scholarly journals Two Cases of Enlarged Zuckerkandl's Tubercle of the Thyroid Displacing the Recurrent Laryngeal Nerve Laterally

2011 ◽  
Vol 2011 ◽  
pp. 1-3 ◽  
Author(s):  
Emin Gurleyik
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Thyroid Tissue ◽  
Close Relation ◽  
Lateral Approach ◽  
Laryngeal Nerve ◽  
Follicular Neoplasm ◽  
Posterior Extension ◽  
Grade 3 ◽  
Recurrent Laryngeal Nerves ◽  
Anatomic Feature

The thyroid has many anatomic variations. Zuckerkandl's tubercle (ZT) is the posterior extension of lateral lobes. ZT has a relation with the recurrent laryngeal nerve (RLN). RLN lateral to ZT is an uncommon occurrence. This paper presents two cases of this uncommon situation. A 60-year-old female patient with large multinodular goiter was treated with total thyroidectomy. A 69-year-old male patient with follicular neoplasm was treated with total lobectomy. The inferior thyroid arteries and the recurrent laryngeal nerves were identified with usual lateral approach. A left ZT was found in case 1 and a right ZT in case 2. Distal parts of the RLNs were displaced laterally by enlarged ZTs in both cases. Grade 3 ZTs composed of thyroid tissue were placed between the trachea and the RLNs. The ZT is a common anatomic feature of the thyroid. Close relation of the tubercle with the RLN is an important surgical entity. The enlarged ZT seldom pushes the nerve laterally. The knowledge of the anatomy of ZT and its relation with the RLN including all variations is mandatory for safe thyroid operations.

scholarly journals Identifying Recurrent Laryngeal Nerve in Thyroid Surgery Using Relationship with Superior Parathyroid Gland and Tubercle of Zuckerkandl

2015 ◽  
Vol 23 (3) ◽  
pp. 99-103
Author(s):  
Somesh Mozumder ◽  
Shirish Dubey ◽  
Aniruddha Dam ◽  
Anup Kumar Bhowmick
Keyword(s):  
Prospective Study ◽  
Recurrent Laryngeal Nerve ◽  
Parathyroid Gland ◽  
Thyroid Surgery ◽  
Intimate Relationship ◽  
Laryngeal Nerve ◽  
Laryngeal Nerves ◽  
Recurrent Laryngeal Nerves ◽  
A Prospective Study ◽  
Relationship Of

Introduction: Recurrent laryngeal nerves (RLN) are particularly prone to injury during thyroid surgeries due to its intimate relationship and proximity with the gland. Zuckerkandl’s tubercle (ZT) helps in preserving RLN intra operative. Material and Methods: A prospective study for identifying RLN in thyroid surgery using relationship with superior parathyroid gland and tubercle of Zuckerkandl was conducted on 50 thyroidectomy patients between August 2013 and February 2014. Results: In all cases ZT was identified. Temporary paralysis of RLN was seen in 3 (6%) cases and permanent paralysis in 2 (4%) of cases. Discussion: The site of greatest risk during thyroidectomy to the RLN is in the last 2-3 cm extralaryngeal course of the nerve. Relationship of recurrent laryngeal nerve with superior parathyroid gland and tubercle of Zukerkandl (ZT) is known. Conclusion: Use of ZT and superior parathyroids as a landmark allows safe dissection of RLN.

scholarly journals Involvement of hypoglossal and recurrent laryngeal nerves on swallowing pressure

2018 ◽  
Vol 124 (5) ◽  
pp. 1148-1154 ◽  
Author(s):  
Takanori Tsujimura ◽  
Taku Suzuki ◽  
Midori Yoshihara ◽  
Shogo Sakai ◽  
Naomi Koshi ◽  
...  
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Hypoglossal Nerve ◽  
Sensory Information ◽  
Upper Esophageal Sphincter ◽  
Laryngeal Nerve ◽  
Nerve Transection ◽  
Swallowing Function ◽  
Esophageal Sphincter ◽  
Recurrent Laryngeal Nerves ◽  
Swallowing Pressure

