Recurrent laryngeal nerve landmarks revisited

Asgharpour, Elham; Maranillo, Eva; Sañudo, José Ramón; Pascual‐Font, Arán; Rodríguez‐Niedenführ, Marc; Valderrama, Francisco; Viejo, F.; Parkin, Ian; Vázquez, Teresa

doi:10.1002/hed.21882

Cited by 40 publications

(38 citation statements)

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“…A total of 53 studies ( n = 53,577 total nerves; 33,571 Right RLNs and 20,006 Left RLNs) were included: 35 intraoperative, 17 cadaveric and 1 imaging (CT) (Reed, 1943; Wade, 1955; Hunt, Poole & Reeve, 1968; Stewart, Mountain & Colcock, 1972; Skandalakis et al, 1976; Papadatos, 1978; Proye et al, 1982; Flament, Delattre & Palot, 1983; Henry et al, 1988; Menck, Grüber & Lierse, 1990; Lekacos et al, 1992; Freschi et al, 1994; Moreau et al, 1998; Sasou, Nakamura & Kurihara, 1998; Sturniolo et al, 1999; Campos & Henriques, 2000; Raffaelli, Iacobone & Henry, 2000; Watanabe et al, 2001; Watanabe et al, 2016; Monfared, Gorti & Kim, 2002; Page, Foulon & Strunski, 2003; Hermans et al, 2003; Ardito et al, 2004; Toniato et al, 2004; Spartà et al, 2004; Sciumè et al, 2005; Shindo, Wu & Park, 2005; Beneragama & Serpell, 2006; Maranillo et al, 2008; Makay et al, 2008; Serpell, Yeung & Grodski, 2009; Lee et al, 2009; Sunanda, Tilakeratne & De Silva, 2010; Shao et al, 2010; Wang et al, 2011; Kaisha, Wobenjo & Saidi, 2011; Kandil et al, 2011; Pradeep, Jayashree & Harshita, 2012; Chiang et al, 2012; Tang et al, 2012; Benouaich et al, 2012; Asgharpour et al, 2012; Silva, Siqueira & Arruda, 2013; Donatini, Carnaille & Dionigi, 2013; Satoh et al, 2013; Cai et al, 2013; Hong, Park & Yang, 2014; Yang et al, 2014; Han, Bai & Lu, 2015; Dolezel et al, 2015; Iacobone et al, 2015; Buła et al, 2015; Ngo Nyeki et al, 2015; Barczyński et al, 2015). The dates of the included studies spanned the period from 1943 to 2016.…”

Section: Resultsmentioning

confidence: 99%

The Non-Recurrent Laryngeal Nerve: a meta-analysis and clinical considerations

Henry

Sanna

Graves

et al. 2017

PeerJ

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BackgroundThe Non-Recurrent Laryngeal Nerve (NRLN) is a rare embryologically-derived variant of the Recurrent Laryngeal Nerve (RLN). The presence of an NRLN significantly increases the risk of iatrogenic injury and operative complications. Our aim was to provide a comprehensive meta-analysis of the overall prevalence of the NRLN, its origin, and its association with an aberrant subclavian artery.MethodsThrough March 2016, a database search was performed of PubMed, CNKI, ScienceDirect, EMBASE, BIOSIS, SciELO, and Web of Science. The references in the included articles were also extensively searched. At least two reviewers judged eligibility and assessed and extracted articles. MetaXL was used for analysis, with all pooled prevalence rates calculated using a random effects model. Heterogeneity among the included studies was assessed using the Chi2 test and the I2 statistic.ResultsFifty-three studies (33,571 right RLNs) reported data on the prevalence of a right NRLN. The pooled prevalence estimate was 0.7% (95% CI [0.6–0.9]). The NRLN was found to originate from the vagus nerve at or above the laryngotracheal junction in 58.3% and below it in 41.7%. A right NRLN was associated with an aberrant subclavian artery in 86.7% of cases.ConclusionThe NRLN is a rare yet very clinically relevant structure for surgeons and is associated with increased risk of iatrogenic injury, most often leading to temporary or permanent vocal cord paralysis. A thorough understanding of the prevalence, origin, and associated pathologies is vital for preventing injuries and complications.

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Section: Resultsmentioning

confidence: 99%

The Non-Recurrent Laryngeal Nerve: a meta-analysis and clinical considerations

Henry

Sanna

Graves

et al. 2017

PeerJ

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“…A total of 69 studies [3–7, 9–21, 25–75] were included ( n = 28,387 total nerves): 26 intraoperative, 42 cadaveric, and 1 that included both intraoperative and cadaveric subjects [50]. Among the intraoperative studies, 16 were prospective and 10 were retrospective.…”

Section: Resultsmentioning

confidence: 99%

“…However, it has recently been shown that the RLN can also contribute significantly to the innervation of the cricothyroid muscle [2]. Its terminal branches must split in order to innervate their respective muscles, but this branching can occur anywhere from several centimeters from the inferior rim of the cricothyroid joint to within the larynx itself [3–8]. The terminal branch of the RLN as it courses superior to the cricothyroid joint is commonly deemed the inferior laryngeal nerve.…”

Section: Introductionmentioning

confidence: 99%

Extralaryngeal branching of the recurrent laryngeal nerve: a meta-analysis of 28,387 nerves

Henry

Vikse

Graves

et al. 2016

Langenbecks Arch Surg

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Introduction The recurrent laryngeal nerves (RLN) are branches of the vagus nerve that go on to innervate most of the intrinsic muscles of the larynx. Historically, the RLN has been considered to branch after it enters the larynx, but numerous studies have demonstrated that it often branches before. The wide variability of this extralaryngeal branching (ELB) has significant implications for the risk of iatrogenic injury. We aimed to assess the anatomical characteristics of ELB comprehensively. Methods Articles on the ELB of the RLN were identified by a comprehensive database search. Relevant data were extracted and pooled into a meta-analysis of the prevalence of branching, branching pattern, distance of ELB point from the larynx, and presence of positive motor signals in anterior and posterior ELB branches.Results A total of 69 articles (n = 28,387 nerves) from both intraoperative and cadaveric modalities were included in the meta-analysis. The overall pooled prevalence of ELB was 60.0 % (95 % CI 52.0-67.7). Cadaveric and intraoperative subgroups differed with prevalence rates of 73.3 % (95 % CI 61.0-84.0) and 39.2 % (95 % CI 29.0-49.9), respectively. Cadavers most often presented with a ELB pattern of bifurcation, with a prevalence of 61.1 %, followed by no branching at 23.4 %. Branching of the RLN occurred most often at a distance of 1-2 cm (74.8 % of cases) prior to entering the larynx. A positive motor signal was most often noted in anterior RLN branches (99.9 %) but only in 1.5 % of posterior branches. Conclusions The anatomy of the RLN is highly variable, and ELB is likely to have been underreported in intraoperative studies. Because of its high likelihood, the possibility of ELB needs to be assessed in patients to prevent iatrogenic injury and long-term postoperative complications.

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“…RLN is located anterior to the tracheoesophageal sulcus (41.6%), posterior to the inferior thyroid artery (35.8%), lateral to Berry's ligament (88.1%), below the inferior rim of the inferior constrictor muscle (90.4%), and entering the larynx before its terminal division (54.6%). 6 An almost certain way to ensure the integrity of the RLN is to always identify the nerve during all surgical procedure on thyroid and parathyroid glands. 7 Anatomy of laryngeal nerve is shown in Figure 1.…”

Section: Introductionmentioning

confidence: 99%