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The inferior laryngeal nerve: surgical and anatomic considerations. Report of 251 thyroidectomies

  • Anatomic Bases of Medical, Radiological and Surgical Techniques
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Abstract

This surgical anatomic study aimed to determine (1) the anatomic relation of the laryngeal inferior nerve with the inferior thyroid artery, (2) the existence of extralaryngeal branches of division of the nerve and (3) the size of the nerve seen macroscopically. Two hundred and fifty-one patients underwent thyroid surgery during a period of 30 months. There were 50 males and 201 females. The male population underwent 28 total thyroidectomies, 13 left lobectomies and 9 right lobectomies. The female population underwent 124 total thyroidectomies, 33 left lobectomies and 44 right lobectomies. On the right side: the nerve was found superficial to the artery in 70.24% of females and 51.35% of males, the nerve was divided in 23.81% of females and 21.62% of males and seemed unusually thin in 14.29% of females and 5.41% of males. On the left side: the nerve was found superficial to the artery in 87.26% of females and 95.12% of males, the nerve was divided in 15.29% of females and 14.63% of males and seemed unusually thin in 10.83% of females and 2.44% of males. In conclusion, the inferior laryngeal nerve is characterized by its important anatomic variations, especially on the right side. These variations might be different even between males and females. Knowledge of these variations is very important in order to best identify and preserve the inferior laryngeal nerve during thyroid surgery.

Résumé

Il s'agit d'une étude anatomique per-opératoire ayant pour but de préciser (1) les rapports du nerf laryngé inférieur avec l'artère thyroïdienne inférieure, (2) l'existence de branches de division nerveuses extra-laryngées et (3) une appréciation subjective du calibre macroscopique du nerf. 251 patients ont bénéficié d'une chirurgie thyroïdienne (50 hommes et 201 femmes) sur une période de 30 mois. Pour les hommes ont été réalisées 28 thyroïdectomies totales, 13 lobo-isthmectomies gauches et 9 lobo-isthmectomies droites. Pour les femmes ont été réalisées 124 thyroïdectomies totales, 33 lobo-isthmectomies gauches et 44 lobo-isthmectomies droites. Du côté droit, le nerf était superficiel par rapport à l'artère dans 70,24% des cas chez les femmes et 51,35% chez les hommes, il était divisé dans 23,81% des cas chez les femmes et 21,62% chez les hommes et il était anormalement fin dans 14,29% des cas chez les femmes et 5,41% chez les hommes. Du coté gauche, il était profond dans 87,26% des cas chez les femmes et 95,12% chez les hommes, il était divisé dans 15,29% des cas chez les femmes et 14,63% chez les hommes et il était anormalement fin dans 10,83% des cas chez les femmes et 2,44% chez les hommes. En conclusion, le nerf laryngé inférieur est caractérisé par ses grandes variations anatomiques, en particulier du côté droit. De plus ces variations sont possiblement différentes entre les sexes. La connaissance de ces variations est indispensable pour le repérage et la préservation du nerf au cours de la chirurgie thyroïdienne.

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Authors and Affiliations

  1. Service d'ORL et de chirurgie cervico-faciale, Hôpital Nord, CHU, Place Victor Pauchet, 80054, Amiens cedex, France

    C. Page & V. Strunski

  2. Laboratoire d'anatomie et d'organogenèse, Faculté de médecine, 3, rue des Louvels, 80000, Amiens, France

    P. Foulon

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  1. C. Page
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  2. P. Foulon
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  3. V. Strunski
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Correspondence to C. Page.

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Page, C., Foulon, P. & Strunski, V. The inferior laryngeal nerve: surgical and anatomic considerations. Report of 251 thyroidectomies. Surg Radiol Anat 25, 188–191 (2003). https://doi.org/10.1007/s00276-003-0129-7

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  • DOI: https://doi.org/10.1007/s00276-003-0129-7

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