Advertisement

Langenbeck's Archives of Surgery

, Volume 393, Issue 5, pp 681–685 | Cite as

The recurrent laryngeal nerve and the inferior thyroid artery—anatomical variations during surgery

  • Ozer MakayEmail author
  • Gokhan Icoz
  • Mustafa Yilmaz
  • Mahir Akyildiz
  • Enis Yetkin
Original Article

Abstract

Background and aims

Recognition of variations of the inferior laryngeal nerve is essential. We aimed to investigate the relationship of the inferior laryngeal nerve with the inferior thyroid artery.

Materials and methods

A study was undertaken between August 2005 and August 2006. A total of 253 adult patients undergoing thyroid surgery were included in this prospective, non-randomized study. Both sides of the thyroid gland were considered separately.

Results

Sixteen variations of the nerve were clarified. In the most observed variation, the nerve was deep to the artery. Two and three nervous branches were seen in 22.5% and 1.6% of the patients, respectively. Bifurcation of the nerve was mostly observed on the left side. No non-recurrent laryngeal nerve was found.

Conclusion

To avoid the risk of nerve damage during thyroid surgery, a good knowledge of the variations of the inferior laryngeal nerve is essential. This is important to achieve an undisturbed quality of life for the thyroid patient.

Keywords

Inferior laryngeal nerve Inferior thyroid artery Thyroid surgery Variations 

References

  1. 1.
    Ardito G, Revelli R, d’Alatri L, Lerro V, Guidi ML, Ardito F (2004) Revised anatomy of the recurrent laryngeal nerves. Am J Surg 187:249–253PubMedCrossRefGoogle Scholar
  2. 2.
    Sturniolo G, d’Alia C, Tonante A, Gagliano E, Taranto F, Lo Schiavo MG (1999) The recurrent laryngeal nerve related to thyroid surgery. Am J Surg 177:485–488PubMedCrossRefGoogle Scholar
  3. 3.
    Mishra AK, Agarwal A, Selven CK, Nair A (2007) Response to “Anatomic configurations of the recurrent laryngeal nerve and inferior thyroid artery”. Surgery 141:281–282PubMedCrossRefGoogle Scholar
  4. 4.
    Beneragama T, Serpell JW (2006) Extralaryngeal bifurcation of the recurrent laryngeal nerve: a common variation. ANZ J Surg 76:928–931PubMedCrossRefGoogle Scholar
  5. 5.
    Makay O, Unalp O, Icoz G, Akyildiz M, Yetkin E (2006) Completion thyroidectomy for thyroid cancer. Acta Chir Belg 106:528–531PubMedGoogle Scholar
  6. 6.
    Uen YH, Chen TH, Shyu JF, Shyr YM, Su CH, Chen JY (2006) Surgical anatomy of the recurrent laryngeal nerves and its clinical applications in chinese adults. Surg Today 36:312–315PubMedCrossRefGoogle Scholar
  7. 7.
    Shaha AR (1993) Safe ligation of the superior thyroid vessels. J Surg Oncol 53:208PubMedCrossRefGoogle Scholar
  8. 8.
    Lekacos NL, Tzardis PJ, Sfikakis PG, Patoulis SD, Restos SD (1992) Course of the recurrent laryngeal nerve relative to the inferior thyroid artery and the suspensory ligament of Berry. Int Surg 77:287–288PubMedGoogle Scholar
  9. 9.
    Moreau S, De Rugy MG, Babin E, Salame E, Delmas P, Valdazo A (1998) The recurrent laryngeal nerve: related vascular anatomy. Laryngoscope 108:1351–1353PubMedCrossRefGoogle Scholar
  10. 10.
    Simon MM (1943) Recurrent laryngeal nerve in thyroid surgery—triangle for its recognition and protection. Am J Surg 60:212–220CrossRefGoogle Scholar
  11. 11.
    Berlin DD (1935) The recurrent laryngeal nerves in total ablation of the normal thyroid gland; an anatomical and surgical study. Surg Gynecol Obstet 60:19–26Google Scholar
  12. 12.
    Armstrong WG, Hinton JW (1951) Multiple divisions of the recurrent laryngeal nerve; an anatomic study. Arch Surg 62:532–599Google Scholar
  13. 13.
    Yalcin B (2006) Anatomic configurations of the recurrent laryngeal nerve and inferior thyroid artery. Surgery 139:181–187PubMedCrossRefGoogle Scholar
  14. 14.
    Page C, Foulon P, Strunski V (2003) The inferior laryngeal nerve: surgical and anatomic considerations. Report of 251 thyroidectomies. Surg Radiol Anat 25:188–191PubMedCrossRefGoogle Scholar
  15. 15.
    Riddell VH (1956) Injury to recurrent laryngeal nerves during thyroidectomy; a comparison between the results of identification and non-identification in 1022 nerves exposed to risk. Lancet 271:638–641PubMedCrossRefGoogle Scholar
  16. 16.
