A Cadaveric Study of Occurrence of Extralaryngeal Branches of the Recurrent Laryngeal Nerve with Reference to its Importance in Thyroid Surgery

Recurrent Laryngeal Nerve Palsy (RLNP) is the most common complication of thyroid surgery. Patients complain of hoarseness of voice and sometimes variable amount of respiratory distress due to palsy of recurrent laryngeal nerve (RLN), extra laryngeal branches of which are often ligated along with Inferior Thyroid Artery (ITA) during thyroidectomy. So prevalence and variable pattern of extra laryngeal nerve branches (ELNB) of RLN should be known to the thyroid surgeon to avoid post operative complications. Materials and Methods Dissection was carried on the neck of properly embalmed 25 adult cadavers including both sexes in the dissection hall to study extra laryngeal nerve branches (ELNB) of 50 RLN specimens. Results Out of 50 RLN, 13 nerves (26%) have ELNBs. Only in 4 cadavers (16%) they are bilateral. In 9 cases RLN branches were surrounding either single trunk of ITA or branches of the artery. In rest of the 4 cases ELNBs were passing entirely either in front or behind the ITA Conclusion The gold standard for preservation of the RLN during thyroid surgery is still visual anatomical identification. Proper dissection and anatomical identification of the RLN and all its branches is very important prior to the clamping of the ITA and all its branches.