Identification of the recurrent laryngeal nerve at the cricothyroid joint: Our experience of 181 thyroid procedures

Sykes, R.; Moorthy, Ram; Olaleye, Oladejo; Black, Irene

doi:10.1111/coa.12254

Cited by 2 publications

(7 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Three previous studies have described using the superior approach to finding the RLN. While the authors of one study do not describe the specific technique [ 9 ], the authors of the other two studies followed the technique first described by Shindo et al [ 6 , 10 ]. This technique involves releasing the superior pole, finding and releasing the tubercle of Zuckerkandl, retracting the gland medially, and then searching for the RLN as it courses towards the cricothyroid junction.…”

Section: Discussionmentioning

confidence: 99%

“…With the use of the retrograde medial approach, the rates of permanent vocal cord palsy and hypocalcemia are similar to the rates reported with other superior approaches to finding the RLN; however, the rates of temporary vocal cord palsy and hypocalcemia appear higher. With regard to the permanent complications, in a study of 181 patients, Sykes et al reported permanent vocal cord palsy and hypocalcemia rates of 0.4% and 2.2% respectively [ 10 ]. In a study of 67 patients, Veyseller et al reported the corresponding rates to be 0 [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

“…In a study of 67 patients, Veyseller et al reported the corresponding rates to be 0 [ 9 ]. With regard to the transient complications, Sykes et al reported a 2.2% rate of temporary vocal cord palsy [ 10 ]; whereas Veyseller et al reported temporary vocal cord palsy and hypocalcemia rates of 0% and 8.3% respectively [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

“…The surgical technique for the superior approach has not been described in sufficient detail and its outcomes have not been documented well in literature. Only three studies report on the routine use of the superior approach: one study used a single sentence to describe the surgical technique [ 9 ], and the authors of the other two studies followed a technique that appears to be a modification of the lateral approach [ 6 , 10 ]. In this technique the thyroid is retracted medially, and the RLN is found by searching between Zukerkandl’s tubercle and the cricopharyngeus muscle [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

A systematic approach to the recurrent laryngeal nerve dissection at the cricothyroid junction

Butskiy

Chang

Luu

et al. 2018

J of Otolaryngol - Head & Neck Surg

View full text Add to dashboard Cite

BackgroundTo describe and evaluate a four step systematic approach to dissecting the recurrent laryngeal nerve (RLN) starting at the cricothyroid junction during thyroid surgery (subsequently referred to as the retrograde medial approach).MethodsAll thyroidectomies completed by the senior author between August 2014 and January 2016 were retrospectively reviewed. Patients were excluded if concurrent lateral or central neck dissection was performed. A follow up period of 1 year was included.ResultsSurgical photographs and illustrations demonstrate the four steps in the retrograde medial approach to dissection of the RLN in thyroid surgery.Three hundred forty-two consecutive thyroid surgeries were performed in 17 months, including 213 hemithyroidectomies, 91 total thyroidectomies, and 38 completion thyroidectomies. The rate of temporary and permanent hypocalcemia was 13% (95% confidence interval [CI]: 8–20%) and 3% (95% CI: 1–8%) respectively. The rate of temporary and permanent vocal cord palsy was 9% (95% CI: 6–12%) and 0.3% (95%CI: 0.01–2%) respectively. The median surgical times for hemithyroidectomy, total thyroidectomy, and completion thyroidectomy were 39 min (Interquartile range [IQR]: 33–47 min), 48 min (IQR: 40–60 min), and 40 min (IQR: 35–51 min) respectively. 1% of cases required conversion to an alternative surgical approach.ConclusionIn a tertiary endocrine head and neck practice, the routine use of the retrograde medial approach to RLN dissection is safe and results in a short operative time, and a low conversion rate to other RLN dissection approaches.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

A systematic approach to the recurrent laryngeal nerve dissection at the cricothyroid junction

Butskiy

Chang

Luu

et al. 2018

J of Otolaryngol - Head & Neck Surg

View full text Add to dashboard Cite

show abstract

“…However, after the definition of the transoral endoscopic thyroidectomy vestibular approach (TOETVA) technique, the identification and dissection of the RLN had to be changed to the craniocaudal approach in patients who undergo this procedure [ 8 ]. There are only a few studies in the literature that evaluated the morbidity rates of the craniocaudal approach or that compared the morbidity rates of craniocaudal and lateral approaches in open thyroidectomy (OT) [ 9 10 11 12 13 ]. The aims of our study were to compare the rates of adverse electromyographic (EMG) changes, loss of signal (LOS), and RLN injury in craniocaudal and lateral approaches to the RLN during thyroidectomy under CIONM, and to evaluate the clinicopathological and anatomical features which affected the occurrence of adverse EMG changes and LOS.…”

Section: Introductionmentioning

confidence: 99%

Is craniocaudal dissection of recurrent laryngeal nerve safer than lateral approach: a prospective randomized study comparing both techniques by using continuous intraoperative nerve monitoring

et al. 2022

View full text Add to dashboard Cite

Purpose This study was performed to compare the real-time electromyographic (EMG) changes and the rate of recurrent laryngeal nerve (RLN) injury in craniocaudal and lateral approaches for RLN during thyroidectomy. Methods One hundred twelve and 86 patients were prospectively randomized to receive lateral (group 1) or craniocaudal (group 2) approach to RLN, respectively, under continuous intraoperative nerve monitoring. Results Loss of signal (LOS) occurred in 7 (2.0%) of 356 nerves at risk (NAR). LOS was significantly associated with repeated adverse EMG changes and presence of RLN entrapment at the ligament of Berry (LOB), which was accompanied by other clinicopathological or anatomical features, such as tubercle of Zuckerkandl (TZ), extralaryngeal branching, hyperthyroidism, autoimmune thyroid disease (ATD), or thyroid lobe volume of >29 cm 3 (P = 0.001 and P = 0.030, respectively). The rate of repeated adverse EMG changes and LOS in the NARs with LOB entrapment accompanied by other clinicopathological and anatomical features was higher in group 1 vs. group 2 (11.1% vs. 2.2%, respectively and 9.7% vs. 0%, respectively; P = 0.070). The total rate of vocal cord palsy (VCP) was significantly higher in group 1 than in group 2 (P = 0.005). The rate of permanent VCP showed no significant difference between the 2 groups. Conclusion The craniocaudal approach to the RLN is safer than the lateral approach in the RLNs with entrapment at the LOB accompanied by other features, such as TZ, extralaryngeal branching, hyperthyroidism, ATD, or high thyroid lobe volume.

show abstract

Identification of the recurrent laryngeal nerve at the cricothyroid joint: Our experience of 181 thyroid procedures

Cited by 2 publications

References 7 publications

A systematic approach to the recurrent laryngeal nerve dissection at the cricothyroid junction

A systematic approach to the recurrent laryngeal nerve dissection at the cricothyroid junction

Is craniocaudal dissection of recurrent laryngeal nerve safer than lateral approach: a prospective randomized study comparing both techniques by using continuous intraoperative nerve monitoring

Contact Info

Product

Resources

About