    Clader DN, Luter PW, Daniels BT (1957) A photographic study of the superior and inferior laryngeal nerves and the superior and inferior thyroid arteries. Am Surg 23:609–618PubMedGoogle Scholar
  17. 17.
    Nemiroff PM, Katz AD (1982) Extralaryngeal divisions of the recurrent laryngeal nerve. Surgical and clinical significance. Am J Surg 144:466–469PubMedCrossRefGoogle Scholar
  18. 18.
    Schweizer V, Dorfl J (1997) The anatomy of the inferior laryngeal nerve. Clin Otolaryngol Allied Sci 22:362–369PubMedCrossRefGoogle Scholar
  19. 19.
    Steinberg JL, Khane GJ, Fernandes CM, Nel JP (1986) Anatomy of the recurrent laryngeal nerve: a redescription. J Laryngol Otol 100:919–927PubMedCrossRefGoogle Scholar
  20. 20.
    Harness JK, Fung L, Thompson NW, Burney RE, McLeod MK (1986) Total thyroidectomy: complications and technique. World J Surg 10:781–786PubMedCrossRefGoogle Scholar
  21. 21.
    Jatzko GR, Lisborg PH, Muller MG, Wette VM (1994) Recurrent nerve palsy after thyroid operations—principal nerve identification and a literature review. Surgery 115:139–144PubMedGoogle Scholar
  22. 22.
    Lo CY, Kwok KF, Yuen PW (2000) A prospective evaluation of recurrent laryngeal nerve paralysis during thyroidectomy. Arch Surg 135:204–207PubMedCrossRefGoogle Scholar
  23. 23.
    Steurer M, Passler C, Denk DM, Schneider B, Niederle B, Bigenzahn W (2002) Advantages of recurrent laryngeal nerve identification in thyroidectomy and parathyroidectomy and the importance of preoperative and postoperative laryngoscopic examination in more than 1000 nerves at risk. Laryngoscope 112:124–133PubMedCrossRefGoogle Scholar
  24. 24.
    Chiang FY, Wang LF, Huang YF, Lee KW, Kuo WR (2005) Recurrent laryngeal nerve palsy after thyroidectomy with routine identification of the recurrent laryngeal nerve. Surgery 137:342–347PubMedCrossRefGoogle Scholar
  25. 25.
    Al-fakhri N, Schwartz A, Runkel N, Buhr HJ (1998) Rate of complications with systematic exposure of the recurrent laryngeal nerve and parathyroid glands in operations for benign thyroid gland diseases. Zentralbl Chir 123:21–24PubMedGoogle Scholar
  26. 26.
    Mattig H, Bildat D, Metzger B (1998) Reducing the rate of recurrent nerve paralysis by routine exposure of the nerves in thyroid gland operations. Zentralbl Chir 123:17–20PubMedGoogle Scholar
  27. 27.
    Kasemsuwan L, Nubthuenetr S (1997) Recurrent laryngeal nerve paralysis: a complication of thyroidectomy. J Otolaryngol 26:365–367PubMedGoogle Scholar
  28. 28.
    Bergamaschi R, Becouarn G, Ronceray J, Arnaud JP (1998) Morbidity of thyroid surgery. Am J Surg 176:71–75PubMedCrossRefGoogle Scholar
  29. 29.
    Wagner HE, Seiler C (1994) Recurrent laryngeal nerve palsy after thyroid gland surgery. Br J Surg 81:226–228PubMedCrossRefGoogle Scholar
  30. 30.
    Pelizzo MR, Toniato A, Gemo G (1998) Zuckerkandl’s tuberculum: an arrow pointing to the recurrent laryngeal nerve (constant anatomical landmark). J Am Coll Surg 187:333–336PubMedCrossRefGoogle Scholar
  31. 31.
    Toniato A, Boschin IM (2006) Re: “anatomic configurations of the recurrent laryngeal nerve and inferior thyroid artery”. Surgery 140:482–483 author reply 483PubMedCrossRefGoogle Scholar
  32. 32.
    Cakir BO, Ercan I, Sam B, Turgut S (2006) Reliable surgical landmarks for the identification of the recurrent laryngeal nerve. Otolaryngol Head Neck Surg 135:299–302PubMedCrossRefGoogle Scholar
  33. 33.
    Hisham AN, Lukman MR (2002) Recurrent laryngeal nerve in thyroid surgery: a critical appraisal. ANZ J Surg 72:887–889PubMedCrossRefGoogle Scholar
  34. 34.
    Hollinshead WH (1982) Anatomy for surgeons: the head and neck. vol 1 3rd (ed) Philadelphia, Harper & Row, p 455–458Google Scholar
  35. 35.
    Moreau S, Goullet de Rugy M, Babin E, Salame E, Delmas P, Valdazo A (1998) The recurrent laryngeal nerve: related vascular anatomy. Laryngoscope 108:1351–1353PubMedCrossRefGoogle Scholar
  36. 36.
    Shaha AR (2000) Thyroid cancer: extent of thyroidectomy. Cancer Control 7:240–245PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Ozer Makay
    • 1
    Email author
  • Gokhan Icoz
    • 1
  • Mustafa Yilmaz
    • 1
  • Mahir Akyildiz
    • 1
  • Enis Yetkin
    • 1
  1. 1.Department of General Surgery, School of MedicineEge UniversityIzmirTurkey

Personalised recommendations