Does Extralaryngeal Branching Have An Impact on the Rate of Postoperative Transient or Permanent Recurrent Laryngeal Nerve Palsy?
- 21 November 2008
- journal article
- research article
- Published by Wiley in World Journal of Surgery
- Vol. 33 (2), 261-265
- https://doi.org/10.1007/s00268-008-9832-1
Abstract
Background This prospective study assessed the prevalence of the extralaryngeal branching of the recurrent laryngeal nerve (RLN) and its impact on the incidence of postoperative transient or permanent RLN palsy. Methods Total or hemithyroidectomy was performed in 115 patients, with a total of 195 RLNs displayed. The RLN extralaryngeal branches were routinely identified and preserved. The postoperative course of each patient was evaluated. Outcomes of patients with and without branching RLN were compared. Results In all, 36 of 195 (18.5%) nerves showed extralaryngeal branching: 27 cases (25.5%) on the right and 9 on the left side (10.1%; p = 0.0088).Trifurcation of the RLN was identified in two dissections (1%). Bilateral bifurcations were observed in 3 of 80 (3.7%) patients. We reported four (2.1%) unilateral permanent RLN palsies, eight cases of unilateral transient nerve palsy (4.1%), and one bilateral transient RLN injury (0.6%). The comparative analysis of postoperative outcomes between branched and nonbranched RLNs revealed that the anatomical variation was more frequently associated both with unilateral permanent RLN palsy (relative risk, 13.25; 95% confidence interval, 1.42–123.73; p = 0.0204) and unilateral transient RLN palsy (relative risk, 7.36; 95% confidence interval, 1.84–29.4; p = 0.0061). The only case of bilateral transient RLN injury was associated with a nonrecurrent inferior laryngeal nerve. Conclusions Branched RLNs represent a risk factor both for transient and permanent nerve palsy after surgery. Awareness of this anatomical variation and its routine investigation are essential during thyroid surgery to limit its relevant impact on postoperative RLN injury rate.Keywords
This publication has 29 references indexed in Scilit:
- NERVE STIMULATION IN THYROID SURGERY: IS IT REALLY USEFUL?Anz Journal of Surgery, 2007
- The role of intraoperative neuromonitoring of recurrent laryngeal nerve during thyroidectomy: A comparative study on 1000 nerves at riskSurgery, 2006
- EXTRALARYNGEAL BIFURCATION OF THE RECURRENT LARYNGEAL NERVE: A COMMON VARIATIONAnz Journal of Surgery, 2006
- Intraoperative neurophysiology testing of the recurrent laryngeal nerve: Plaudits and pitfallsSurgery, 2005
- Should Total Thyroidectomy Become the Preferred Procedure for Surgical Management of Graves' Disease?Thyroid®, 2005
- Recurrent laryngeal nerve palsy after thyroidectomy with routine identification of the recurrent laryngeal nerveSurgery, 2005
- Revisited anatomy of the recurrent laryngeal nervesThe American Journal of Surgery, 2004
- Incidence and Importance of the Tubercle of Zuckerkandl in Thyroid SurgeryThe European Journal of Surgery, 2001
- Zuckerkandl Tubercle of the Thyroid Gland: The Nearly Forgotten Anatomical LandmarkAsian Journal of Surgery, 2000
- A reappraisal of the surgical anatomy of the thyroid and parathyroid glandsBritish Journal of Surgery, 1968