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

Pradeep PV, Jayashree B, Harshita SS - Anat Res Int (2012)

Bottom Line: 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.

View Article: PubMed Central - PubMed

Affiliation: Department of Endocrine Surgery, Narayana Medical College & Superspeciality Hospital, Chinthareddypalem, Nellore 524002, India.

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.

No MeSH data available.


Related in: MedlinePlus

(A) depicts the two branches of right RLN, and (B) shows three branches of left RLN. Para: parathyroid glands.
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fig3: (A) depicts the two branches of right RLN, and (B) shows three branches of left RLN. Para: parathyroid glands.

Mentions: RLN continued as a single branch in majority cases: however, around 30% cases had branches. The branching pattern is shown in Table 2. Figure 3(A) shows two branches and Figure 3(B) shows three branches for the RLN. RLN was deep to ITA in 64.3% (n = 375), superficial to ITA in 25.5% (n = 161), and between the branches in 8.2% (n = 48). The TZ which is an extension from the posterior portion of the thyroid lobes was seen as grade 1 in 65.2% (n = 381), grade 2 in 25.1% (n = 147), and grade 3 in 9.5% (n = 56Figure 4). The RLN was medial to the TZ in 98% of the cases. The relationship of the RLN to the LOB is given in Table 3. In more than 30% of the cases the RLN passed through the LOB. The pyramidal lobe was absent in 21.78% (n = 88).


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

Pradeep PV, Jayashree B, Harshita SS - Anat Res Int (2012)

(A) depicts the two branches of right RLN, and (B) shows three branches of left RLN. Para: parathyroid glands.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3378964&req=5

fig3: (A) depicts the two branches of right RLN, and (B) shows three branches of left RLN. Para: parathyroid glands.
Mentions: RLN continued as a single branch in majority cases: however, around 30% cases had branches. The branching pattern is shown in Table 2. Figure 3(A) shows two branches and Figure 3(B) shows three branches for the RLN. RLN was deep to ITA in 64.3% (n = 375), superficial to ITA in 25.5% (n = 161), and between the branches in 8.2% (n = 48). The TZ which is an extension from the posterior portion of the thyroid lobes was seen as grade 1 in 65.2% (n = 381), grade 2 in 25.1% (n = 147), and grade 3 in 9.5% (n = 56Figure 4). The RLN was medial to the TZ in 98% of the cases. The relationship of the RLN to the LOB is given in Table 3. In more than 30% of the cases the RLN passed through the LOB. The pyramidal lobe was absent in 21.78% (n = 88).

Bottom Line: 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.

View Article: PubMed Central - PubMed

Affiliation: Department of Endocrine Surgery, Narayana Medical College & Superspeciality Hospital, Chinthareddypalem, Nellore 524002, India.

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.

No MeSH data available.


Related in: MedlinePlus