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. 2018 Jan;59(1):82-89.
doi: 10.1007/s12020-017-1466-3. Epub 2017 Nov 8.

A functional assessment of anatomical variants of the recurrent laryngeal nerve during thyroidectomies using neuromonitoring

Beata Wojtczak  1 , Krzysztof Kaliszewski  2 , Krzysztof Sutkowski  2 , Marek Bolanowski  3 , Marcin Barczyński  4
Affiliations

A functional assessment of anatomical variants of the recurrent laryngeal nerve during thyroidectomies using neuromonitoring

Beata Wojtczak et al. Endocrine. 2018 Jan.

Abstract

Purpose: The aim of the study was to assess the usefulness of intraoperative neuromonitoring (IONM) in identifying anatomical variants of the recurrent laryngeal nerve (RLN) during thyroidectomies, with emphasis on the nerve's relationship to the inferior thyroid artery (ITA), Zuckerkandl's tubercle, nonrecurrent laryngeal nerves (NRLNs), and extralaryngeal bifurcation.

Methods: A total of 128 subjects undergoing surgery for thyroid disorders were enrolled in the study, and the course and anatomical variants of RLN were assessed with IONM application.

Results: The standard relationship between RLN and ITA was that the artery and nerve intersect (100%). The right RLN was below the ITA in 76.67% of the patients, and the left RNL was below it in 75.81%. There were no statistically significant differences in the relationship between RLN and ITA on the two sides; and gender did not significantly influence the relationship between the RLN and ITA on either side. In one patient a nonrecurrent inferior laryngeal nerve was present on the right side (0.83%). RLN bifurcation was observed in 33.33% of the patients on the right and in 19.35% on the left side; the difference between sides was statistically significant (p < 0.05). Posterior tubercle (Zuckerkandl's tubercle) was observed on the right in 83% of the subjects and on the left in 69%. The age, thyroid volume and body mass index (BMI) did not influence the size of the tumor.

Conclusions: The utilization of IONM of the RLN in thyroid surgery adds a new dimension to the standard of visual nerve identification allowing for functional nerve testing at the most vulnerable area of the dissection: at the level of Berry's ligament, posterior tubercle (Zuckerkandl's tubercle) and crossing of the RLN with the inferior thyroid artery.

Keywords: Neuromonitoring; Recurrent laryngeal nerve; Thyroid surgery.

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Conflict of interest statement

Conflict of interest

The authors declare that they have no competing interests.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Comment in

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