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An applied anatomical study on the recurrent laryngeal nerve and inferior thyroid artery

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Abstract

Purpose

The aim of this study was to provide some important information about the morphology and topography of the recurrent laryngeal nerve (RLN) and inferior thyroid artery (ITA), which significantly helps localize and protect the RLN in neck surgery, especially in thyroid surgery.

Methods

Eighty adult cadavers (160 sides) fixed with formalin were dissected, analyzed and measured.

Results

(1) 87.5% of the RLNs gave off multiple branches like a tree; the incidence of the RLN loop, connecting one branch to another was 3.125%; in 9.375%, one branch of RLN combined with cervical sympathetic chain (CSC) or superior laryngeal nerve (SLN). (2) A double RLN appeared in four sides, a non-recurrent inferior laryngeal nerve appeared in two cases. (3) In two cases, the RLN communicated with both of the SLN and the CSC near thyroid gland. (4) Most of the ITAs was derived from thyrocervical trunk, and divided into two or three branches before entering the thyroid gland. (5) Three ITAs gave off esophageal branch, one ITA gave off tracheal branch, one right ITA originated abnormally. (6) On the left side, the RLN was behind the ITA in 86.25% of the cases, in front of the artery in 7.5%, the nerve was between artery branches in 2.5%, the artery was between nerve branches in 1.25%, and was among the combined in 2.5%. On the right side, the RLN was in front of the artery in 75.0%, behind the artery in 10.0%, among the branches of the artery in 5.0%, 10.0% the branches of both nerves and artery were interlaced that the relationship between the branches of the nerve and the artery was uncertain.

Conclusions

Because of the variability of the RLN and ITA and the complicated relationship between them, it is necessary to dissect and recognize the RLN to avoid mistaking, ignoring, and misligating of the nerve before ligating the ITA.

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References

  1. Çakır BÖ, Ercan I, Sam B, Turgut S (2006) Reliable surgical landmarks for the identification of the recurrent laryngeal nerve. Otolaryngol Head Neck Surg 135:299–302

    Article  PubMed  Google Scholar 

  2. Campos BA, Henriques PR (2000) Relationship between the recurrent laryngeal nerve and the inferior thyroid artery: a study in corpses. Rev Hosp Clín Fac Med Sao Paulo 55(6):195–200

    PubMed  CAS  Google Scholar 

  3. Cernea CR, Hojaij FC, Carlucci DD Jr, Gotoda R et al (2009) Recurrent laryngeal nerve: a plexus rather than a nerve? Arch Otolaryngol Head Neck Surg 135(11):1098–1102

    Article  PubMed  Google Scholar 

  4. Chiang FY, Wang LF, Huang YF, Lee KW, Kuo WR (2005) Recurrent laryngeal nerve palsy after thyroidectomy with routine identification of the recurrent laryngeal nerve. Surgery 137:342–347

    Article  PubMed  Google Scholar 

  5. Duclos A, Lifante JC, Ducarroz S, Soardo P, Colin C, Peix JL (2011) Influence of intraoperative neuromonitoring on surgeons’ technique during thyroidectomy. World J Surg 35(4):773–778

    Article  PubMed  Google Scholar 

  6. Edis AJ (1979) Prevention and management of complications associated with thyroid and parathyroid surgery. Surg Clin North Am 59:83–92

    PubMed  CAS  Google Scholar 

  7. Gregg RL (1957) Avoiding injury to the extralaryngeal nerves. Ann Otol Rhinol Laryngol 66(3):656–678

    PubMed  CAS  Google Scholar 

  8. Jatzko GR, Lisborg PH, Müller MG, Wette VM (1994) Recurrent nerve palsy after thyroid operations—principal nerve identification and a literature review. Surgery 115:139–144

    PubMed  CAS  Google Scholar 

  9. Kahky MP, Weber RS (1993) Complications of surgery of the thyroid and parathyroid glands. Surg Clin North Am 73:307–321

    PubMed  CAS  Google Scholar 

  10. Karlan MS, Catz B, Dunkelman D, Uyeda RY, Gleischman S (1984) A safe technique for thyroidectomy with complete nerve dissection and parathyroid preservation. Head Neck Surg 6:1014–1019

