Skip to main content
SpringerLink
Log in

Variations in Recurrent Laryngeal Nerve in Thyroidectomy

  • Original Article
  • Published:
Indian Journal of Otolaryngology and Head & Neck Surgery Aims and scope Submit manuscript

Abstract

The aim of this study was to identify and evaluate variations in anatomy and the course of Recurrent. Laryngeal nerve (RLN) with respect to various landmarks. A retrospective study was conducted in the department of ENT and head and neck surgery in our institute including 52 eu-thyroid cases who had undergone primary thyroid surgery over a period of 1 year. 48 cases underwent hemi-thyroidectomy and 4 had total thyroidectomy. During the surgery the anatomy and relationship to surrounding structures of the RLN that were observed were recorded and compiled among the 56 sides that were operated on, RLN was identified as a single trunk in 47 cases (83.9%). The nerve showed extra-laryngeal branches in 6 cases (10.7%) while 3 cases were found to have degenerated RLN. None of the cases were found with a non-recurrent laryngeal nerve. With respect to inferior thyroid artery (ITA), 82% cases had the nerve passing deep to it and in the rest 18% the nerve passed anterior to the artery. While in none of the cases the nerve passed in between the branches of the artery. With respect to the tracheo-esophageal groove, RLN was found within the groove in 44 cases, while in 12 cases RLN was located lateral to the trachea-oesophageal groove. In the current study, variations in the anatomy of RLN was found less frequently, owing to the comparatively small sample size. The ITA and trachea-esophageal groove were both found as reliable landmarks for tracking the RLN.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Wojtczak B, Kaliszewski K, Sutkowski K, Bolanowski M, Barczyński M (2018) A functional assessment of anatomical variants of the recurrent laryngeal nerve during thyroidectomies using neuromonitoring. Endocrine. ;59(1):82-89. doi:https://doi.org/10.1007/s12020-017-1466-3 - DOI- PMC - PubMed

  2. Toniato A, Boschin IM, Piotto A, Pelizzo MR, Guolo A, Foletto M, Casalide E Complications in thyroid surgery for carcinoma: one institution’s surgical experience. World J Surg. 2008 Apr;32(4):572-5. doi: https://doi.org/10.1007/s00268-007-9362-2. PMID: 18204947

  3. Thomusch O, Machens A, Sekulla C, Ukkat J, Lippert H, Gastinger I, Dralle H (2000) Nov;24(11):1335-41 Multivariate analysis of risk factors for postoperative complications in benign goiter surgery: prospective multicenter study in Germany. World J Surg. doi: https://doi.org/10.1007/s002680010221. PMID: 11038203

  4. Kelly J, Mahalingam S (2015 Jun) Surgical treatment of head and neck cancers in the ancient world. J Laryngol Otol 129(6):535–539. https://doi.org/10.1017/S0022215115001218Epub 2015 May 25. PMID: 26004289

  5. Ling XY, Smoll NR (2016) Jan;29(1):104 – 10 A systematic review of variations of the recurrent laryngeal nerve. Clin Anat. doi: 10.1002/ca.22613. Epub 2015 Oct 5. PMID: 26297484

  6. Fowler CH, Hanson W (1929) Surgical anatomy of the thyroid gland with special reference to the relations of the recurrent laryngeal nerve. Surg gynaecol obstet 49:59–66

    Google Scholar 

  7. Berlin D, Lahey FH (1929) Dissections of the recurrent and superior laryngeal nerves. Surg Gynecol Obstet 49:102–104

    Google Scholar 

  8. Ziegelman EF (1933) Laryngeal nerves. Arch Otolaryngol 18:793–808

    Article  Google Scholar 

  9. Armstrong WG, Hinton JW (1951) Multiple division of the recurrent laryngeal nerve. Arch Surg 62:532–539

    CAS  Google Scholar 

  10. Fontenot TE, Randolph GW, Friedlander PL, Masoodi H, Yola IM, Kandil E (2014 Oct) Gender, race, and electrophysiologic characteristics of the branched recurrent laryngeal nerve. Laryngoscope 124(10):2433–2437. https://doi.org/10.1002/lary.24631Epub 2014 Mar 25. PMID: 24493270

