A Closer Look at Laryngeal Nerves during Thyroid Surgery: A Descriptive Study of 584 Nerves

P V Pradeep,Skandha S Harshita,B Jayashree

doi:10.1155/2012/490390

P V Pradeep, Skandha S Harshita + Show 1 more

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https://doi.org/10.1155/2012/490390

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Abstract

Morbidity after thyroidectomy is related to injuries to the parathyroids, recurrent laryngeal (RLN) and external branch of superior laryngeal nerves (EBSLN). Mostly these are due to variations in the surgical anatomy. In this study we analyse the surgical anatomy of the laryngeal nerves in Indian patients undergoing thyroidectomy. Materials and Methods. Retrospective study (February 2008 to February 2010). Patients undergoing surgery for benign goitres, T1, T2 thyroid cancers without lymph node involvement were included. Data on EBSLN types, RLN course and its relation to the TZ & LOB were recorded. Results. 404 thyroid surgeries (180 total & 224 hemithyroidectomy) were performed. Data related to 584 EBSLN and RLN were included (324 right sided & 260 left sided). EBSLN patterns were Type 1 in 71.4%, Type IIA in 12.3%, and Type IIB in 7.36%. The nerve was not seen in 4.3% cases. RLN had one branch in 69.34%, two branches in 29.11% and three branches in 1.36%. 25% of the RLN was superficial to the inferior thyroid artery, 65% deep to it and 8.2% between the branches. TZ was Grade 1 in 65.2%, Grade II in 25.1% and Grade III in 9.5%. 31.16% of the RLN passes through the LOB. Conclusions. A thorough knowledge of the laryngeal nerves and anatomical variations is necessary for safe thyroid surgery.

Highlights

Thyroid surgery was associated with high mortality rates in the early nineteenth century
It has been realised that the recurrent laryngeal (RLN) has extralaryngeal branching and this can be damaged if the individual branches are not taken care of by meticulous dissection [10, 11]
In this study we analyse the surgical anatomy of the laryngeal nerves both RLN and external branch of superior laryngeal nerves (EBSLN) and its variations in Indian patients undergoing thyroid surgeries at a specialised endocrine surgical unit

Summary

Introduction

Thyroid surgery was associated with high mortality rates in the early nineteenth century. Several studies have been published revealing the anatomy of the laryngeal nerves as seen during thyroid surgery [1, 3,4,5]. It has been realised that the RLN has extralaryngeal branching and this can be damaged if the individual branches are not taken care of by meticulous dissection [10, 11]. No such detailed study has been published from Indian subjects. In this study we analyse the surgical anatomy of the laryngeal nerves both RLN and EBSLN and its variations in Indian patients undergoing thyroid surgeries at a specialised endocrine surgical unit

Methods

Results

Conclusion