A detailed study of the relationship between the external laryngeal nerve and superior thyroid artery, including its glandular branches

Yalçın, Bülent; Develı, Sedat; Tubbs, R. Shane; Poyrazoğlu, Yavuz

doi:10.1002/ca.22198

Cited by 6 publications

(6 citation statements)

References 14 publications

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“…It is also crucial for the surgeons to consider the less common piercing pattern or RLN lying deep to the BL for a hassle-free procedure. The piercing pattern, where the nerve can be intricately intertwined with the BL, poses a unique peril as, in such cases, nerve bres can easily be severed while incising the ligament during thyroidectomy [30]. For obvious reasons, such patterns are associated with the highest morbidity of nerve palsy [30].…”

Section: Discussionmentioning

confidence: 99%

“…The piercing pattern, where the nerve can be intricately intertwined with the BL, poses a unique peril as, in such cases, nerve bres can easily be severed while incising the ligament during thyroidectomy [30]. For obvious reasons, such patterns are associated with the highest morbidity of nerve palsy [30]. Serpell [26] highlighted that the substantial variability in the relationship of the nerve to the BL could arise from a lack of appropriate anatomical assessment of the ligament itself [30].…”

Section: Discussionmentioning

confidence: 99%

“…For obvious reasons, such patterns are associated with the highest morbidity of nerve palsy [30]. Serpell [26] highlighted that the substantial variability in the relationship of the nerve to the BL could arise from a lack of appropriate anatomical assessment of the ligament itself [30]. They also noted that the BL comprises two fascial layers.…”

Section: Discussionmentioning

confidence: 99%

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Identification of valid anatomical landmarks to locate and protect recurrent laryngeal nerve during thyroid surgery: a cadaveric study

et al. 2022

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Recurrent laryngeal nerve (RLN) is the most critical structure in terms of intricacy. Anatomic variations of the nerve may further make thyroid surgery cumbersome. The present study was undertaken to provide comprehensive knowledge about the soundness of commonly used anatomical landmarks such as Berry's ligament (BL), tracheoesophageal groove (TEG), inferior thyroid artery (ITA) and the midpoint of the posterior border of the thyroid gland in the identi cation of the nerve intraoperatively. MethodsThirty adult cadavers were dissected to identify the RLN in the neck and to locate it in relation to the aforementioned anatomical landmarks. ResultsThe RLN/BL relationship: RLN was most often located super cial to the BL (88.3%), followed by deep to the BL in 8.4%, and piercing the BL in 3.3% of cases, respectively. The RLN/TEG relationship: the RLN was located inside the TEG in most cases (71.7%), followed by RLN lying outside the TEG in 28.3%. Outside the groove, it was most commonly found lateral to the TEG (64.7%). RLN/ITA relationship: the nerve was passing deep to the artery in most of the cases (65%), followed by super cial (30%) and rarely (5%) inbetween the branches. RLN/ midpoint posterior border of thyroid relationship: In 57 (95%) cases, RLN was coursing in the area posterior to the midpoint of the posterior border of the gland with an average distance of 4.95 ± 2.23 mm ranging between 2.21mm to 12.1mm. ConclusionsBoth the BL and TEG are potentially crucial for safeguarding RLN. Although in results, BL turns out to be more consistent than TEG, we propose the utilization of both these anatomical landmarks together for complication-free neck surgeries. Furthermore, the midpoint of the posterior border of the thyroid turns out to be the single most consistent landmark for identifying RLN during partial thyroidectomy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Identification of valid anatomical landmarks to locate and protect recurrent laryngeal nerve during thyroid surgery: a cadaveric study

et al. 2022

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“…Awareness of the anatomical variations of both the ebSLN and ibSLN with the STA and SLA, respectively, is clinically significant to minimize nerve injury during surgical procedures of the neck. A brief literature review of the variation of the SLN and its implications in surgical procedures of the neck is summarized in Supplementary Table S1 [ 1 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 ].…”

