Injury to the recurrent laryngeal nerve is a serious complication in thyroid and parathyroid surgery. Pdf recurrent laryngeal nerve monitoring during thyroid. A case study in human anatomy dickran altounian1, cathy tran2, christina tran1, allison spencer1, alexandra shendrik3, brian p. Pdf objective injury to the recurrent laryngeal nerve rln remains a significant cause of morbidity during thyroid surgery. The identification of recurrent laryngeal nerve by. Mid this article has been rated as midimportance on the. The recurrent laryngeal nerve receives sensory innervation from the trachea, esophagus and pyriform sinus before it enters the larynx deep to the inferior constrictor muscle and posterior to the cricothyroid articulation. Surgical anatomy of recurrent laryngeal nerve during thyroid and laryngeal surgeries.
We hereby present a case where a partial recurrent laryngeal nerve. Practitioners interested in maximizing the information obtained from laryngeal imaging must be familiar with laryngeal anatomy. The right and left nerves are not symmetrical, with the left nerve looping under the aortic arch, and the right nerve looping under. The designation of recurrent is due to its anatomic location, since it is a loop of the vagus nerve, recurring inferiorly to the subclavian artery. Recurrent laryngeal nerve rln preservation is critical in both parathyroid and thyroid surgery. Partial recurrent laryngeal nerve paralysis or paresis. The vocal cord assumes a median or paramedian position. Inferior laryngeal nerve definition at, a free online dictionary with pronunciation, synonyms and translation. Eleven adult cadavers 5 male6 female were dissected bilaterally to expose the path of the recurrent laryngeal nerve. The recurrent laryngeal nerve can be a real challenge to the surgeon operating in its area. The recurrent laryngeal nerve rln is a branch of the vagus nerve cranial nerve x that supplies all the intrinsic muscles of the larynx, with the exception of the cricothyroid muscles. Its terminal branches must split in order to innervate their. A complication free outcome of the medical treatment, especially of benign diseases.
His past and recent medical history was free of viral infections, trauma, or any other medical condition. The recurrent laryngeal nerve rln is a branch of the vagus nerve cranial nerve x that supplies all the intrinsic muscles of the larynx, with the exception. A novel variation of the recurrent laryngeal nerve bmc. Recurrent laryngeal nerve an overview sciencedirect topics. Nerve the cordlike association of nerve tissues that links the. A double rln appeared in four sides, a non recurrent inferior laryngeal nerve appeared in two cases. Finding of branches of the recurrent laryngeal nerve in. The recurrent laryngeal nerve rln, also known as the inferior laryngeal nerve, is a branch of the vagus nerve cn x which has a characteristic loop around the right subclavian artery on the right and the aortic arch on the left before returning up to achieve the tracheoesophageal groove and then the larynx summary.
Natal, south africa introduction a series of neck dissections was don one 90 fresh, frozen, nonembalmed human cadavers 48 hours following death to sho,w the anatomy of th righe t and left recurrent laryngeal nerves. Recurrent laryngeal nerve rln paralysis is an unfortunate complication in thyroid surgery. The superior laryngeal nerve descends, by the side of the pharynx, behind the internal carotid artery, and divides into two branches the external laryngeal nerve and the internal laryngeal nerve the external laryngeal nerve is the smaller, external branch. The pharyngeal nerve is a branch of the maxillary division of the trigeminal nerve and contributes to the pterygopalatine ganglion gross anatomy.
In some cases, it may be quite difficult to identify the nerve localization. An unusual anomaly is the socalled nonrecurrent laryngeal nerve. The thyroid weighs about 20 g and each lateral lobe is about 4 cm long. Due to anatomical variations of the sln, careful blunt dissection of the superior.
A new type of nonrecurrent inferior laryngeal nerve in a. In endoscopic thyroidectomy, endoscopic magnified view allows us to identify the recurrent laryngeal nerve clearly. Laryngeal nerve palsy usually refers to the palsy of the recurrent largyngeal nerve. The branches provide both sensory and motor fibers. If you would like a large, unwatermarked image for your web page or. External branch of the superior laryngeal nerve monitoring. Pdf iatrogenic bilateral recurrent laryngeal nerve injury. A 50yearold woman was presented to our department with a nodule in the right thyroid lobe, and she reported no voice changes. Because of the inefficiencies of the routing the nerve takes, its often hailed as one of the most striking cases against intelligent design. The paths of the left and right recurrent laryngeal nerves vary slightly with the left recurrent laryngeal nerve dividing from the main vagus nerve at the level of the aortic arch. Laryngeal nerve, internal definition of laryngeal nerve. A nonrecurrent inferior laryngeal nerve nriln is found more frequently on the right side than on the left, and it is closely associated with an aberrant right subclavian artery. In most series the incidence is reportedto beless than 1%. Chapter 33 surgical anatomy and monitoring of the recurrent laryngeal nerve gregory w.
