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Kastan OZ, Ozturk S, Calguner E, Agırdır BV, Sindel M. Relationship of Recurrent Laryngeal Nerve with Inferior Horn of Thyroid Cartilage, Berry's Ligament and Zuckerkandl's Tubercle. Indian J Otolaryngol Head Neck Surg 2022; 74:2065-2070. [PMID: 36452808 PMCID: PMC9702094 DOI: 10.1007/s12070-020-02018-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 07/27/2020] [Indexed: 10/23/2022] Open
Abstract
During neck surgery; Zuckerkandl's tubercle, Berry's ligament, the inferior horn of thyroid cartilages have become crucial anatomical landmarks in order to protect the integrity of the recurrent laryngeal nerve. Forty-two male postmortem human cadavers were used. The proximal part of the recurrent laryngeal nerve, before the inferior thyroid artery arises from its source has been observed in 87% inside the tracheoesophageal groove and in 13% running laterally to the trachea. The recurrent laryngeal nerve was encountered passing behind and through the branches of the inferior thyroid artery in 92% and 8% respectively. At all sides; the nerve was piercing the larynx 0.6 ± 0.1 mm below the inferior horn of thyroid cartilage, passing next to the inner-lower side of Berry's ligament and running under the lower middle part of Zuckerkandl's tubercle. These landmarks and their upper mentioned distances to the laryngeal nerve can be taken into consideration as important surgical guides.
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Affiliation(s)
- Ozlem Zumre Kastan
- Vocational School of Health Services, Akdeniz University, Antalya, Turkey
| | - Serra Ozturk
- Department of Anatomy, Faculty of Medicine, Akdeniz University, Dumlupınar Boulevard & Campus, Antalya, 07058 Turkey
| | - Engin Calguner
- Department of Anatomy, Faculty of Medicine, University of Kyrenia, Kyrenia, Turkish Republic of Northern Cyprus
| | - Bulent Veli Agırdır
- Department of Otorhinolaryngology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Muzaffer Sindel
- Department of Anatomy, Faculty of Medicine, Akdeniz University, Dumlupınar Boulevard & Campus, Antalya, 07058 Turkey
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Lu KN, Ding JW, Zhang Y, Shi JJ, Zhou L, Peng Y, Shen J, Lu S, Sun SH, Ni YQ, Cui HR, Luo DC. The Anatomical and Clinical Significance of the Superior Laryngeal Nerve. Otolaryngol Head Neck Surg 2021; 165:690-695. [PMID: 33618572 DOI: 10.1177/0194599821989622] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This study summarizes the anatomical features of the superior laryngeal nerve in Chinese to enable the rapid location of the superior laryngeal nerve during an operation. STUDY DESIGN Retrospective analysis of anatomical data. SETTING Hangzhou First People's Hospital Affiliated to Nanjing Medical University. METHODS A total of 71 embalmed human cadavers (132 heminecks) were examined over 3 months. The length and diameter of the internal and external branches of the superior laryngeal nerve and their relationships with different landmarks were recorded. RESULTS The total length of the internal branch of the superior laryngeal nerve was 23.4 ± 6.9 mm. The length of the external branch of the superior laryngeal nerve was 47.7 ± 11.0 mm. Considering the midpoint of the lower edge of the thyroid cartilage as the starting point and using that edge as a horizontal line, when the entry point is above that line, the external branch of the superior laryngeal nerve can be found within 41.1 mm and at an angle of 57.2°. When the entry point is below the lower edge of the thyroid cartilage, the external branch of the superior laryngeal nerve can be found within 34.0 mm and at an angle of 36.5°. CONCLUSION The superior laryngeal nerve in Chinese people has distinct anatomical characteristics. This article provides a new method of quickly locating the external branch of the superior laryngeal nerve during the operation, which can reduce the probability of damaging the external branch of the superior laryngeal nerve.
