Avoiding the Esophageal Branches of the Recurrent Laryngeal Nerve During Retractor Placement: Precluding Postoperative Dysphagia During Anterior Approaches to the Cervical Spine

Abstract

Study Design: Anatomical cadaver study. Objectives: Postoperative dysphagia is a significant complication following anterior approaches to the cervical spine and the etiology of this complication is poorly understood. Herein, we studied the esophageal branches of the recurrent laryngeal nerves to improve understanding of their anatomy and potential involvement in dysphagia. Methods: Ten fresh frozen cadaveric human specimens were dissected (20 sides). All specimens were adults with no evidence of prior surgery of the anterior neck. The recurrent laryngeal nerves were identified under a surgical microscope and observations and measurements of their esophageal branches made. Results: For each recurrent laryngeal nerve, 5-7 (mean 6.2) esophageal branches were identified. These branches ranged from 0.8 to 2.1 cm (mean 1.5 cm) in length and 0.5 to 2 mm (mean 1 mm) in diameter. They arose from the recurrent laryngeal nerves between vertebral levels T1 and C6. They all traveled to the anterior aspect of the esophagus. No statistical differences were seen between left and right sides or between sexes. Conclusion: The esophageal branches of the recurrent laryngeal nerve have been poorly described and could contribute to complications such as swallowing dysfunction following anterior cervical discectomy and fusion procedures. Therefore, a better understanding of their anatomy is important for spine surgeons. Our study revealed that these branches are always present on both sides and the anterior surface of the esophagus should be avoided while retracting it in order to minimize the risk of postoperative dysphagia.

An anatomical study of the pharyngeal plexus: Application to avoiding postoperative dysphagia following anterior approaches to the cervical spine

“…In this study, we focused on the anatomy of the retropharyngeal space. Anatomical knowledge of this space is vital for understanding intra-and post-operative complications such as hematoma and dysphagia (Fisahn et al, 2019;O'Neill et al, 2014). Although several anatomical studies on the retropharyngeal space have been performed, this is the first to our knowledge to have adopted the surgeon's perspective and to provide potential anatomical landmarks for avoiding the PP (Iwanaga et al, 2020;von Glinski et al, 2021).…”

“…Dysphagia, a serious complication after ACDF, has been reported at rates ranging from 0% to 51%, differing between inpatients and outpatients (Fisahn et al, 2019;Yerneni et al, 2019).…”

Anterior servikal omurga cerrahisi sonrası farklı endotrakeal tüp kaf basınçlarının disfajı üzerine etkileri

“…Dysphagia after anterior cervical spine surgery is a common finding in the early post-surgical term [12][13][14] . Injuryto the recurrent laryngeal nerve (RLN) branches due to the retractors used in anterior cervical spine surgery has an essential role in the development of post-surgical dysphagia.…”

Extralaryngeal branching of the recurrent laryngeal nerve. Autopsy case series

“…Кроме того, ав-торы предположили, что развитие дисфагии после оперативных вмешательств на органах шеи обусловлено повреждением именно трахеопищеводных ветвей ВГН. Так, в 1,7-50,3% случаев после операций на шейном отделе позвоночника (anterior cervical spine surgery) отмечается нарушение функции глотания, которое сохраняется у 10% пациентов дольше одного года [2].…”

“…ORIGINAL STUDY Эндокринная хирургия / Endocrine Surger y | 5 ОБОСНОВАНИЕ Гортань человека с физиологической точки зрения представляет собой сложный «узловой» орган, обеспечивающий одновременно дыхание, пищеотведение и формирование голоса [1][2][3]. Основным регулятором этой деятельности является возвратный гортанный нерв (ВГН) (исключение составляет лишь перстнещитовидная мышца, иннервацию которой осуществляет наружная ветвь верхнего гортанного нерва).…”