Selective reinnervation of the abductor and adductor muscles of. In these cases lack of information about this situation increases the risk of iatrogenic damage of the nerve. Rln imaging can determine both the location and trajectory relative to key cervical structures. Recurrent laryngeal nerve radiology reference article. The recurrent laryngeal nerves rln are branches of the vagus nerve, which classically arise in the inferior neck and innervate the intrinsic muscles of the larynx except for the cricothyroid muscle. The most common complications of anterior neck surgery are dysphagia and rln palsy.
Recurrent laryngeal nerve anastomosis following thyroid surgery. Our aim was to provide a comprehensive metaanalysis of the overall prevalence of the nrln, its origin, and its association with an aberrant subclavian artery. There are two recurrent laryngeal nerves, right and left, in the human body. Functional rehabilitation of the larynx after unilateral vocal cord paralysis was. Laryngeal nerve palsy or paralysis anatomy, physiology. However, we should know that the finding of branches of. Imaging of the recurrent laryngeal nerve springerlink. In this chapter, we present an overview of nerve imaging. Background the nonrecurrent laryngeal nerve nrln is a rare embryologicallyderived variant of the recurrent laryngeal nerve rln. The identification and dissection of the rln is the gold standard for preserving its function. The recurrent and superior laryngeal nerves pdf download. Finally, it ascends within the visceral compartment of the neck, behind the thyroid gland, between the esophagus and trachea.
The right recurrent laryngeal nerve is thus at greater risk than the left when the cloward retractor is placed in the space between the larynx and the carotid sheath and opened maximally. The nonrecurrent inferior laryngeal nerve nriln is a rare anatomic variation associated with subclavian artery abnormalities. The recurrent laryngeal nerve is a branch of the vagus nerve that supplies all the intrinsic muscles of the larynx, with the exception of the cricothyroid muscles. The nonrln nrln is a rare anatomical anomaly of the rln, with an incidence of 0. Nonrecurrent laryngeal nerve in thyroid surgery a n hisham ms, a sarojah ms, a alvin ms, nteast and endoetine surgical unit, departmentofsurgety,kualalumpurhospital, kualalumpur, malaysia introduction the nonrecuncntlaryngeal nerve nrin is a rare clinical entity. You may not embed one of our images on your web page without a link back to our site. Bilateral recurrent laryngeal nerve injury is mostly iatrogenic. We are pleased to provide you with the picture named recurrent laryngeal nerve anatomy. The recurrent laryngeal then passes below and behind the aorta, at the level of the ligamentum arteriosum. The medial margins are free to permit the opening and closing of the airway.
If you would like to participate, please visit the project page, where you can join the discussion and see a list of open tasks. Kendall the interpretation of laryngeal imaging in the evaluation of patients with voice problems requires a strong foundation in the anatomy and physiology of the larynx. The right recurrent laryngeal nerve approaches the larynx at a 25 angle relative to the sagittal plane, whereas the left approaches at a 4. The presence of an nrln significantly increases the risk of iatrogenic injury and operative complications. However, it has recently been shown that the rln can also contribute significantly to the innervation of the cricothyroid muscle. Sercarz, md functional laryngeal reinnervation depends upon theprecise reinnervation ofthe laryngeal abductor and adductor muscle groups. In such elusive locations, we aimed to identify rlns using peroperative injection of a blue dye into. Injury to the recurrent laryngeal nerve is one of the most severe complications of thyroid surgery.
Pathology involving the recurrent laryngeal nerves andor the extracranial. One of the branches of the vagus nerve, a long and important nerve that originates in the brain stem. Berke, md losangeles, california ming ye, md joel a. Randolph the accident of hemorrhage is a minor evil. Optimal management of acute recurrent laryngeal nerve injury. The superior pole of the thyroid is dissected free, and care is taken to identify and. Several anatomic variations of the nerve increase the likelihood of iatrogenic damage. Anatomy any of the cordlike bundles of fibres that conduct sensory or motor impulses between the brain or spinal cord and another.
