%0 Journal Article
%T A Closer Look at Laryngeal Nerves during Thyroid Surgery: A Descriptive Study of 584 Nerves
%A P. V. Pradeep
%A B. Jayashree
%A Skandha S. Harshita
%J Anatomy Research International
%D 2012
%I Hindawi Publishing Corporation
%R 10.1155/2012/490390
%X Morbidity after thyroidectomy is related to injuries to the parathyroids, recurrent laryngeal (RLN) and external branch of superior laryngeal nerves (EBSLN). Mostly these are due to variations in the surgical anatomy. In this study we analyse the surgical anatomy of the laryngeal nerves in Indian patients undergoing thyroidectomy. Materials and Methods. Retrospective study (February 2008 to February 2010). Patients undergoing surgery for benign goitres, T1, T2 thyroid cancers without lymph node involvement were included. Data on EBSLN types, RLN course and its relation to the TZ & LOB were recorded. Results. 404 thyroid surgeries (180 total & 224 hemithyroidectomy) were performed. Data related to 584 EBSLN and RLN were included (324 right sided & 260 left sided). EBSLN patterns were Type 1 in 71.4%, Type IIA in 12.3%, and Type IIB in 7.36%. The nerve was not seen in 4.3% cases. RLN had one branch in 69.34%, two branches in 29.11% and three branches in 1.36%. 25% of the RLN was superficial to the inferior thyroid artery, 65% deep to it and 8.2% between the branches. TZ was Grade 1 in 65.2%, Grade II in 25.1% and Grade III in 9.5%. 31.16% of the RLN passes through the LOB. Conclusions. A thorough knowledge of the laryngeal nerves and anatomical variations is necessary for safe thyroid surgery. 1. Introduction Thyroid surgery was associated with high mortality rates in the early nineteenth century. The high mortality (20%) was attributed to the lack of meticulous dissection techniques and asepsis [1]. So much so, in the year 1850 the French Academy of Medicine banned thyroid surgery [2]. With the advent of antiseptic techniques and antibiotics the mortality due to sepsis has disappeared. So also, the refinement in surgical techniques, recognition of the presence of parathyroids, RLN, and need to protect the EBSLN resulted in lesser morbidity. Through understanding of the surgical anatomy has been crucial in decreasing the morbidity. Mostly the morbidity is due to technical failure to identify the vital structures and the variations in the surgical anatomy when the gland is pathologically enlarged. Several studies have been published revealing the anatomy of the laryngeal nerves as seen during thyroid surgery [1, 3¨C5]. Exposure of EBSLN and individual ligation of superior thyroid artery branches in the medial thyroid space was initially stressed to avoid injury to it [1, 6, 7]. Based on the course of the EBSLN; classifications were also put forward by Cernea et al. and Friedman et al. [4, 8]. EBSLN has several branches to pharynx and thyroid gland apart
%U http://www.hindawi.com/journals/ari/2012/490390/