  
Surgical Anatomy ◽  
Laryngeal Nerve ◽  
Anterior Surface ◽  
Common Structure ◽  
Adjacent Structures ◽  
Posterior Extension ◽  
Crossing Point

Background. Variations of recurrent laryngeal nerve (RLN) and Zuckerkandl’s tubercle (ZT), which is posterior extension of lateral lobes, may affect safety of thyroidectomy. Methods. Total and hemithyroidectomy were surgical procedures in 60 and 40 patients, respectively. Surgical anatomy was studied in 87 right and 73 left lobes. Presence of ZT was noted and its incidence was determined. RLNs were identified and fully isolated. Relationship between ZT and RLN was established. Results. ZTs were identified in 66 (66%) patients and in 81 (51%) lobes. ZT was present in 53 (61%) right and in 28 (38%) left lobes. ZTs were bilateral in 15 (25%) of 60 total thyroidectomy cases. Smaller tubercles show the neurovascular crossing point. RLN was posterior (medial) to ZT in 76 (94%) occurrences. RLN was laying on anterior surface of ZT only in 5 (6%) instances. Conclusions. RLN is unusually laying lateral to ZT which is common structure in the thyroid. Lateral RLN may be more vulnerable to injury. Total thyroidectomy requires dissection of ZT adjacent to RLN. Based on unusual relations and variations, RLN should be fully isolated before excision of adjacent structures.

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.

Outcome of Thyroid Surgeries at Patan Hospital

2018 ◽  
Vol 6 (1) ◽  
pp. 11-14
Author(s):  
Deepak Yadav ◽  
Bhawana Dangol ◽  
Anita GC ◽  
Namita Shrestha ◽  
Ishwor Raj Devkota ◽  
...  
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Total Thyroidectomy ◽  
Neck Dissection ◽  
Recurrent Laryngeal Nerve Palsy ◽  
Central Compartment ◽  
Neck Surgery ◽  
Laryngeal Nerve ◽  
Completion Thyroidectomy ◽  
Lateral Neck ◽  
Lateral Neck Dissection

Objective: To assess the outcome of thyroid surgeries at Patan HospitalMaterials and Methods: It is a retrospective study of in-patient records of patients undergoing thyroid surgeries for various indications from April 2013 to January 2015 at Patan Hospital, Lalitpur.Results: During the period of 21 months, 75 patients underwent thyroid surgeries. Majority of patients underwent hemithyroidectomy (35) followed by total thyroidectomy (28), subtotal thyroidectomy (7) and completion thyroidectomy (5). Out of 28 patients undergoing total thyroidectomy (TT), 11 underwent central compartment clearance (CCC), 5 underwent CCC and lateral neck dissection. Among 5 patients undergoing completion thyroidectomy, CCC was performed in all cases and in one patient lateral neck dissection was also performed.  A total of 13 patients developed unilateral recurrent laryngeal nerve palsy (RLN), among them 5 had permanent palsy. Tracheostomy had to be done in immediate postoperative period for stridor following total thyroidectomy (TT) in one case. Temporary hypocalcaemia was observed in 10 (10/28) cases following TT, out of which 8 had undergone CCC. Permanent hypocalcaemia was observed in 7 (7/28) cases following TT out of which 3 had undergone CCC. Chylous leak occurred in one of the patient undergoing left level II-IV neck dissection which was managed conservatively. None of the patient had to be transfused postoperatively.Conclusion: Complications to thyroid surgery are not uncommon. Visualization of recurrent laryngeal nerve alone in our context is adequate in experienced hands. Identification of parathyroid during thyroidectomy is recommended to avoid hypocalcaemia. Meticulous dissection can reduce the complications.Nepalese Journal of ENT Head and Neck Surgery, Vol. 6, No. 1, 2015

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 A current view on recurrent laryngeal nerve injury in total thyroidectomy

2021 ◽  
Vol 28 (1) ◽  
pp. 7-12
Author(s):  
Lucian ALECU ◽  
◽  
Iulian SLAVU ◽  
Adrian TULIN ◽  
Vlad BRAGA ◽  
...  
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Total Thyroidectomy ◽  
Nerve Injury ◽  
Unintentional Injury ◽  
Recurrent Laryngeal Nerve Injury ◽  
Laryngeal Nerve ◽  
Current View ◽  
Pubmed Database ◽  
Laryngeal Nerve Injury ◽  
The Moment

Introduction: Recurrent laryngeal nerve damage during total thyroidectomy was, is, and probably will be in the near future the Achilles’ heel of total thyroidectomy. Material and method: To perform the research we used the PubMed database. The questions were conceived to respect the PICOS guidelines. The PRISMA checklist was used to filter the results. The search was structured following the words: „recurrent laryngeal nerve injury” AND „total thyroidectomy”. Results: A total of 60 papers were identified. We excluded 12 papers as they were duplicates. From the 48 papers left, another 4 could not be obtained. Another 3 papers from the 44 left were excluded due to the fact they were not written in English. One paper was excluded as the subject did not follow our research purpose. 40 papers were left for analysis and discussion. Conclusion: To prevent recurrent laryngeal nerve lesions, at the moment in the literature there is no consensus. Unintentional injury to the recurrent laryngeal nerve is predictable but not an avertible situation thus bilateral lesions still represent a dramatic situation across the world for the patients and the operating surgeon.

