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A functional assessment of anatomical variants of the recurrent laryngeal nerve during thyroidectomies using neuromonitoring
PURPOSE: The aim of the study was to assess the usefulness of intraoperative neuromonitoring (IONM) in identifying anatomical variants of the recurrent laryngeal nerve (RLN) during thyroidectomies, with emphasis on the nerve’s relationship to the inferior thyroid artery (ITA), Zuckerkandl’s tubercle...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer US
2017
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5765187/ https://www.ncbi.nlm.nih.gov/pubmed/29119329 http://dx.doi.org/10.1007/s12020-017-1466-3 |
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author | Wojtczak, Beata Kaliszewski, Krzysztof Sutkowski, Krzysztof Bolanowski, Marek Barczyński, Marcin |
author_facet | Wojtczak, Beata Kaliszewski, Krzysztof Sutkowski, Krzysztof Bolanowski, Marek Barczyński, Marcin |
author_sort | Wojtczak, Beata |
collection | PubMed |
description | PURPOSE: The aim of the study was to assess the usefulness of intraoperative neuromonitoring (IONM) in identifying anatomical variants of the recurrent laryngeal nerve (RLN) during thyroidectomies, with emphasis on the nerve’s relationship to the inferior thyroid artery (ITA), Zuckerkandl’s tubercle, nonrecurrent laryngeal nerves (NRLNs), and extralaryngeal bifurcation. METHODS: A total of 128 subjects undergoing surgery for thyroid disorders were enrolled in the study, and the course and anatomical variants of RLN were assessed with IONM application. RESULTS: The standard relationship between RLN and ITA was that the artery and nerve intersect (100%). The right RLN was below the ITA in 76.67% of the patients, and the left RNL was below it in 75.81%. There were no statistically significant differences in the relationship between RLN and ITA on the two sides; and gender did not significantly influence the relationship between the RLN and ITA on either side. In one patient a nonrecurrent inferior laryngeal nerve was present on the right side (0.83%). RLN bifurcation was observed in 33.33% of the patients on the right and in 19.35% on the left side; the difference between sides was statistically significant (p < 0.05). Posterior tubercle (Zuckerkandl’s tubercle) was observed on the right in 83% of the subjects and on the left in 69%. The age, thyroid volume and body mass index (BMI) did not influence the size of the tumor. CONCLUSIONS: The utilization of IONM of the RLN in thyroid surgery adds a new dimension to the standard of visual nerve identification allowing for functional nerve testing at the most vulnerable area of the dissection: at the level of Berry’s ligament, posterior tubercle (Zuckerkandl’s tubercle) and crossing of the RLN with the inferior thyroid artery. |
format | Online Article Text |
id | pubmed-5765187 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | Springer US |
record_format | MEDLINE/PubMed |
spelling | pubmed-57651872018-01-25 A functional assessment of anatomical variants of the recurrent laryngeal nerve during thyroidectomies using neuromonitoring Wojtczak, Beata Kaliszewski, Krzysztof Sutkowski, Krzysztof Bolanowski, Marek Barczyński, Marcin Endocrine Endocrine Surgery PURPOSE: The aim of the study was to assess the usefulness of intraoperative neuromonitoring (IONM) in identifying anatomical variants of the recurrent laryngeal nerve (RLN) during thyroidectomies, with emphasis on the nerve’s relationship to the inferior thyroid artery (ITA), Zuckerkandl’s tubercle, nonrecurrent laryngeal nerves (NRLNs), and extralaryngeal bifurcation. METHODS: A total of 128 subjects undergoing surgery for thyroid disorders were enrolled in the study, and the course and anatomical variants of RLN were assessed with IONM application. RESULTS: The standard relationship between RLN and ITA was that the artery and nerve intersect (100%). The right RLN was below the ITA in 76.67% of the patients, and the left RNL was below it in 75.81%. There were no statistically significant differences in the relationship between RLN and ITA on the two sides; and gender did not significantly influence the relationship between the RLN and ITA on either side. In one patient a nonrecurrent inferior laryngeal nerve was present on the right side (0.83%). RLN bifurcation was observed in 33.33% of the patients on the right and in 19.35% on the left side; the difference between sides was statistically significant (p < 0.05). Posterior tubercle (Zuckerkandl’s tubercle) was observed on the right in 83% of the subjects and on the left in 69%. The age, thyroid volume and body mass index (BMI) did not influence the size of the tumor. CONCLUSIONS: The utilization of IONM of the RLN in thyroid surgery adds a new dimension to the standard of visual nerve identification allowing for functional nerve testing at the most vulnerable area of the dissection: at the level of Berry’s ligament, posterior tubercle (Zuckerkandl’s tubercle) and crossing of the RLN with the inferior thyroid artery. Springer US 2017-11-08 2018 /pmc/articles/PMC5765187/ /pubmed/29119329 http://dx.doi.org/10.1007/s12020-017-1466-3 Text en © The Author(s) 2017 This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. |
spellingShingle | Endocrine Surgery Wojtczak, Beata Kaliszewski, Krzysztof Sutkowski, Krzysztof Bolanowski, Marek Barczyński, Marcin A functional assessment of anatomical variants of the recurrent laryngeal nerve during thyroidectomies using neuromonitoring |
title | A functional assessment of anatomical variants of the recurrent laryngeal nerve during thyroidectomies using neuromonitoring |
title_full | A functional assessment of anatomical variants of the recurrent laryngeal nerve during thyroidectomies using neuromonitoring |
title_fullStr | A functional assessment of anatomical variants of the recurrent laryngeal nerve during thyroidectomies using neuromonitoring |
title_full_unstemmed | A functional assessment of anatomical variants of the recurrent laryngeal nerve during thyroidectomies using neuromonitoring |
title_short | A functional assessment of anatomical variants of the recurrent laryngeal nerve during thyroidectomies using neuromonitoring |
title_sort | functional assessment of anatomical variants of the recurrent laryngeal nerve during thyroidectomies using neuromonitoring |
topic | Endocrine Surgery |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5765187/ https://www.ncbi.nlm.nih.gov/pubmed/29119329 http://dx.doi.org/10.1007/s12020-017-1466-3 |
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