Le tubercule de Zuckerkandl : incidence et rapport avec le nerf laryngé inférieur

James, Yaovi Edem; Doleagbenou, A.K.; Kassegne, I.; Biramah, B; Keke, K.; Dosseh, E.D.; Ayite, A.; James, Kevin J.

doi:10.1016/j.morpho.2014.07.002

Cited by 6 publications

(5 citation statements)

References 5 publications

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“…In Togo, in a series of 48 patients, James et al did not find ZT in more than half of patients (56.21%). 17 The use of the Berry ligament, which is a thickening of the Gruber's thyroid tracheal ligament attaching the posteromedial edge of the thyroid gland to the cricoid cartilage and to the 1st and 2nd tracheal rings most often encounters bleeding, characteristic of this area with a risk of injury to the nerve at its point of entry into the larynx. The lower laryngeal nerve is less than 3 mm from this ligament generally, runs behind it and must be identified before cutting the ligament.…”

Section: Discussionmentioning

confidence: 99%

Relationship between the Recurrent Laryngeal Nerve and the Inferior Thyroid Artery in the Togolese Subject: Surgical Anatomy Study from 227 Thyroidectomies

Amana¹,

Foma²,

Pegbessou³

et al. 2019

BJOHNS

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Introduction Identification of the recurrent laryngeal nerve during thyroid surgeries is recommended to preserve its functionl integrity. This study aims to determine the relationship between the recurrent laryngeal nerves and the inferior thyroid arteries during thyroidectomies, as well as any particularities and intraoperative complications. Materials and Methods Observational cross-sectional study of all culturally Togolese patients who underwent thyroidectomy with nerve dissection in the ENT department of Sylvanus Olympio University Hospital from 1 January 2013 to 30 June 2017, i.e. a period of 4 years 6 months. Results The sex ratio was 0.14 i.e., 7 women for 1 man and the average age of 41.82 years. Tissue nodules and multinodular goiters were the most operated lesions in 40.97% and 33.04%, respectively, with a plunging character in 17 cases. We had 306 cases of nerve dissection but the recurrent laryngeal nerve could not be found in 1 case on the right. It was globally retro-arterial (under the trunk and under the branches of the inferior thyroid artery) in 75.08% of cases with prevalence of the truncal, pre arterial situation in 16.07% and inter-arterial in 3.28% cases. The nerve was non-recurrent (type II pathway) in 1 case on the right. There was no recurrence injury. Parathyroid devascularization (5 cases) was autotransplanted. The surgeon's experience did not have a significant impact on the occurrence of intraoperative complications (p = 0.24). Conclusion This observational cross-sectional anatomical-surgical study supports the existing data on the relationships between the recurrent laryngeal nerve and the inferior thyroid artery by confirming their variability. Nevertheless, it was marked by the predominance of the retro arterial truncal situation of the nerve unlike the literature that most often reports a situation of the nerve under the arterial branches.

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Section: Discussionmentioning

confidence: 99%

Relationship between the Recurrent Laryngeal Nerve and the Inferior Thyroid Artery in the Togolese Subject: Surgical Anatomy Study from 227 Thyroidectomies

Amana¹,

Foma²,

Pegbessou³

et al. 2019

BJOHNS

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“…Nonrecurrent course of the right nerve is a rare variation [ 18 – 20 ]. The RLN has various relations with the Berry ligament, inferior thyroidal artery, and Zuckerkandl's tubercle [ 21 – 26 ]. Another anatomical variation of the RLN is the ETB along its cervical course prior to the laryngeal entry.…”

Section: Discussionmentioning

confidence: 99%

Morphology and Functional Anatomy of the Recurrent Laryngeal Nerve with Extralaryngeal Terminal Bifurcation

Cetin

Gürleyik

Doğan

2016

Anatomy Research International

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Anatomical variations of the recurrent laryngeal nerve (RLN), such as an extralaryngeal terminal bifurcation (ETB), threaten the safety of thyroid surgery. Besides the morphology of the nerve branches, intraoperative evaluation of their functional anatomy may be useful to preserve motor activity. We exposed 67 RLNs in 36 patients. The main trunk, bifurcation point, and terminal branches of bifid nerves were macroscopically determined and exposed during thyroid surgery. The functional anatomy of the nerve branches was evaluated by intraoperative nerve monitoring (IONM). Forty-six RLNs with an ETB were intraoperatively exposed. The bifurcation point was located along the prearterial, arterial, and postarterial segments in 11%, 39%, and 50% of bifid RLNs, respectively. Motor activity was determined in all anterior branches. The functional anatomy of terminal branches detected motor activity in 4 (8.7%) posterior branches of 46 bifid RLNs. The motor activity in posterior branches created a wave amplitude at 25–69% of that in the corresponding anterior branches. The functional anatomy of bifid RLNs demonstrated that anterior branches always contained motor fibres while posterior branches seldom contained motor fibres. The motor activity of the posterior branch was weaker than that of the anterior branch. IONM may help to differentiate between motor and sensory functions of nerve branches. The morphology and functional anatomy of all nerve branches must be preserved to ensure a safer surgery.

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“…Anatomical variations of the RLN, increasing the risk of injury to the nerve, threaten the safety of thyroid surgery [7, 9–11]. Despite the rarity, nonrecurrent course of the nerve deserves a special attention in order to minimize the risk of vocal cord palsy.…”

Section: Discussionmentioning

confidence: 99%

Nonrecurrent Laryngeal Nerve in the Era of Intraoperative Nerve Monitoring

Gürleyik

Gurleyik

2016

Advances in Medicine

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Nonrecurrent laryngeal nerve (non-RLN) is an anatomical variation increasing the risk of vocal cord palsy. Prediction and early identification of non-RLN may minimize such a risk of injury. This study assessed the effect of intraoperative neuromonitoring (IONM) on the detection of non-RLN. A total of 462 (236 right) nerves in 272 patients were identified and totally exposed, and all intraoperative steps of IONM were sequentially applied on the vagus nerve (VN) and RLN. Right predissection VN stimulation at a distal point did not create a sound signal in three cases (3/236; 1.27%). Proximal dissection of the right VN under IONM guidance established a proximal point, creating a positive signal. The separation point of non-RLN from VN was discovered in all three patients. Non-RLNs were exposed from separation to laryngeal entry. Positive IONM signals were obtained after resection of thyroid lobes, and postoperative period was uneventful in patients with non-RLN. Absence of distal VN signal is a precise predictor of the non-RLN. IONM-guided proximal dissection of the right VN leads to identification of the non-RLN. The prediction of non-RLN by the absence of the VN signal at an early stage of surgery may prevent or minimize the risk of nerve injury.

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Le tubercule de Zuckerkandl : incidence et rapport avec le nerf laryngé inférieur

Cited by 6 publications

References 5 publications

Relationship between the Recurrent Laryngeal Nerve and the Inferior Thyroid Artery in the Togolese Subject: Surgical Anatomy Study from 227 Thyroidectomies

Relationship between the Recurrent Laryngeal Nerve and the Inferior Thyroid Artery in the Togolese Subject: Surgical Anatomy Study from 227 Thyroidectomies

Morphology and Functional Anatomy of the Recurrent Laryngeal Nerve with Extralaryngeal Terminal Bifurcation

Nonrecurrent Laryngeal Nerve in the Era of Intraoperative Nerve Monitoring

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