Recurrent laryngeal nerve in thyroid surgery: A critical appraisal

Abstract

Although various methods of localizing the RLN have been described, surgeons should be aware of the variations and have a thorough knowledge of normal anatomy in order to achieve a high standard of care. This will ensure the integrity and safety of the RLN in thyroid surgery. The anatomical variation may be minor in degree, but is of great importance as it may affect the outcome of the surgery and the patient's quality of life.

Retrospective Analysis of Thyroidectomy Cases That Became Subjects Due to Unintended Consequences

“…33 RLS yaralanmasının azaltıl-masında sinirin anatomik seyrinin aranması gereken noktaların bilinmesi önem taşımaktadır. 34,35 Ses kısıklığı altı aya kadar uzarsa tek taraflı RLS hasarı düşünülür. Vokal kord hasarının bir yıldan fazla devam etmesi halinde ise kalıcı sinir hasarı düşü-nülmelidir.…”

“Friend or Foe” of a Thyroid Surgeon?—the Tubercle of Zuckerkandl

“…One such anomaly, the tubercle of Zuckerkandl (TZN), is a posterolateral extension of the thyroid gland that has also been called as the posterior horn of thyroid [described for the first time by Otto Madelung in 1867 and later by Emil Zuckerkandl (1849-1910)] [1][2][3]. This tubercle arises from the lateral anlage [the thyroid gland develops from two anlages, and while the median analge is larger, the lateral one is smaller].…”

“…While performing total thyroidectomy especially for cancer, it is essential not to leave behind this tubercle as it contains thyroid tissue. The author has found this tubercle more often on the right side and invariably pointing to the intersection between the nerve and the ITA, thus serving as a sentinel and pointer to the nerve [1][2][3]. Regarding the relationship of TZN with the nerve, there are many variations that can be observed, but most commonly, the recurrent laryngeal nerve lies between the tubercle and the trachea [4][5][6][7].…”

“…The author, however, has observed the incidence to be around 35 % in his series [2,6,7]. It has been found to be unilateral in most cases (75 %), and the author has found it more often on the right side [2,3]. The tubercle may be classified into four grades according to its size, which may have a role in cadaveric anatomical dissection but none or limited role in the surgical approach and dissection.…”

“…The author, like many previous researchers, would like to highlight that this tubercle is a reliable and constant anatomical landmark pointing to the RLN and is a "friend" of the surgeon performing thyroidectomies [1][2][3][4][5]. However, when large and if the surgeon is inexperienced, it may increase the chances of suboptimal surgery and complications.…”