Abstract
BackgroundThyroid gland is the largest and most vascular structure among the endocrine glands. The recurrent laryngeal nerve and the superior laryngeal nerve are closely related to the thyroid gland; these nerves control voice and are vital in breathing. Anatomical preservation of the recurrent laryngeal nerve (RLN) is the gold standard in thyroid surgery. Visual identification of RLN has decreased the rates of permanent RLN palsy during thyroid and parathyroid operations. Prior knowledge about the branching patterns will help in predicting and preventing injury to the nerve during thyroid surgery.Aim and objectivesThe aim of the study is to observe the terminal branching pattern of recurrent laryngeal nerve before its entry into the larynx.MethodsAn observational study with 50 participants who fulfilled the inclusion and exclusion criteria were enrolled in the study. After a complete evaluation and pre-anaesthetic checkup, the patients were operated and intraoperative findings of RLN branching were recorded and compared for the study.ResultsIn our study, out of the 50 patients who underwent thyroid surgery during the course of the study, right-sided RLN branching was demonstrated in 25 patients (21 right hemithyroidectomy and 4 total thyroidectomy). Ten patients had RLN bifurcation, 7 had trifurcation, 5 had numerous branches, and 3 with no branching pattern were noted. Similarly, out of 29 patients (25 left hemithyroidectomy and 4 total thyroidectomy) in whom left-sided RLN branching was studied, bifurcation was seen in 10 patients, trifurcation in 12 patients, and multiple branching was observed in 7.ConclusionThe anatomical variations seen in RLN may increase the risk of vocal cord palsy due to its injury. Anatomical variations are categorized according to the original direction of the RLN and the number of terminal branches in the larynx. This classification aids in the identification and preservation of its branches, hence facilitating a safer thyroidectomy.
Published Version
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