Swallowing pressure generation is important to ensure safe transport of an ingested bolus without aspiration or leaving residue in the pharynx. To clarify the mechanism, we measured swallowing pressure at the oropharynx (OP), upper esophageal sphincter (UES), and cervical esophagus (CE) using a specially designed manometric catheter in anesthetized rats. A swallow, evoked by punctate mechanical stimulation to the larynx, was identified by recording activation of the suprahyoid and thyrohyoid muscles using electromyography (EMG). Areas under the curve of the swallowing pressure at the OP, UES, and CE from two trials indicated high intrasubject reproducibility. Effects of transecting the hypoglossal nerve (12N) and recurrent laryngeal nerve (RLN) on swallowing were investigated. Following bilateral hypoglossal nerve transection (Bi-12Nx), OP pressure was significantly decreased, and time intervals between peaks of thyrohyoid EMG bursts and OP pressure were significantly shorter. Decreased OP pressure and shortened times between peaks of thyrohyoid EMG bursts and OP pressure following Bi-12Nx were significantly increased and longer, respectively, after covering the hard and soft palates with acrylic material. UES pressure was significantly decreased after bilateral RLN transection compared with that before transection. These results suggest that the 12N and RLN play crucial roles in OP and UES pressure during swallowing, respectively. We speculate that covering the palates with a palatal augmentation prosthesis may reverse the reduced swallowing pressure in patients with 12N or tongue damage by the changes of the sensory information and of the contact between the tongue and a palates. NEW & NOTEWORTHY Hypoglossal nerve transection reduced swallowing pressure at the oropharynx. Covering the hard and soft palates with acrylic material may reverse the reduced swallowing function caused by hypoglossal nerve damage. Recurrent laryngeal nerve transection reduced upper esophageal sphincter negative pressure during swallowing.

scholarly journals Does methylene blue help in the early identification of the recurrent laryngeal nerve?

2018 ◽  
Vol 7 (1) ◽  
pp. 8-11
Author(s):  
Sujan Singh Chhetri ◽  
Toran KC ◽  
Meera Bista ◽  
Nayan Bahadur Mahato
Keyword(s):  
Methylene Blue ◽  
Recurrent Laryngeal Nerve ◽  
Cross Sectional Study ◽  
Laryngeal Nerve ◽  
Anatomical Landmarks ◽  
Cross Sectional ◽  
Visual Identification ◽  
Recurrent Laryngeal Nerves ◽  
One Year ◽  
Visualization Techniques

Background: Identification of recurrent laryngeal nerve is of utmost importance during thyroid surgery. Different anatomical landmarks have been used to recognize and preserve the nerve. Injury may lead to vocal cord paralysis. Different adjuvant methods have been used to aid in the identification of the nerve.Objective: To determine whether methylene blue smear helps to identify the recurrent laryngeal nerve safely and efficiently.Methodology: Observational cross sectional study done in 30 patients who underwent different thyroidectomies within a duration of one year. Recurrent laryngeal nerve identified using methylene blue smear and compared with the conventional visualization techniques exercising different known anatomical landmarks. The duration and ease of identification of the nerve was noted and graded.Results: Total of 39 recurrent laryngeal nerves were identified from 28 females and two males. The duration and the ease of dissection of the nerve was inconstant. Earliest time for recognition of the nerve was one and half minutes while the slowest time was 12 minutes. Conclusion: No matter what techniques are used, visual identification and verification of the recurrent laryngeal nerve is of paramount importance. No techniques demonstrated added advantage to one another.

Characteristic travelling patterns of non-recurrent laryngeal nerves

2014 ◽  
Vol 128 (6) ◽  
pp. 534-539 ◽  
Author(s):  
K H Hong ◽  
H T Park ◽  
Y S Yang
Keyword(s):  
Computed Tomography ◽  
Recurrent Laryngeal Nerve ◽  
Subclavian Artery ◽  
Vocal Fold ◽  
Laryngeal Nerve ◽  
New Classification ◽  
Laryngeal Nerves ◽  
Brachiocephalic Trunk ◽  
Recurrent Laryngeal Nerves ◽  
The Right