    Article  PubMed  CAS  Google Scholar 

  11. Lahey FH, Hoover WB (1938) Injuries to the recurrent laryngeal nerve in thyroid operations. Ann Surg 108:545–562

    Article  PubMed  CAS  Google Scholar 

  12. Makay O, Icoz G, Yilmaz M, Akyildiz M, Yetkin E (2008) The recurrent laryngeal nerve and the inferior thyroid artery—anatomical variations during surgery. Langenbecks Arch Surg 393:681–685

    Article  PubMed  Google Scholar 

  13. Marusch F, Hussock J, Haring G, Hachenberg T, Gastinger I (2005) Influence of muscle relaxation on neuromonitoring of the recurrent laryngeal nerve during thyroid surgery. Br J Anaesth 94(5):596–600

    Article  PubMed  CAS  Google Scholar 

  14. Max MH, Scherm M, Bland KI (1983) Early and late complications after thyroid operations. South Med J 76(8):977–980

    Article  PubMed  CAS  Google Scholar 

  15. Nordland M (1930) The larynx as related to surgery of the thyroid based on an anatomical study. Surg Gynecol Obstet 11:449–459

    Google Scholar 

  16. Page C, Foulon P, Strunski V (2003) The inferior laryngeal nerve: surgical and anatomic considerations: report of 251 thyroidectomies. Surg Radiol Anat 25(3–4):188–191

    Article  PubMed  CAS  Google Scholar 

  17. Randolph GW, Kobler JB, Wilkins J (2004) Recurrent laryngeal nerve identification and assessment during thyroid surgery: laryngeal palpation. World J Surg 28(8):755–760

    Article  PubMed  Google Scholar 

  18. Riddell VH (1956) Injury to recurrent laryngeal nerves during thyroidectomy—a comparison between the results of identification and non-identification in 1022 nerves exposed to risk. Lancet 271:638–641

    Article  PubMed  CAS  Google Scholar 

  19. Simon MM (1943) Recurrent laryngeal nerve in thyroid surgery–triangle for its recognition and protection. Am J Surg 60(2):212–220

    Article  Google Scholar 

  20. Sun S-Q, Zhao J, Lu H, He GQ, Ran JH, Peng XH (2001) An anatomical study of the recurrent laryngeal nerve: its branching patterns and relationship to the inferior thyroid artery. Surg Radiol Anat 23:363–369

    Article  PubMed  CAS  Google Scholar 

  21. Toniato A, Mazzarotto R, Piotto A, Bernante P, Pagetta C, Pelizzo MR (2004) Identification of the non-recurrent laryngeal nerve during thyroid surgery: 20-year experience. World J Surg 28:659–661

    Article  PubMed  Google Scholar 

  22. Toniato A, Boschin IM, Pagetta C, Casalide E, Pelizzo M (2010) A “Pilot light” of the right non-recurrent laryngeal nerve. Acta Otorhinolaryngol Ital 30:107–109

    PubMed  CAS  Google Scholar 

  23. Yalcin B, Tunali S, Ozan H (2008) Extralaryngeal division of the recurrent laryngeal nerve: a new description for the inferior laryngeal nerve. Surg Radiol Anat 30(3):215–220

    Article  PubMed  Google Scholar 

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Acknowledgments

Sincere thanks go to Ke-Jian Wang, Sheng-Wei Gan and Gao-wu Wang, Associate Professor, for their assistance, Institute of Neuroscience, National Class Preclinical Medicine Experimental Teaching Demonstration Center, Chongqing Medical University, Chongqing. Sincere thanks go to Chongqing Science and Technology Committee and National Basic Research Program of China (2009CB18300), for their support.

Conflict of interest

None.

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Authors and Affiliations

  1. National Class Preclinical Medicine Experimental Teaching Demonstration Center, Chongqing Medical University, Chongqing, 400016, China

    Wen-Jing Tang, Xing-Lu Wang, Yu-Xing Sun & Hai-Xia Huang

  2. Institute of Neuroscience, National Class Preclinical Medicine Experimental Teaching Demonstration Center, Chongqing Medical University, Chongqing, 400016, China

    Shan-Quan Sun

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  1. Wen-Jing Tang
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  2. Shan-Quan Sun
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Correspondence to Shan-Quan Sun.

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Tang, WJ., Sun, SQ., Wang, XL. et al. An applied anatomical study on the recurrent laryngeal nerve and inferior thyroid artery. Surg Radiol Anat 34, 325–332 (2012). https://doi.org/10.1007/s00276-011-0905-8

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  • DOI: https://doi.org/10.1007/s00276-011-0905-8

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