Surgery
Department of Surgery, Tulane University, School of Medicine, New Orleans, LA 70112, USA.
Published: December 2011
Introduction: Recognition of extralaryngeal bifurcation of the recurrent laryngeal nerve (RLN) is crucial, because inadvertent intraoperative division may lead to significant morbidity. The purpose of this study was to examine the incidence of extralaryngeal bifurcation of the RLN and the distance that the initial bifurcation occurs from the cricothyroid insertion site of the RLN. We also sought to demonstrate the location of the RLN branches containing a predominance of motor fibers.
Methods: This prospective study of 220 patients with data on 310 RLNs collected the type of operation, incidence of bifurcation, distance from the cricothyroid insertion point to the point of initial bifurcation, and location of the motor fibers by assessing a stimulus response on the Medtronic NIMS as they relate to the laryngeal muscles.
Results: A total of 310 RLNs in 220 patients were studied. There were 133 RLNs (42.9%) that bifurcated before entering the larynx. These bifurcations occurred 51.1% on the right, 48.9% on the left, and 33.3% bilaterally. The median branching distance from the cricothyroid membrane on the right was 6.33 mm, and on the left was 6.37 mm. In all bifurcated RLNs, the motor fibers were located exclusively in the anterior branches.
Conclusion: Extralaryngeal bifurcation was found in 42.9% of the RLNs in this case series. The motor fibers are located in the anterior branches. Great caution is therefore required after the presumed identification of the RLN to ensure there is no unidentified anterior branch.
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http://dx.doi.org/10.1016/j.surg.2011.09.002 | DOI Listing |
J Coll Physicians Surg Pak
December 2022
Department of Surgery, Medical Faculty, Duzce University, Duzce, Turkey.
Redo thyroid surgery on patients with unilateral recurrent laryngeal nerve (RLN) palsy certainly poses a great surgical challenge. We present a case of a patient with unilateral vocal cord (VC) palsy who underwent redo thyroid surgery under intraoperative neuromonitoring. The patient's normal speaking voice was maintained after the primary surgery, even though preoperative laryngoscopy showed an immobile right VC with a normal structure.
View Article and Find Full Text PDFClin J Gastroenterol
August 2021
Department of Surgical Oncology, Gifu University School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan.
Right-sided Zenker's diverticulum is a rare pharyngoesophageal diverticulum. The risk of intraoperative injury of the recurrent laryngeal nerve is high during transcervical diverticulectomy because this nerve presents many variations of extralaryngeal bifurcation before entry into the larynx. We present a case of right-sided Zenker's diverticulum that was safely resected with the use of intraoperative neuromonitoring to prevent right recurrent laryngeal nerve injury.
View Article and Find Full Text PDFInt J Surg
November 2020
Department of General Surgery, Qilu Hospital of Shandong University, Jinan, 250012, Shandong, China. Electronic address:
Background: The use of intraoperative neuromonitoring (IONM) for visual identification of recurrent laryngeal nerve (RLN) has decreased the rates of RLN injury (RLNI) during thyroid surgery. However, little attention has been paid to RLNI near the nerve entry point (NEP), where most injuries occur. The aim of this study was to determine the mechanism of RLNI near the NEP and to describe the recovery of nerve function.
View Article and Find Full Text PDFEar Nose Throat J
December 2021
Department of Pathology, Jingzhou No. 1 People's Hospital and First Affiliated Hospital of Yangtze University, Hubei Province, China.
Objective: To study terminal bifurcation of recurrent laryngeal nerves (RLNs) with original direction to larynx entry and to decrease the risk of vocal cord paralysis in thyroid patients.
Methods: The RLNs of 294 patients (482 sides) were dissected according to the branches into the larynx, and the original direction of each RLN trunk in thyroid surgery was recorded.
Results: (1) About 30.
Int J Surg Case Rep
November 2018
Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
Introduction: Recurrent laryngeal nerve injury is a major complication of thyroid surgery. An endotracheal tube with electromyography electrodes attached to it was recently developed for intraoperative neuromonitoring during thyroid surgery. Here we describe the successful identification and preservation of an extralaryngeal bifurcation of the recurrent laryngeal nerve by intraoperative neuromonitoring in a patient undergoing thyroid surgery.
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