Recurrent laryngeal nerve palsy is a major obstacle in thyroid surgery. Wallace school of osteopathic medicine, lillington, north carolina, usa. The morbidity of these complications has led to the investigation of the impact of sidedness in anterior cervical spine surgery. The pharyngeal nerve divides off the maxillary division just after emerging from the foramen rotundum to enter the pterygopalatine fossa. The recurrent laryngeal nerve rln innervates all the important laryngeal muscles except the cricothyroid. Article information, pdf download for selective reinnervation of the abductor and. The left recurrent laryngeal nerve arises from the vagus trunk, as it passes in front of the aortic arch. Careful dissection of the rln during surgery reduces the risk of damage. Ta the terminal branch of the recurrent laryngeal nerve as the latter passes deep to the inferior pharyngeal constrictor. The recurrent laryngeal nerve is responsible for both abduction opening and adduction closing of the vocal.
Accurate diagnosis can be made only by visualizing the vocal cords while the patient is awake. A new type of nonrecurrent inferior laryngeal nerve in a cadaver with a right retroesophageal subclavian artery newton bw, rodgers sa, rau jn, hong my, terreberry rr department of anatomy, campbell university jerry m. Recurrent laryngeal nerve the recurrent laryngeal nerve is a myelinated nerve. Ga this article has been rated as gaclass on the projects quality scale. The laryngeal nerve is a nerve branching down from the vagus nerve towards the larynx. The left recurrent laryngeal nerve curves medially around the aortic arch during development and is approximately 1 m long. Nonrecurrent nerve is a very rare variation of the inferior laryngeal nerve. Nonrecurrent inferior laryngeal nerves and anatomical. The muscles that are responsible for vocal cord movement are mainly innervated by. The recurrent laryngeal nerve is a branch of cranial nerve x, otherwise known as the vagus nerve. This article highlights the normal anatomy, anatomical variants and ways to identify the nerve as the. Pdf surgical anatomy of recurrent laryngeal nerve during.
The anatomy of the recurrent laryngeal nerve is variable. Recurrent laryngeal nerve injury causes and surgery. The nonrecurrent laryngeal nerve a rare phenomenon. We hope this picture recurrent laryngeal nerve anatomy can help you study and research. Recurrent laryngeal nerve injury produces an abductor laryngeal paralysis. Instant anatomy is a specialised web site for you to learn all about human anatomy of the body with diagrams, podcasts and revision questions. The aim was to study the anatomic relationship between recurrent laryngeal nerve rln and cervical fascia combined with the requirements in anterior cervical spine surgery acss summary of background data. Surgical anatomy and monitoring of the recurrent laryngeal.
She had no history of surgery or radiation to the head or neck. Wedel1, 3 1 college of osteopathic medicine of the pacific, western university of health sciences, pomona, ca usa. Contrary to routine dissection of the rln, most surgeons tend to avoid rather than routinely expose and identify the external branch of the superior laryngeal nerve ebsln during thyroidectomy or parathyroidectomy. Anatomic relationship between right recurrent laryngeal. Originates lateral to cornu of hyoid bone, pierces thyrohyoid membrane, travels under mucosa in pyriform recess sensory innervation. Medicolegal implications of surgical errors and complications in. It can occur secondary to the surgical technique or becau. Extralaryngeal branching of the recurrent laryngeal nerve. Clinically relevant anatomy of recurrent laryngeal nerve. The presence of the aberrant right subclavian artery on preoperative computed tomography ct scan suggests nriln. There are two recurrent laryngeal nerves right and left in the human body both arising from the vagus.
Anatomy of larynx free download as powerpoint presentation. Effect of recurrent laryngeal nerve identification. One promising way to ensure the integrity of the recurrent laryngeal nerve is to identify the nerve always. Anatomy of recurrent laryngeal nerveanatomy of recurrent. After the recurrent laryngeal nerve leaves the vagus nerve, it goes down into the chest and then loops back up, to supply nerves to the larynx the voice box. This means that the descending portion of the featured nerve belongs to the vagus, and the. The benefits and advantages of each procedure as well as relevant anatomy and techniques are delineated. Instant anatomy head and neck nerves cranial x vagus. Less frequently superior laryngeal nerve sln lesions are observed. A variant nerve that mimics the left recurrent laryngeal. It descends on the larynx, beneath the sternothyroid muscle, to supply the cricothyroid muscle. Thyroidectomy creates a potential risk for all parathyroid glands and the recurrent laryngeal nerve rln. A branch of the vagus nerve curving upward, on the right side around the root of the subclavian artery, on the left side around the arch of the aorta, then passing superiorly, posterior to the common carotid artery between the trachea and the esophagus to the larynx. Treatment of recurrent laryngeal nerve injury jama.
All right side normal muscles did not reveal any kind of denervation. Laryngeal nerve, recurrent article about laryngeal nerve. Virtually all members of the animal kingdom have at least a rudimentary nervous system. This facilitates exposure of the recurrent laryngeal nerve and the parathyroid.
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