AbstractBackground:The non-recurrent laryngeal nerve is subject to potential injury during thyroid surgery. Intra-operative identification and preservation of this nerve can be challenging. Its presence is associated with an aberrant subclavian artery and the developmental absence of the brachiocephalic trunk. This study aimed to evaluate the incidence of non-recurrent laryngeal nerves and present a new classification system for the course of these nerves.Methods:Non-recurrent laryngeal nerves were identified on the right side in 15 patients who underwent thyroidectomy. The incidence of non-recurrent laryngeal nerves (during thyroidectomy) and aberrant subclavian arteries (using neck computed tomography) was evaluated, and the course of the nerves was classified according to their travelling patterns.Results:The overall incidence of non-recurrent laryngeal nerves was 0.68 per cent. The travelling patterns of the nerves could be classified as: descending (33 per cent), vertical (27 per cent), ascending (20 per cent) or V-shaped (20 per cent).Conclusion:Clinicians need to be aware of these variations to avoid non-recurrent laryngeal nerve damage. A retroesophageal subclavian artery (on neck computed tomography) virtually assures a non-recurrent laryngeal nerve. This information is important for preventing vocal fold paralysis. Following a review of non-recurrent laryngeal nerve travelling patterns, a new classification was devised.

scholarly journals The Recurrent Laryngeal Nerve in Relation to the Inferior Thyroid Artery in Adult Filipino Cadavers

2011 ◽  
Vol 26 (2) ◽  
pp. 13-17 ◽  
Author(s):  
Jacob S. Matubis ◽  
Karen June P. Dumlao ◽  
Ryner Jose C. Carrillo
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Thyroid Surgery ◽  
Anatomical Variations ◽  
The Philippines ◽  
Laryngeal Nerve ◽  
Inferior Thyroid Artery ◽  
Laryngeal Nerves ◽  
Recurrent Laryngeal Nerves ◽  
The Right ◽  
Relationship Of

Objective: To describe the anatomic relationship of the recurrent laryngeal nerve and the inferior thyroid artery in adult cadavers in the Philippines and to compare the proportions of these anatomic relationships with those reported in the foreign literature. Methods: Study design: Descriptive, cross-sectional Setting: University of the Philippines College of Medicine Anatomy Laboratory Subjects: Fifty-four (54)  preserved cadavers (108 sides) dissected within a period from June 2008 to Aug 2010. The anatomy and position of both  the right and the left recurrent laryngeal nerves (RLN) and inferior thyroid arteries (ITA) were noted. The RLN was further classified into 2 variations: non-branching or branching prior to insertion at the cricothyroid joint, under the inferior constrictor muscle.  The ITA was also classified into non-branching and branching.  The results were compared to two foreign studies using a Z-test for two proportions. Results: Fifty four (54) cadavers (108) sides were dissected. Among the  cadavers, both the recurrent laryngeal nerves and inferior thyroid arteries had a maximum of two branches although both the RLNs and ITAs for both the right and left sides were mostly non-branching. The right side of one cadaver was noted to have both a branching RLN and a branching ITA. There were no non-recurrent laryngeal nerves seen among the 54 cadavers. For both left and right sides, the RLN was mostly dorsal to the ITA. Branching RLNs was mostly dorsal to a non-branching ITAs. Most of the non-branching RLNs were dorsal to the ITAs. Non-branching RLNs were usually dorsal to the ITA.               The local patterns of the course of the RLN in relation to the ITA approximates those of Chinese where there is predominance of the RLN dorsal to the ITA  but differs from those of Brazilians where the RLN is usually between ITA branches.    Conclusion: There are multiple anatomical variations with regards to the relationship of the RLN and the ITA. The anatomic variation among Asians may be different from Brazilians. The surgeon’s knowledge of the possible various configurations of the RLN and ITA should be able to help in identification and preservation of the RLN and prevention of complications in thyroid surgery. Keywords: recurrent laryngeal nerve, inferior thyroid  artery, thyroid surgery, Filipino cadavers, anatomical variations

scholarly journals The Effect of Intraoperative Neuromonitoring on Damage to the Laryngeal Nerves in Patients Undergoing Total Thyroidectomy.

2021 ◽  
Author(s):  
Piotr Bryk ◽  
Stanisław Głuszek
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Total Thyroidectomy ◽  
Nodular Goiter ◽  
Intraoperative Neuromonitoring ◽  
Laryngeal Nerve ◽  
Control Group ◽  
Study Group ◽  
Laryngeal Nerves ◽  
Recurrent Laryngeal Nerves

