The recurrent laryngeal nerve related to thyroid surgery

Sturniolo, G; D'Alia, C; Tonante, A; Gagliano, E; Taranto, Filippo; Schiavo, Maria Grazia Lo

doi:10.1016/s0002-9610(99)00101-4

Cited by 135 publications

(120 citation statements)

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“…The major concern during thyroidectomy is preservation of the RLN and parathyroid since injury to these sites results in a lower quality of life [11]. Therefore, safe thyroid surgery requires a sufficient understanding of normal anatomy and anatomical variation associated with the thyroid.…”

Section: Discussionmentioning

confidence: 99%

“…However, excessive exposure of the nerve may induce temporary neuropraxia by blocking the vasa nervorum [7]. To apply Simon's triangle as an anatomical landmark to preserve the RLN during surgery, numerous investigators have reported the relationship between structures such as the inferior thyroidal artery, the ligament of Berry, thyroid cartilage and the ZT [4,5,11,[17][18][19][20]. However, reports regarding the ZT are not abundant, and there is no detailed classification of the relationship with the RLN.…”

Section: Discussionmentioning

confidence: 99%

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The Zuckerkandl's Tubercle: A Useful Anatomical Landmark for Detecting both the Recurrent Laryngeal Nerve and the Superior Parathyroid during Thyroid Surgery

et al. 2008

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Abstract. Zuckerkandl's tubercle (ZT) is a well-documented anatomical structure. This study evaluated ZT anatomical characteristics in terms of the recurrent laryngeal nerve (RLN) and the superior parathyroid (SP). The study involved 325 (10 with benign tumors and 315 with malignancies) patients who underwent thyroidectomy between February and June 2007. ZTs were classified according to size: Grade 0 (unrecognizable), Grade I (≤5 mm), Grade II (6~10 mm) and Grade III (>10 mm). The incidence and size of the ZT and its positional relationship to the RLN and SP were investigated during thyroid surgery. ZTs were identified in most patients (right 89.3%, left 85.6%). The distribution of ZTs according to grade was as follows: Grade 0, right 10.7% and left 14.4%; Grade I, right 7.9% and left 11.1%; Grade II, right 43.5% and left 38.5%; and Grade III, right 37.9% and left 35.9%. The most common RLN course was in a groove between the ZT and the main body of the thyroid. The majority of SPs were cranial to the ZT which was located at the 1 or 2 o'clock position (96.1%) in the left, and at 10 or 11 o'clock (95.2%) in the right. The smaller the size of the ZT, the greater the distance between the ZT and the SP. There was a constant relationship between the ZT and RLN and SP. Therefore, an identification of ZT and an understanding of the relationship between the ZT and RLN and SP are essential for performing safe thyroid surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The Zuckerkandl's Tubercle: A Useful Anatomical Landmark for Detecting both the Recurrent Laryngeal Nerve and the Superior Parathyroid during Thyroid Surgery

et al. 2008

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“…[56] İONM'nin RLS bulunmasına önemli katkı sağladığı birçok çalışmada gösterilmiştir. Wojtczak ve ark.…”

Section: Rls'nin Görülmesiunclassified

A review of methods for the preservation of laryngeal nerves during thyroidectomy

2018

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Vokal kordun abdüktör ve addüktör kaslarının motor inervayonu reküren laringeal sinir (RLS) tarafından sağlanırken, vokal kordun gerici kası olarak isimlendirilen krikotiroid kasın motor inervasyonu ise superior laringeal sinirin eksternal dalı (SLSE) tarafından sağlanmaktadır. Tiroidektomi sırasında anatomik olarak yakın komşulukları nedeniyle tiroidektomi sırasında hem RLS hem de SLSE yaralanma (zedelenme) riski altındadır. Vokal kord fonksiyonunun bozulmaması için hem RLS hem SLSE'nin ameliyat sırasında titizlikle korunması gerekir. Günümüzde tiroidektomi sırasında RLS'nin tiroidektomi alanında tam olarak görülmesi, RLS'nin korunması için altın standart yöntem olarak kabul edilmektedir. RLS'nin bulunmasında ve güvenli diseksiyonunda yeterli cerrahi anatomi bilgisi, klinik deneyim ve titiz cerrahi teknik temel faktörlerdir. Tiroidektomi sırasında RLS, tiroidin büyüme şekli ve cerrahın seçi-mine göre 4 farklı yaklaşımla bulunabilir. Bunlar lateral, inferior, süperior ve medial yaklaşımlardır. Lateral yaklaşım primer tiroit cerrahisinde en sık uygulanan ymntemdir. RLS, genellikle tiroit orta kutbu düzeyinde inferior tiroit arter civarında diseksiyon yapılarak bulunur. İnferior yaklaşımda genel olarak ikincil cerrahi yapılan olgularda RLS'inin boyun bölgesine girdiği ve skar dokusunun olmadığı alanda bulunur. Süperior yaklaşımda ileri dercede büyük guatrlarda veya büyük substernal bileşeni olan guatrlarda önerilir. Bu tiroit üst kutbu serbestleştirildikten sonra kutup öne ve laterale çekilir ve RLS krikofaringeal kas alt sınırında larinkse girdiği bölgede ortaya konur. Medial yaklaşım substernal veya retrofaringeal büyümüş guatrlarda tercih edilen bir yaklaşımdır. Bu yöntemde ilk önce istmus ayrılıop istmus ve lobun mediali trakea üzerinden diseke edilerek trakeanın anterolaterali ortaya konur. Lateral kesimi açığa çıkarılmış 2. veya 3. trakeal halka lateral yüzü ile tiroit arasınaki lifler ve Berry ligament lifleri aşama aşama kraniale doğru açılarak tiroidin medialinde, trakeanın lateralinde RLS'nin görüş alanına girmesi sağlanır. RLS'nin anatomik bütünlüğünün korunması fonksiyonunun da korunduğunu göstermez. İntraoperatif sinir monitörizasyonu (İONM) RLS'nin korunması için altın standart olan sinirin görülmesine ek olarak fonksiyonel değerlendirilmesini sağlayan yöntemdir. İONM RLS'nin görülmesine, anatomic çeşitliliklerinin belirlenmesine, RLS yaralanmasının intraoperative tanınmasına, bilateral vokal kord paralizisinin önlenmesine, preoperative vokal kord paralizili hastalarda sinirin elektrik aktivite varlığının saptanarak korunmasına önemli katkılar sağlamakta-dır. SLSE'nin korunması için standartlaşmış bir yöntem olmamakla beraber tiroit üst kutbunun serbestleştirlmesi sırasında SLSE'nin korunabilmesi için üç yöntem tanımlanmıştır. Bunlar SLSE görülmeden süperior tiroit damar dallarının kapsül üzerinde ayrı ayrı serbestleştirilmesi, üst pol damarları ayrılmadan önce SLSE'nin araştırılmesı ve görülmesi veya İONM eşliğinde SLSE'nin bulunması ve üst polün diseke edilmesidir. İONM SLSE'nin bulunması, doğrulan...

