Abstract
BackgroundTo describe and evaluate a four step systematic approach to dissecting the recurrent laryngeal nerve (RLN) starting at the cricothyroid junction during thyroid surgery (subsequently referred to as the retrograde medial approach).MethodsAll thyroidectomies completed by the senior author between August 2014 and January 2016 were retrospectively reviewed. Patients were excluded if concurrent lateral or central neck dissection was performed. A follow up period of 1 year was included.ResultsSurgical photographs and illustrations demonstrate the four steps in the retrograde medial approach to dissection of the RLN in thyroid surgery.Three hundred forty-two consecutive thyroid surgeries were performed in 17 months, including 213 hemithyroidectomies, 91 total thyroidectomies, and 38 completion thyroidectomies. The rate of temporary and permanent hypocalcemia was 13% (95% confidence interval [CI]: 8–20%) and 3% (95% CI: 1–8%) respectively. The rate of temporary and permanent vocal cord palsy was 9% (95% CI: 6–12%) and 0.3% (95%CI: 0.01–2%) respectively. The median surgical times for hemithyroidectomy, total thyroidectomy, and completion thyroidectomy were 39 min (Interquartile range [IQR]: 33–47 min), 48 min (IQR: 40–60 min), and 40 min (IQR: 35–51 min) respectively. 1% of cases required conversion to an alternative surgical approach.ConclusionIn a tertiary endocrine head and neck practice, the routine use of the retrograde medial approach to RLN dissection is safe and results in a short operative time, and a low conversion rate to other RLN dissection approaches.
Highlights
To describe and evaluate a four step systematic approach to dissecting the recurrent laryngeal nerve (RLN) starting at the cricothyroid junction during thyroid surgery
Thyroid surgeries are the most frequent operations performed by head and neck surgeons in the United States [1]. 2015 American Thyroid Association Guidelines recommend “Visual identification of the recurrent laryngeal [RLN] during dissection in all cases” on moderate-quality evidence [2]
For revision cases and for goiter surgery, the inferior approach is often used. In this approach the RLN is found in the soft areolar tissue in the tracheoesophageal groove proximal to the inferior thyroid artery crossing point. One advantage of this technique is that the RLN is found proximally prior to extra-laryngeal branching and away from thyroid bed scarring that might have been caused by prior surgery [3]
Summary
To describe and evaluate a four step systematic approach to dissecting the recurrent laryngeal nerve (RLN) starting at the cricothyroid junction during thyroid surgery (subsequently referred to as the retrograde medial approach). For revision cases and for goiter surgery, the inferior approach is often used. In this approach the RLN is found in the soft areolar tissue in the tracheoesophageal groove proximal to the inferior thyroid artery crossing point. One advantage of this technique is that the RLN is found proximally prior to extra-laryngeal branching and away from thyroid bed scarring that might have been caused by prior surgery [3]. The superior Superior approach is the least used approach In this approach, the RLN is identified as it enters under the inferior constrictor muscle proximal to Butskiy et al Journal of Otolaryngology - Head and Neck Surgery (2018) 47:57
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callMore From: Journal of Otolaryngology - Head & Neck Surgery
Disclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
