Background: Recurrent laryngeal nerve (RLN) injury is a major concern in thyroid surgery as the effects can vary from hoarseness of voice to life-threatening complications like stridor. Hence, identification and preservation of the nerve is of utmost importance. The landmarks for identification are tracheoesophageal groove, inferior thyroid artery (ITA), ligament of berry, and tubercle of Zuckerkandl. The ITA is noted to be a constant landmark in identifying the RLN. The main aim of the study is to identify the relationship of the ITA with the RLN during thyroid surgery.
Materials and methods: A total of 91 patients who underwent total thyroidectomy, completion, and hemithyroidectomy from January 2018 to December 2018 were included in the study. The position of the RLN with respect to the ITA was noted being as superficial, deep, or between the branches.
Results: Among a total of 150 RLNs, 140 (93.3%) were identified and 10 were not identified. In 125 (89%) dissections, the ITA was superficial to the RLN and in 15 dissections it was noted to be deep to the RLN.
Conclusion: Even though the RLN can be identified by various landmarks, the relationship with the ITA is consistent. However, as the nerve may be either superficial or deep to the ITA, knowledge of anatomy and variations of the RLN is necessary to ensure its preservation.
Clinical significance: The knowledge of relationship of the RLN with the ITA helps in identification and preservation of nerve, thus avoiding injury to the nerve and consequent complications.
Calo PG, Pisano G, Medas F, et al. Identification alone versus intraoperative neuromonitoring of the recurrent laryngeal nerve during thyroid surgery: experience of 2034 consecutive patients. J Otolaryngol Head Neck Surg 2014;43(1):16. DOI: 10.1186/1916-0216-43-16.
Dralle H, Sekulla C, Lorenz K, et al. Intra-operative monitoring of recurrent laryngeal nerve in thyroid surgery. World J Surg 2008;32(7):1358–1366. DOI: 10.1007/s00268-008-9483-2.
Chiang FY, Lu IC, Chen HC, et al. Intraoperative neuromonitoring for early localization and identification of recurrent laryngeal nerve during thyroid surgery. Kaohsiung J Med Sci 2010;26(12):633–639. DOI: 10.1016/S1607-551X(10)70097-8.
Rustad WH, Morrison LE. Revised anatomy of the recurrent laryngeal nerves: surgical importance based on the dissection of 100 cadavers. Laryngoscope 1952;62(3):237–249. DOI: 10.1288/00005537-195203000-00001.
Nemiroff PM, Katz AD. Extralaryngeal branches of recurrent laryngeal nerve: surgical and clinical significance. Am J Surg 1982;144(4):466–469. DOI: 10.1016/0002-9610(82)90425-1.
Proye CA, Carnaille BM, Goropouls A. Nonrecurrent and recurrent laryngeal nerve: a surgical pitfall in cervical exploration. Am J Surg 1991;162:495–496. DOI: 10.1016/0002-9610(91)90271-E.