Recurrent Nerve Injury After Total Thyroidectomy: Risk Factor Analysis of a Targeted NSQIP Data Set

2021 ◽  
pp. 000313482110547
Author(s):  
David A. Mahvi ◽  
Lily V. Saadat ◽  
Jamie Knell ◽  
Richard D. Urman ◽  
Edward E. Whang ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Postoperative Complications ◽  
Recurrent Laryngeal Nerve ◽  
Total Thyroidectomy ◽  
Nerve Injury ◽  
Laryngeal Nerve ◽  
Recurrent Nerve ◽  
Improvement Program ◽  
Data Set ◽  
Cardiopulmonary Complications

Background Recurrent laryngeal nerve (RLN) injury is a significant complication after thyroidectomy. Understanding risk factors for RLN injury and the associated postoperative complications may help inform quality improvement initiatives. Methods The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) thyroidectomy-targeted database was utilized for patients undergoing total thyroidectomy between 2016 and 2017. Univariable and multivariable regression were used to identify factors associated with RLN injury. Results A total of 6538 patients were identified. The overall rate of RLN injury was 7.1% (467/6538). Of these, 4129 (63.1%) patients had intraoperative neuromonitoring (IONM), with an associated RLN injury rate of 6.5% (versus 8.2% without). African American and Asian race, non-elective surgery, parathyroid auto-transplantation, and lack of RLN monitoring were all significantly associated with nerve injury on multivariable analysis (P<.05). Patients with RLN injury were more likely to experience cardiopulmonary complications, re-intubation, longer length of stay, readmission, and reoperation. Patients who had IONM and sustained RLN injury remained at risk for developing significant postoperative complications, although the extent of cardiopulmonary complications was less severe in this cohort. Discussion Recurrent laryngeal nerve injury is common after thyroidectomy and is associated with significant morbidity, despite best practices. Attention to preoperative characteristics may help clinicians to further risk stratify patients prior to thyroidectomy. While IONM does not mitigate all complications, use of this technology may decrease severity of postoperative complications.

Importance of Identifying the Course of the Recurrent Laryngeal Nerve in Total and Near-Total Thyroid Lobectomies

2005 ◽  
Vol 71 (3) ◽  
pp. 225-227
Author(s):  
Zeki Acun ◽  
Fikret Cinar ◽  
Alper Cihan ◽  
Suat Can Ulukent ◽  
Lokman Uzun ◽  
...  
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Total Thyroidectomy ◽  
Nerve Injury ◽  
Nerve Palsy ◽  
Recurrent Laryngeal Nerve Palsy ◽  
Recurrent Laryngeal Nerve Injury ◽  
Laryngeal Nerve ◽  
Thyroid Diseases ◽  
Thyroid Lobectomy ◽  
Laryngeal Nerve Injury

In our clinic, near-total thyroidectomy is the principal surgical procedure performed for benign thyroid diseases. We conducted a single-institution study on 176 consecutive patients who underwent near-total thyroidectomy due to various thyroid diseases. We compared the incidence of recurrent laryngeal nerve injury between total and near-total thyroid lobectomy sides in each patient. Our hypothesis was that the incidence of recurrent laryngeal nerve injury after total thyroid lobectomy would be similar to that of near-total thyroid lobectomy when the course of the recurrent laryngeal nerve was identified during surgery. The temporary recurrent laryngeal nerve palsy rates on the total and near-total thyroid lobectomy sides were 3.9 per cent (7 of 176 nerves) and 2.2 per cent (4 of 176 nerves), respectively. The difference was not statistically significant. Permanent recurrent laryngeal nerve palsy did not occur in any of our patients. In conclusion, the incidence of recurrent laryngeal nerve injury in total versus near-total thyroid lobectomy is not different when the course of the recurrent laryngeal nerve is identified during surgery.

scholarly journals The Rare Coincidence: Nonrecurrent Laryngeal Nerve Pointed by a Zuckerkandl's Tubercle

2012 ◽  
Vol 2012 ◽  
pp. 1-3 ◽  
Author(s):  
Emin Gurleyik ◽  
Sami Dogan ◽  
Omer Gunal ◽  
Mevlut Pehlivan
Keyword(s):  
Multinodular Goiter ◽  
Laryngeal Nerve ◽  
Inferior Laryngeal Nerve ◽  
Adjacent Structures ◽  
Toxic Multinodular Goiter ◽  
Posterior Extension ◽  
Right Lobe ◽  
Nonrecurrent Laryngeal Nerve ◽  
The Right ◽  
Case Based

The safety of thyroid operations mainly depends on complete anatomical knowledge. Anatomical and embryological variations of the inferior laryngeal nerve (ILN), of the thyroid gland itself and unusual relations between ILN and the gland threaten operation security are discussed. The patient with toxic multinodular goiter is treated with total thyroidectomy. During dissection of the right lobe, the right ILN which has nonrecurrent course arising directly from cervical vagus nerve is identified and fully isolated until its laryngeal entry. At the operation, we observe bilateral Zuckerkandl's tubercles (ZTs) as posterior extension of both lateral lobes. The left ILN has usual recurrent course in the trachea-esophageal groove. The right ZT is placed between upper and middle third of the lobe points the nonrecurrent ILN. The coincidence of non-recurrent ILN pointed by a ZT is rare anatomical and embryological feature of this case. Based on anatomical and embryological variations, we suggest identification and full exposure of ILN before attempting excision of adjacent structures, like the ZT which has surgical importance for completeness of thyroidectomy.

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