  11. Toniato A, Mazzarotto R, Piotto A, Bernante P, Pagetta C, Pelizzo MR (2004) Jul;28(7):659 – 61 Identification of the nonrecurrent laryngeal nerve during thyroid surgery: 20-year experience. World J Surg. doi: https://doi.org/10.1007/s00268-004-7197-7. Epub 2004 Jun 4. PMID: 15175898

  12. Hisham AN, Lukman MR (2002) Dec;72(12):887-9 Recurrent laryngeal nerve in thyroid surgery: a critical appraisal. ANZ J Surg. doi: https://doi.org/10.1046/j.1445-2197.2002.02578.x. PMID: 12485227

  13. Beneragama T, Serpell JW (2006) Oct;76(10):928 – 31 Extralaryngeal bifurcation of the recurrent laryngeal nerve: a common variation. ANZ J Surg. doi: https://doi.org/10.1111/j.1445-2197.2006.03899.x. PMID: 17007624

  14. RUSTAD WH, MORRISON LF (1952) Mar;62(3):237 – 49 Revised anatomy of the recurrent laryngeal nerves. Surgical importance based on the dissection of 100 cadavers; a preliminary report. Laryngoscope. doi: https://doi.org/10.1288/00005537-195203000-00001. PMID: 14918506

  15. Ardito G, Revelli L, D’Alatri L, Lerro V, Guidi ML, Ardito F (2004) Feb;187(2):249 – 53 Revisited anatomy of the recurrent laryngeal nerves. Am J Surg. doi: 10.1016/j.amjsurg.2003.11.001. PMID: 14769313

  16. Shao T, Qiu W, Yang W Anatomical variations of the recurrent laryngeal nerve in chinese patients: a prospective study of 2,404 patients.Sci Rep. 2016 May5;6:25475. doi: https://doi.org/10.1038/srep25475. PMID: 27146369; PMCID: PMC4857116.

  17. ARMSTRONG WG, HINTON JW Multiple divisions of the recurrent laryngeal nerve. An anatomic study. AMA Arch Surg. 1951 Apr;62(4):532-9. doi: https://doi.org/10.1001/archsurg.1951.01250030540011. PMID: 14810348

  18. Saldanha M, Jayaramaiah SK, Aroor R et al (2019) Relationship of recurrent laryngeal nerve with inferior thyroid artery. Int J Otorhinolaryngol Clin 11(2):27–29

    Article  Google Scholar 

  19. Henry BM, Sanna B, Graves MJ, Sanna S, Vikse J, Tomaszewska IM, Tubbs RS, Tomaszewski KA (2017) The reliability of the Tracheoesophageal groove and the ligament of berry as Landmarks for identifying the recurrent laryngeal nerve: a cadaveric study and Meta-analysis. Biomed Res Int 2017:4357591. https://doi.org/10.1155/2017/4357591Epub 2017 Feb 8. PMID: 28271065; PMCID: PMC5320377

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Funding

No additional funding was sought for the purpose of the study.

Author information

Authors and Affiliations

  1. Dept. of ENT, Head and Neck surgery, Dr. Baba Saheb Ambedkar Medical College and Hospital, Bhagwan Mahavir Marg, Sector 6, Rohini, Delhi, India

    Pankaj Kumar, Moudipa Chatterjee & Ajay Gupta

Authors
  1. Pankaj Kumar
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Moudipa Chatterjee
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ajay Gupta
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Moudipa Chatterjee.

Ethics declarations

Conflict of Interest

There is no conflict of interest between the authors.

Ethics Approval and Consent to Participate

The current study is a retrospective cohort study. Ethical committee approval and informed consent about the study were not sought as all data analysed were collected as part of routine diagnosis and treatment. Patients were diagnosed and treated according to national guidelines and agreements. It is done for each patient without fail and as part of routine care, and in no way an add-on for the purpose of research.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kumar, P., Chatterjee, M. & Gupta, A. Variations in Recurrent Laryngeal Nerve in Thyroidectomy. Indian J Otolaryngol Head Neck Surg 75, 2856–2861 (2023). https://doi.org/10.1007/s12070-023-03859-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12070-023-03859-2

Keywords

Search

Navigation