Section: Discussionmentioning

confidence: 99%

The Superior Laryngeal Nerve and Its Vulnerability in Surgeries of the Neck

Dekhou

Morrison²,

Gemechu

2021

Diagnostics

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Anatomical considerations of the superior laryngeal nerve (SLN), a branch of the vagus, provides information to minimize the potential for iatrogenic intraoperative injury, thereby preventing motor and sensory dysfunctions of the larynx. The present study aims to assess the variation of the SLN and its relationship to the superior thyroid artery (STA) and superior laryngeal artery (SLA). The study was done on 35 formalin-fixed cadavers at Oakland University in 2018–2019. In our study, we found that out of 21 cadavers, 52.4% of the external laryngeal branches (ebSLN) are related posteromedial to the STA, while 47.6% are related anteromedial to it. Out of 14 cadavers, 64.3% of the internal laryngeal branches (ibSLN) are related superoposterior to the SLA, while 35.7% are inferoposterior to it. In most cases, the SLA crosses above the ebSLN while traveling to pierce the thyrohyoid membrane to reach the larynx. The data demonstrate that both the ebSLN and ibSLN display variation in their relationship with the STA and the SLA, respectively. Awareness of these variable relationships is critical for identification and isolation of these structures in order to prevent consequences of nerve injury, primarily a reduction in the highest attainable frequency of the voice and aspiration pneumonia.

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“…Injury of the EB-SLN causes paralysis and/or weakness of the cricothyroid, resulting in changes in voice quality, voice projection, and production of high-pitched sounds (6–8, 13–16). …”

Section: The Superior Laryngeal Nervementioning

confidence: 99%

Neurological Complications in Thyroid Surgery: A Surgical Point of View on Laryngeal Nerves

et al. 2014

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The cervical branches of the vagus nerve that are pertinent to endocrine surgery are the superior and the inferior laryngeal nerves: their anatomical course in the neck places them at risk during thyroid surgery. The external branch of the superior laryngeal nerve (EB) is at risk during thyroid surgery because of its close anatomical relationship with the superior thyroid vessels and the superior thyroid pole region. The rate of EB injury (which leads to the paralysis of the cricothyroid muscle) varies from 0 to 58%. The identification of the EB during surgery helps avoiding both an accidental transection and an excessive stretching. When the nerve is not identified, the ligation of superior thyroid artery branches close to the thyroid gland is suggested, as well as the abstention from an indiscriminate use of energy-based devices that might damage it. The inferior laryngeal nerve (RLN) runs in the tracheoesophageal groove toward the larynx, close to the posterior aspect of the thyroid. It is the main motor nerve of the intrinsic laryngeal muscles, and also provides sensory innervation to the larynx. Its injury finally causes the paralysis of the omolateral vocal cord and various sensory alterations: the symptoms range from mild to severe hoarseness, to acute airway obstruction, and swallowing impairment. Permanent lesions of the RNL occur from 0.3 to 7% of cases, according to different factors. The surgeon must be aware of the possible anatomical variations of the nerve, which should be actively searched for and identified. Visual control and gentle dissection of RLN are imperative. The use of intraoperative nerve monitoring has been safely applied but, at the moment, its impact in the incidence of RLN injuries has not been clarified. In conclusion, despite a thorough surgical technique and the use of intraoperative neuromonitoring, the incidence of neurological complications after thyroid surgery cannot be suppressed, but should be maintained in a low range.

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A detailed study of the relationship between the external laryngeal nerve and superior thyroid artery, including its glandular branches

Cited by 6 publications

References 14 publications

Identification of valid anatomical landmarks to locate and protect recurrent laryngeal nerve during thyroid surgery: a cadaveric study

Identification of valid anatomical landmarks to locate and protect recurrent laryngeal nerve during thyroid surgery: a cadaveric study

The Superior Laryngeal Nerve and Its Vulnerability in Surgeries of the Neck

Neurological Complications in Thyroid Surgery: A Surgical Point of View on Laryngeal Nerves

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