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“…A recent study identifies failure to find the nerve in as many as 18% of cases. 3 Mountain et al showed that the incidence of nerve paralysis was three to four times greater in cases where the nerve was not exposed than in cases where it was routinely exposed. 4 A surgical technique that would help in locating the recurrent laryngeal and superior laryngeal nerve during surgery could potentially reduce damage to these nerves.…”

Section: Objectifmentioning

confidence: 99%

L’identification du nerf laryngé pendant l’opération de la thyroïde — la faisabilité d’une nouvelle approche

Hillermann

Tarpey

Phillips

2003

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : Recurrent laryngeal nerve damage remains one of the most devastating complications of thyroid surgery. However, nerve identification is not always easy, and a reliable method to locate nerves intraoperatively is needed.M Me et th ho od ds s: : Thirty consecutive patients were anesthetized for elective thyroid surgery using a standard technique. Indications for surgery covered a broad spectrum of conditions. In the technique described, the airway is secured with a micro laryngeal tube, and a laryngeal mask airway is inserted through which a fibreoptic scope is inserted to view the larynx. Movement of the arytenoids in response to nerve stimulation can be viewed at any time on a television monitor. The airway is secure throughout the procedure and nerve identification is continuously available.R Re es su ul lt ts s: : In our study 30 patients were anesthetized and nerve stimulation used in all of them to identify both superior and recurrent laryngeal nerve. None of them developed intraoperative complications. One patient had temporary postoperative recurrent laryngeal nerve damage, which was not attributable to use of this method.C Co on nc cl lu us si io on n: : On the basis of our results so far, the method described is feasible and provides a safe method of nerve location during surgery. Laryngeal nerve stimulation is likely to become an integral part of thyroid surgery. Objectif : Les dommages du nerf laryngé récurrent demeurent la Conclusion : D'après les résultats obtenus jusqu'à maintenant, la méthode décrite est faisable et permet une identification peropéra-toire du nerf sans danger. La stimulation du nerf laryngé pourrait donc être intégrée à l'opération de la thyroïde.HYROIDECTOMIES continue to produce complications with the most devastating being damage to the recurrent laryngeal nerve. 1 The rate of recurrent laryngeal nerve palsy varies from 2% to 17% and for superior laryngeal nerve from 9% to 14%. 2 Trauma to one of the laryngeal nerves is more likely if there are variations or distortions of anatomy, malignancy, previous radiation or revision surgery.It is standard practice to identify the recurrent laryngeal nerve but this is not always possible. A recent study identifies failure to find the nerve in as many as 18% of cases. 3 Mountain et al. showed that the incidence of nerve paralysis was three to four times greater in cases where the nerve was not exposed than in cases where it was routinely exposed.

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The recurrent laryngeal nerve related to thyroid surgery

Cited by 135 publications

References 5 publications

The Zuckerkandl's Tubercle: A Useful Anatomical Landmark for Detecting both the Recurrent Laryngeal Nerve and the Superior Parathyroid during Thyroid Surgery

The Zuckerkandl's Tubercle: A Useful Anatomical Landmark for Detecting both the Recurrent Laryngeal Nerve and the Superior Parathyroid during Thyroid Surgery

A review of methods for the preservation of laryngeal nerves during thyroidectomy

L’identification du nerf laryngé pendant l’opération de la thyroïde — la faisabilité d’une nouvelle approche

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