ANATOMY OF RECURRENT LARYNGEAL NERVE IN THYROIDECTOMY
Journal Title: Journal of Evolution of Medical and Dental Sciences - Year 2017, Vol 6, Issue 95
Abstract
BACKGROUND Thyroid surgeries have been through tremendous evolution to make it a safe procedure. Thyroid surgery can today be performed with practically no added mortality other than the risk of general anaesthesia. A likely voice problem is a fearful dream from patient’s point of view. In order to overcome this problem and to achieve enviable results, the surgeon should have in-depth knowledge of the anatomy of the neck especially of the laryngeal nerves, the pathophysiology of thyroid disorders, be versed in the pre and postoperative care of the patient and finally use an unhurried careful, meticulous operative technique adhering to the principles of capsular dissection. MATERIALS AND METHODS The objective of the study is to delineate the various patterns of anatomy of recurrent laryngeal nerve as visualised during thyroidectomy and to assess the incidence of injury to the nerve with total visualisation of the nerve in its entire course in different thyroid disorders. This descriptive study was conducted on 213 patients in the Department of General Surgery. RESULTS Among 213 patients who underwent thyroidectomy, 35.71% (135) RLN found as a single trunk, 43.65% (165) RLN branching into two, 20.64% (78) RLN branching into more than two. Relation of RLN to ITA, 21.16%, 73.54% and 5.3% for anterior to main stem, posterior to main stem and between the branches respectively. Relation of RLN to TOG towards right and left were 73.58%, 21.76%, 4.66% and 81.08%, 15.68%, 3.24% in regard to RLN exactly in TOG lateral to TOG and anteromedial to TOG respectively. 1 (2.816 %) had injury to RLN; 23.02%, 15.08% and 61.90% were the percentages of mode of entry into larynx through Berry’s ligament, posteromedial to Berry’s ligament and lateral to Berry’s ligament respectively. CONCLUSION Recurrent laryngeal nerve injury represents the main damage of the thyroid surgery. The only option to safeguard the nerve is to identity the nerve than to avoid it. The best pattern to identify the nerve is to use Inferior thyroid artery as the anatomical landmark. Identification of the nerve has to be in its entirety. Most common site of recurrent laryngeal nerve injury is at its entry into larynx close to the Berry’s ligament. Bilateral symmetry of the nerve is an evident fact.
Authors and Affiliations
Ramraj R, Vishnu ML
Keywords
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- EP ID EP280642
- DOI 10.14260/jemds/2017/1521
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