Recurrent Laryngeal Nerve

Cernea, Cláudio Roberto; Hojaij, Flávio; Carlucci, Dorival de; Gotoda, Renato; Plopper, Caio; Vanderlei, Felipe Augusto Brasileiro; Brandão, Lenine Garcia

doi:10.1001/archoto.2009.151

Cited by 46 publications

(23 citation statements)

References 22 publications

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“…The course of the RLN with respect to inferior thyroid artery is quite variable: it more commonly courses deep to the inferior thyroid artery, but can also travel anterior to or between its branches (11, 27) (Figure 2). …”

Section: The Inferior Laryngeal Nervementioning

confidence: 99%

“…The more common anatomical variants are: the variable relationship with the branches of the inferior thyroid artery and the ligament of Berry, the various patterns of extralaryngeal branching, and the non-recurrent variant (27). …”

Section: The Inferior Laryngeal Nervementioning

confidence: 99%

“…This division may occur before the RLN enters the larynx near the Berry ligament or the inferior thyroid artery giving origin to up to several extralaryngeal branches extremely varying in sizes. Functional studies of the extralaryngeal nerve branches have well-demonstrated that motor branches to both the abductor and adductor muscles of the larynx are generally located in the anterior division (4, 27, 29), this adding further potential morbidity, since the motor branches are those located closest to the thyroid lobe.…”

Section: The Inferior Laryngeal Nervementioning

confidence: 99%

“…This rate is mainly related to the diagnosis of the patient, with patients undergoing reoperative thyroid surgery and those undergoing extensive surgery for cancer being at greater risk of morbidity, and to the surgeon’s experience (1). The risk of RLN injury in reoperative surgery is described between 2 and 30%, with rate that is also significantly different when the surgery is performed for recurrent benign or recurrent malignant disease: the injury to the nerve in such cases can be due to the difficulty in identifying and preserving the nerve encased in the scar tissue of the previous surgery (27, 29, 31, 38). These results are summarized and shortly commented in Table 4 (42, 44, 47–49).…”

Section: The Inferior Laryngeal Nervementioning

confidence: 99%

“…Obviously, the thyroid surgeon must be aware of the possible anatomical variations of the nerve, and always search for its visual control and gentle dissection of RLN, which are imperative since possible mechanisms of injury include transection, clamping, ligation, traction, thermal injury, and ischemia. A vast majority of injuries occur because of an excessive traction on this extremely delicate structure (these lesions are those more prone to be temporary ones), and in the setting of anatomical variants, especially when an extralaryngeal bifurcation of RLN is present (4, 27, 31). …”

Section: The Inferior Laryngeal Nervementioning

confidence: 99%

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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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Section: The Inferior Laryngeal Nervementioning

confidence: 99%

Section: The Inferior Laryngeal Nervementioning

confidence: 99%