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Affiliation(s)
- Kai-Ning Lu
- Hangzhou Hospital Affiliated to Nanjing Medical University (Hangzhou First People's Hospital), Hangzhou, Zhejiang, China
| | - Jin-Wang Ding
- Head and Neck Surgery, Cancer Hospital of the University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Key Laboratory of Head & Neck Cancer Translational Research of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Yu Zhang
- Department of Oncological Surgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Jing-Jing Shi
- Department of Oncological Surgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Li Zhou
- Department of Oncological Surgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - You Peng
- Department of Oncological Surgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Jie Shen
- Department of Oncological Surgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Si Lu
- Institute of Translational Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Si-Han Sun
- Hangzhou Hospital Affiliated to Nanjing Medical University (Hangzhou First People's Hospital), Hangzhou, Zhejiang, China
| | - Ye-Qin Ni
- Zhejiang Chinese Medical University, The Fourth Clinical College, Hangzhou, Zhejiang, China
| | - Huai-Rui Cui
- Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Ding-Cun Luo
- Hangzhou Hospital Affiliated to Nanjing Medical University (Hangzhou First People's Hospital), Hangzhou, Zhejiang, China
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Surgical anatomy of the external branch of the superior laryngeal nerve: a systematic review and meta-analysis. Langenbecks Arch Surg 2018; 403:811-823. [PMID: 30430230 DOI: 10.1007/s00423-018-1723-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Accepted: 10/22/2018] [Indexed: 01/12/2023]
Abstract
PURPOSE To provide a comprehensive evidence-based assessment of the anatomical characteristics of the external branch of the superior laryngeal nerve (EBSLN). MATERIALS AND METHODS A thorough systematic search was performed on the major electronic databases PubMed, EMBASE, Cochrane library, and ScienceDirect to identify eligible studies. Data were extracted and pooled into a meta-analysis. The primary outcomes were the EBSLN identification rate (total number of EBSLN identified divided by the total number of dissected hemilarynges) and the prevalence of various EBSLN types. RESULTS A total of 56 studies (n = 13,444 hemilarynges) were included. The overall pooled EBSLN identification rate was 89.24% (95% CI 85.49-92.49). This rate was higher for cadaveric (95.00%; 95% CI 89.73-99.35) compared to that reported in intraoperative studies (86.99%; 95% CI 82.37-91.01). Significantly higher identification rates were reported for studies in which intraoperative nerve monitoring was used (95.90%; 95% CI 94.30-97.25) compared to those which only relied on direct visual identification of the EBSLN (76.56%; 95% CI 69.34-83.08). Overall, Cernea type IIa (nerves crossing the superior thyroid artery less than 1 cm above the upper edge of the superior thyroid pole) and Friedman type 1 (nerves running their entire course superficial to the inferior pharyngeal constrictor) were the most prevalent (41.84%; 95% CI 33.28-48.08 and 50%; 95% CI 29.90-65.62, respectively). The combined prevalence of Cernea IIa and IIb (nerves crossing the superior thyroid artery below the upper edge of the superior thyroid pole) was higher in intraoperative studies compared to that in cadaveric studies (64.3% vs 49.4%). The EBSLN coursed medial to the superior thyroid artery in 70.98% (95% CI 55.14-84.68) of all cases. CONCLUSION The use of intraoperative nerve monitoring improves EBSLN identification rates. In light of the highly variable anatomical patterns displayed by the EBSLN, thorough pre-operative knowledge of its anatomy can be crucial in minimizing incidences of its iatrogenic injury.
