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Anatomical considerations of the recurrent laryngeal nerve and it´s vulnerability during surgical procedures of the neck
EANS Academy. Fahim D. Sep 27, 2019; 276088; EP11011
Dr. Daniel Fahim
Dr. Daniel Fahim

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Abstract
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Introduction: Accurate knowledge of anatomical variability of the recurrent laryngeal nerve (RLN) provides information for preventing iatrogenic injury, improving patient safety, optimizing clinical outcomes, and ultimately guiding best clinical and surgical practices. The present study aims to assess the potential anatomical variations of the RLN pertaining to its course, branching pattern, and relationship to the inferior thyroid artery, which potentially makes it vulnerable to injury, compression, or stretch during surgery of the neck. Variations of the RLN will be investigated together with side preference considerations.
Methods: The study was done on 55 formalin-fixed cadavers used for dissection at Oakland University William Beaumont School of Medicine between 2016-2018. Following careful dissection and critical observation, cadavers with anatomical variations were photographed and the data was analyzed quantitatively and in a descriptive way.
Results: Our findings indicate that extralaryngeal branches coming off of the RLN on both the right and left side innervate the esophagus, trachea, and intrinsic laryngeal muscles. On the right side, 89.1% of the cadavers demonstrated 2-5 extralaryngeal branches. On the left side, 74.6% of the cadavers demonstrated 2-3 extralaryngeal branches. In relation to the inferior thyroid artery, 67.9% of right RLN's were related anteriorly, while 32.1% were related posteriorly. On the other hand, 32.1% of left RLN's were anterior to the inferior thyroid artery, while 67.9% were posterior. On both sides 3-5% of RLN's crossed between branches of inferior thyroid artery. These findings demonstrate a significant amount of variations in the course and branching pattern of the RLN.
Conclusion: Anatomical consideration of these variations is essential to minimize complications associated with surgical procedures of the neck, especially anterior cervical spine surgery and thyroidectomies. The information gained in this study emphasizes the need for special considerations during surgical procedures, and side preferences in preserving the extralaryngeal branches of the RLN.
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