Abstract Background: Assessment of intraoperative neuromonitoring in the prevention of damage to the recurrent laryngeal nerve during total thyroidectomy.Material and methods: A group of 367 patients qualified for the study, including 312 women (85.01%) and 55 (14.99%) men, aged 18-79, having undergone total thyroidectomy due to a neutral nodular goiter. The patients were operated on by one surgeon. The study group consisted of 205 patients, including 173 (84.39%) women and 32 (15.61%) men, aged 19-79, who were operated on with the use of intraoperative neuromonitoring. The control group consisted of 162 patients, including 139 (85.80%) women and 23 (14.20%) men, aged 18-77 years, who had undergone surgery only with macroscopic visualization of the recurrent laryngeal nerve without the application of intraoperative neuromonitoring. Then, in the period from 2 to 10 years after the surgery, follow-up examinations were performed, which included 153 patients from the control group (74.6% [153/205]) and 122 patients from the study group (75.3% [122 / 162] Results: The frequency of vocal fold palsy did not differ significantly statistically in the study group and the control group (study group: 4.9% [10/205], control group: 4.9% [8/162]; p = 0.979). In the follow-up study, the incidence of laryngeal fold palsy did not show statistically significant differences between the study and control groups. Most of the damage to the recurrent laryngeal nerves was persistent.Conclusions: Neuromonitoring did not reduce the number of recurrent laryngeal nerve injuries in relation to the nerve visualization alone in noncapsular total thyroidectomy for benign nodular goiter, performed by the same experienced surgeon.

scholarly journals Incidence and Surgical Importance of Zuckerkandl’s Tubercle of the Thyroid and Its Relations with Recurrent Laryngeal Nerve

ISRN Surgery ◽  
2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Emin Gurleyik ◽  
Gunay Gurleyik
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Total Thyroidectomy ◽  
Surgical Procedures ◽  
Surgical Anatomy ◽  
Laryngeal Nerve ◽  
Anterior Surface ◽  
Common Structure ◽  
Adjacent Structures ◽  
Posterior Extension ◽  
Crossing Point

Background. Variations of recurrent laryngeal nerve (RLN) and Zuckerkandl’s tubercle (ZT), which is posterior extension of lateral lobes, may affect safety of thyroidectomy. Methods. Total and hemithyroidectomy were surgical procedures in 60 and 40 patients, respectively. Surgical anatomy was studied in 87 right and 73 left lobes. Presence of ZT was noted and its incidence was determined. RLNs were identified and fully isolated. Relationship between ZT and RLN was established. Results. ZTs were identified in 66 (66%) patients and in 81 (51%) lobes. ZT was present in 53 (61%) right and in 28 (38%) left lobes. ZTs were bilateral in 15 (25%) of 60 total thyroidectomy cases. Smaller tubercles show the neurovascular crossing point. RLN was posterior (medial) to ZT in 76 (94%) occurrences. RLN was laying on anterior surface of ZT only in 5 (6%) instances. Conclusions. RLN is unusually laying lateral to ZT which is common structure in the thyroid. Lateral RLN may be more vulnerable to injury. Total thyroidectomy requires dissection of ZT adjacent to RLN. Based on unusual relations and variations, RLN should be fully isolated before excision of adjacent structures.

Use of a disposable electrode for recurrent laryngeal nerve monitoring

1998 ◽  
Vol 112 (6) ◽  
pp. 561-564 ◽  
Author(s):  
V. Srinivasan ◽  
D. J. Premachandra
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Electrode System ◽  
Laryngeal Nerve ◽  
Electromyographic Activity ◽  
Nerve Monitoring ◽  
Non Invasive ◽  
Disposable Electrode ◽  
Recurrent Laryngeal Nerves ◽  
Intrinsic Laryngeal Muscles ◽  
Recurrent Laryngeal Nerve Monitoring

AbstractOur experience with a non-invasive, disposable electrode for intra-operative identification and monitoring of the recurrent laryngeal nerve is described. The electrode system, while simply attached to the endotracheal tube, acts as a laryngeal surface electrode and detects electromyographic activity of the intrinsic laryngeal muscles when the recurrent laryngeal nerve is stimulated. We have successfully used this electrode to monitor 19 recurrent laryngeal nerves in 15 patients who have undergone partial or total thyroidectomy. We feel that this device can be useful particularly in cases of re-exploration and malignancies of the thyroid gland.

scholarly journals Comparison of Recurrent Laryngeal Nerve Identification Time in the Lower Central Triangle During Thyroid Surgery Using Neurophysiological Mapping and Monitoring