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Ortega C, Maranillo E, McHanwell S, Sañudo J, Vázquez-Osorio T. External laryngeal nerve landmarks revisited. Head Neck 2018; 40:1926-1933. [DOI: 10.1002/hed.25186] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 01/18/2018] [Accepted: 02/20/2018] [Indexed: 11/11/2022] Open
Affiliation(s)
- Consuelo Ortega
- Otorhinolaryngology Service; Infanta Sofía University Hospital; Madrid Spain
| | - Eva Maranillo
- Human Anatomy and Embryology Department, School of Medicine; Complutense University of Madrid; Madrid Spain
| | - Steve McHanwell
- School of Medical Education and School of Dental Sciences, Faculty of Medical Sciences; Newcastle University; United Kingdom
| | - Jose Sañudo
- Human Anatomy and Embryology Department, School of Medicine; Complutense University of Madrid; Madrid Spain
| | - Teresa Vázquez-Osorio
- Human Anatomy and Embryology Department, School of Medicine; Complutense University of Madrid; Madrid Spain
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Henry BM, Vikse J, Graves MJ, Sanna S, Sanna B, Tomaszewska IM, Hsieh WC, Tubbs RS, Tomaszewski KA. Variable relationship of the recurrent laryngeal nerve to the inferior thyroid artery: A meta-analysis and surgical implications. Head Neck 2016; 39:177-186. [DOI: 10.1002/hed.24582] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 07/20/2016] [Accepted: 08/02/2016] [Indexed: 11/09/2022] Open
Affiliation(s)
- Brandon Michael Henry
- International Evidence-Based Anatomy Working Group; Krakow Poland
- Department of Anatomy; Jagiellonian University Medical College; Krakow Poland
| | - Jens Vikse
- International Evidence-Based Anatomy Working Group; Krakow Poland
- Department of Anatomy; Jagiellonian University Medical College; Krakow Poland
| | - Matthew J. Graves
- International Evidence-Based Anatomy Working Group; Krakow Poland
- Department of Anatomy; Jagiellonian University Medical College; Krakow Poland
| | - Silvia Sanna
- Department of Surgical Sciences; University of Cagliari; Sardinia Italy
| | - Beatrice Sanna
- Faculty of Medicine and Surgery; University of Cagliari; Sardinia Italy
| | - Iwona M. Tomaszewska
- Department of Medical Education; Jagiellonian University Medical College; Krakow Poland
| | - Wan Chin Hsieh
- International Evidence-Based Anatomy Working Group; Krakow Poland
- First Faculty of Medicine; Charles University; Prague Czech Republic
| | | | - Krzysztof A. Tomaszewski
- International Evidence-Based Anatomy Working Group; Krakow Poland
- Department of Anatomy; Jagiellonian University Medical College; Krakow Poland
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Ling XY, Smoll NR. A systematic review of variations of the recurrent laryngeal nerve. Clin Anat 2015; 29:104-10. [PMID: 26297484 DOI: 10.1002/ca.22613] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 08/06/2015] [Accepted: 08/14/2015] [Indexed: 11/11/2022]
Abstract
With thyroid cancer fast becoming one of the most common endocrine cancers, the frequency of thyroid surgery has increased. A common and debilitating concern with thyroid surgery is recurrent laryngeal nerve (RLN) paralysis leading to glottal obstruction and airway compromise. A systematic review regarding the anatomical variation of the recurrent laryngeal nerve was performed to determine the position of anatomical variants of the RLN in relation to the inferior thyroid artery (ITA) as well as the prevalence of nonrecurrent laryngeal nerve (NRLN). MEDLINE, Web of Science, MEDITEXT, AMED, CINAHL, Cochrane, ProQuest, Pubmed, and ScienceDirect. Databases were searched using the search terms "inferior thyroid artery," "recurrent laryngeal nerve," "nonrecurrent laryngeal nerve," and "anatomical variation." The reference sections of the articles found were searched for additional reports. The references of all articles were searched to find articles missed in the database search. A total of 8,655 RLN sides were included in this study. One thousand eight hundred and thirteen (20.95%; 95% confidence interval (CI) 20.09, 2,182) showed a Type A configuration of RLN in relation to the ITA, 2,432 (28.10%; 95% CI 27.15, 29.06) showed a Type B configuration and 4,410 (50.95%; 95% CI 49.89, 52.01) showed a Type C configuration between the RLN and the ITA. The second search returned with 38,568 recurrent laryngeal sides and only 221 (0.57%; 95%CI 0.5, 0.65) NRLN documented. The RLN is most commonly found in the posterior position, relative to the ITA. The incidence of the NRLN is low, only occurring in 0.57% of people.
