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EXTRALARYNGEAL BIFURCATION OF THE RECURRENT LARYNGEAL NERVE: A COMMON VARIATION
Author(s) -
Beneragama Tilan,
Serpell Jonathan W.
Publication year - 2006
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/j.1445-2197.2006.03899.x
Subject(s) - medicine , recurrent laryngeal nerve , thyroidectomy , surgery , larynx , vocal cord paralysis , parathyroidectomy , paralysis , superior laryngeal nerve , recurrent nerve , thyroid , parathyroid hormone , calcium
Extralaryngeal bifurcation and trifurcation of the recurrent laryngeal nerve (RLN) is not well described in anatomical texts. This significant anatomical variation is important because prevention of vocal cord paralysis requires preservation of all branches of the RLN. The aim of this study was to examine the prevalence of extralaryngeal bifurcation of the RLN seen during thyroid/parathyroid surgeries. All patients undergoing total thyroidectomy, hemithyroidectomy and parathyroidectomy (excluding all minimally invasive procedures) carried out by a single endocrine surgeon from November 2003 to December 2004 were included. Operative data obtained prospectively included the location of the nerve, number of branches and the distance in millimetres from the inferior border of the cricothyroid to the point of bifurcation. A total of 213 (right = 114, left = 99) RLN in 137 patients were studied. Seventy‐seven (36%) nerves bifurcated or trifurcated before entry into the larynx. Bifurcations were more common on the right (43%) than on the left (28%) ( P = 0.05). Trifurcations were seen in eight nerves, seven on the right and one on the left ( P = 0.05). Bilaterally branched RLN were observed in 14 (18%) of 77 patients undergoing a bilateral procedure. One non‐RLN was identified on the right. The median distance from the cricothyroid to the point of division was 18 mm on the right and 13 mm on the left. Extralaryngeal division of the RLN is a common anatomical variant occurring more frequently on the right. Unseen branches of the RLN are at risk of injury during surgery. Therefore, great care is required following presumed identification of the RLN to ensure that there are no other unidentified branches.