Medicina ◽  
2021 ◽  
Vol 57 (8) ◽  
pp. 748
Author(s):  
Eunhye Lee ◽  
Keunchul Lee ◽  
Hyeongwon Yu ◽  
Sujin Kim ◽  
Youngjun Chai ◽  
...  
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Vocal Cord ◽  
Thyroid Surgery ◽  
Vocal Cord Palsy ◽  
Laryngeal Nerve ◽  
Follicular Neoplasm ◽  
National University ◽  
Seoul National University ◽  
Definition Of ◽  
Intraoperative Nerve Monitoring

Background and Objectives: Preserving the recurrent laryngeal nerve (RLN) is important in thyroid surgery. However, no standardized surgical method for locating the RLN has been established. We defined a new anatomical definition termed “lower central triangle” (LCT) for consistent identification of RLN and used intraoperative nerve monitoring (IONM) to aid in identification and dissection of RLN. Materials and Methods: Patients undergone thyroidectomy were reviewed retrospectively in Seoul National University Bundang Hospital from January to September 2017. Patients with papillary thyroid carcinoma, follicular neoplasm, and Graves’ Disease were included while right side non-RLN in arteriosus lusoria, cancer invasion, pre-existing vocal cord palsy, or under the age of 18 were excluded. RLNs were tested with IONM within LCT consisting of the lower pole as the apex and the common carotid artery as the opposite side. The samples were divided into two groups, IONM and non-IONM. Results: Forty lobes in total were included, 22 in IONM group and 18 in non-IONM group. Groups were not significantly different in age, cancer proportion, and accompanying thyroiditis while sex and nodule size differed. RLN detection time was 10.43 sec shorter (p < 0.001), and confirmation time was 10.67 sec shorter (p = 0.09) in IONM group than in non-IONM group. Both right and left RLNs were located predominately in the middle of LCT. No transient or permanent vocal cord palsy occurred. Conclusions: While IONM is an appropriate aid for thyroidectomy, our approach using LCT to locate the RLN is a novel definition of anatomy that provides prompt identification of the RLN in thyroid surgery.

scholarly journals Application of the original method of intra-operative electrophysiological stimulation of recurrent laryngeal nerve with surgical interventions on the neck organs

2020 ◽  
Vol 179 (3) ◽  
pp. 19-24
Author(s):  
Yu. V. Kovalenko ◽  
A. S. Tolstokorov ◽  
S. N. Kotov ◽  
G. A. Manakhov ◽  
E. N. Kurochkina
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Functional Activity ◽  
Control Method ◽  
Intraoperative Complications ◽  
Original Method ◽  
Laryngeal Nerve ◽  
The Body ◽  
Surgical Interventions ◽  
Laryngeal Nerves ◽  
Recurrent Laryngeal Nerves

The OBJECTIVE was the reduction in the frequency of specific complications of surgical treatment of patients with pathology of the thyroid and parathyroid glands using the original method of monitoring the neuro-functional activity of the recurrent laryngeal nerve.METHODS AND MATERIALS. The research was conducted in two stages. At the first stage, the object of the topographic-anatomical study was 50 male and female corpses. The research, based on the fixed material, was focused upon the study of the anatomic special features of recurrent laryngeal nerves, their relations with neighboring structures, the study of peculiarities of recurrent laryngeal nerve syntopy and its neighboring structures to find the least traumatic way of incision during electroneurophysiological monitoring of activity. At the second stage, the object of the study was 60 patients with a benign pathology of the thyroid gland, who were operated on with the use of the original method of intra-operational visualization and control method over neuro-functional activity of recurrent laryngeal nerve.RESULTS. The frequency of the three different variants of topographic-anatomical position of recurrent laryngeal nerve depends on the side of the body. The safest, stable and the fastest one to be found is the left recurrent laryngeal nerve. Postoperative unilateral paresis of the larynx, diagnosed in 4 of 60 patients, is regarded as postischemic. Two-sided paresis of the larynx was diagnosed in 1 patient.CONCLUSION. This method allows to minimize the development of severe intraoperative complications, to reduce the frequency of postoperative paralysis and paresis of the larynx. Intra-operative visualization of recurrent laryngeal nerves is especially necessary during the repeated surgeries with postoperative scar transformations with wrong syntopy of neck organs and vascular-nerve structures, which makes it possible to minimize the number of postoperative paralyses and paresis of larynx and to get positive effect without carrying out the intubation of trachea among patients with postoperative paralysis of larynx or stenosis, and to avoid more serious damage of larynx or trachea in case of intubation.

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