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Anagnostopoulou S, Mavridis I. Emerging patterns of the human superior thyroid artery and review of its clinical anatomy. Surg Radiol Anat 2013; 36:33-8. [DOI: 10.1007/s00276-013-1149-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Accepted: 06/07/2013] [Indexed: 11/29/2022]
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Asgharpour E, Maranillo E, Sañudo J, Pascual-Font A, Rodriguez-Niedenführ M, Valderrama FJ, Viejo F, Parkin IG, Vázquez T. Recurrent laryngeal nerve landmarks revisited. Head Neck 2011; 34:1240-6. [PMID: 22076749 DOI: 10.1002/hed.21882] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2011] [Revised: 05/18/2011] [Accepted: 06/27/2011] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The aim of this work was to evaluate, to prove their reliability, the different surgical landmarks previously proposed as a mean to locate the recurrent laryngeal nerve (RLN). METHODS The necks of 143 (68 male and 76 female) human adult embalmed cadavers were examined. RLN origin and length and its relationship to different landmarks were recorded and results compared with those previously reported. Statistical comparisons were performed using the chi-square test (significance, p ≤ .05). RESULTS Mostly, RLN is located anterior to the tracheoesophageal sulcus (41.6%), posterior to the inferior thyroid artery (35.8%), lateral to Berry's ligament (88.1%), below the inferior rim of the inferior constrictor muscle (90.4%), and entering the larynx before its terminal division (54.6%). CONCLUSIONS The position of the RLN in relation to those structures classically considered as landmarks is highly variable. The most reliable relationships are those with Berry's ligament or the inferior constrictor muscle.
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Affiliation(s)
- Elham Asgharpour
- Department of Human Anatomy and Embriology I, Faculty of Medicine, Complutense University of Madrid, Madrid, Spain
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Kiray A, Naderi S, Ergur I, Korman E. Surgical anatomy of the internal branch of the superior laryngeal nerve. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2006; 15:1320-5. [PMID: 16402208 PMCID: PMC2438561 DOI: 10.1007/s00586-005-0006-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2004] [Revised: 06/04/2005] [Accepted: 10/06/2005] [Indexed: 11/25/2022]
Abstract
The internal branch of the superior laryngeal nerve (ibSLN) may be injured during anterior approaches to the cervical spine, resulting in loss of laryngeal cough reflex, and, in turn, the risk of aspiration pneumonia. Such a risk dictates the knowledge regarding anatomical details of this nerve. In this study, 24 ibSLN of 12 formaldehyde fixed adult male cadavers were used. Linear and angular parameters were measured using a Vernier caliper, with a sensitivity of 0.1 mm, and a 1 degrees goniometer. The diameter and the length of the ibSLN were measured as 2.1+/-0.2 mm and 57.2+/-7.7 mm, respectively. The ibSLN originates from the vagus nerve at the C1 level in 5 cases (20.83%), at the C2 level in 14 cases (58.34%), and at the C2-3 intervertebral disc level in 5 cases (20.83%) of the specimens. The distance between the origin of ibSLN and the bifurcation of carotid artery was 35.2+/-12.9 mm. The distance between the ibSLN and midline was 24.2+/-3.3 mm, 20.2+/-3.6 mm, and 15.9+/-4.3 mm at the level of C2-3, C3-4, and at the C4-5 intervertebral disc level, respectively. The angles of ibSLN were mean 19.6+/-2.6 degrees medially with sagittal plane, and 23.6+/-2.6 degrees anteriorly with coronal plane. At the area between the thyroid cartilage and the hyoid bone the ibSLN is the only nerve which traverses lateral to medial. It is accompanied by the superior laryngeal artery, a branch of the superior thyroid artery. The ibSLN is under the risk of injury as a result of cutting or compression of the blades of the retractor at this level. The morphometric data regarding the ibSLN, information regarding the distances between the nerve, and the other consistent structures may help us identify this nerve, and to avoid the nerve injury.
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Affiliation(s)
- Amac Kiray
- Dokuz Eylul University, School of Medicine, Department of Anatomy, Izmir, Turkey.
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