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Normal anatomy, variants and factors associated with the cervical vagus nerve topography: a high-resolution ultrasound study

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Abstract

Purpose

To describe the cervical vagus nerve (CVN) topography at the thyroid lobe (TL) level using high-resolution ultrasound and to investigate the possible association with anthropometric data, TL size, and thyroid disease.

Methods

We prospectively examined 550 CVNs in 275 (205 female, 70 male) individuals with normal thyroid (53/275, 19.3%), multinodular disease (167/275, 60.7%), and Hashimoto thyroiditis (55/275, 20%). The CVN location relative to the common carotid artery was recorded as typical (lateral position) and atypical (anterior, medial, and posterior position). The shortest distance between CVN and TL margin, the TL dimensions, and volume were measured.

Results

Normal thyroid subjects had lateral-positioned right CVNs in 100% and lateral/anterior/medial left CVNs in 81.1%, 15.1%, and 3.8%, respectively. CVN types did not differ significantly bilaterally between study groups. Asymmetry in CVN topography in all subjects was found in 22.2%, of which anterior CVN was the most common atypical position (64%), especially on the left side (82%). Significant gender, age, body mass, and BMI differences among CVN types were observed on the left side only. Among CVN types, no difference in TL dimensions, volume, and CVN-TL distance was found in all study groups. A weak negative correlation was recorded between CVN-thyroid distance and TL volume only on the left side (r = − 0.147, p = 0.01).

Conclusion

Asymmetry in CVN topography is mainly due to the increased incidence of the anterior location of CVN on the left side. Age and anthropometric parameters are different on the left side possibly due to the increased prevalence of left CVN variants.

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Funding

No funding was received for conducting this study.

Author information

Authors and Affiliations

  1. Diagnostic and Interventional Ultrasound Practice, Crete, Heraklion, Greece

    Eleni Drakonaki

  2. Biostatistics Laboratory, Department of Social Medicine, School of Medicine, University of Crete, Crete, Heraklion, Greece

    Gregory Clouverakis

  3. Department of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece

    Maria Piagkou

  4. Department of Anatomy, School of Medicine, University of Crete, Heraklion, Crete, Greece

    Eleni Drakonaki, Ioannis Koliarakis & John Tsiaoussis

  5. Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA

    Phaedon D. Zavras

  6. Department of Endocrinology, Venizeleion General Hospital, Heraklion, Greece

    Irini Vourliotaki

  7. Department of Anatomy and Surgical Anatomy, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloníki, Greece

    Konstantinos Natsis

Authors
  1. Eleni Drakonaki
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  2. Gregory Clouverakis
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  3. Maria Piagkou
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  4. Ioannis Koliarakis
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  5. Phaedon D. Zavras
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  7. Konstantinos Natsis
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  8. John Tsiaoussis
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Contributions

ED: Study conception and design, Data Collection, Original draft writing. GC: Data statistical analysis, Manuscript editing. ΜP: Manuscript review and editing. IK: References management, manuscript review. PZ: Literature search, manuscript review. IV: Patient and data collection, manuscript review. KN: Manuscript review and editing. JT: Project development, Manuscript review and editing, Supervision. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Eleni Drakonaki.

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Conflict of interest

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Ethical approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Review Board and Ethics Committee of Venizeleion General Hospital, Heraklion Greece (approval number 14/30-9-20).

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Written informed consent was provided by all participants.

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Written informed consent was provided by all participants.

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Drakonaki, E., Clouverakis, G., Piagkou, M. et al. Normal anatomy, variants and factors associated with the cervical vagus nerve topography: a high-resolution ultrasound study. Surg Radiol Anat 43, 1753–1764 (2021). https://doi.org/10.1007/s00276-021-02832-4

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  • DOI: https://doi.org/10.1007/s00276-021-02832-4

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