Extensive Extra-laryngeal Branching and Sympathetic Anastomosis of Recurrent Laryngeal Nerve: Nerve Wracking Trap
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Damage to the recurrent laryngeal nerves (RLNs) is one of the dreaded complications of thyroid and parathyroid surgery (1). In case of anatomical variations this risk is further increased. Terminal branching of RLN occurs anywhere from several centimeters from the cricothyroid muscle to within the larynx itself (2). Prevalence of extra-laryngeal branching (ELB) is reported to be around 60% (3). Another anatomical variation is anastomosis between RLN, and the cervical sympathetic chain known as sympathetic inferior laryngeal anastomotic branch (SILAB) which is rare (1%–2%) (4). We recently operated upon a patient of papillary thyroid carcinoma and encountered both these anatomic variations.
Abstract
Damage to the recurrent laryngeal nerves (RLNs) is one of the dreaded complications of thyroid and parathyroid surgery (1). In case of anatomical variations this risk is further increased. Terminal branching of RLN occurs anywhere from several centimeters from the cricothyroid muscle to within the larynx itself (2). Prevalence of extra-laryngeal branching (ELB) is reported to be around 60% (3). Another anatomical variation is anastomosis between RLN, and the cervical sympathetic chain known as sympathetic inferior laryngeal anastomotic branch (SILAB) which is rare (1%–2%) (4). We recently operated upon a patient of papillary thyroid carcinoma and encountered both these anatomic variations.
참고문헌 (4)
- Joliat GR, "Recurrent laryngeal nerve injury after thyroid and parathyroid surgery: incidence and postoperative evolution assessment", Medicine (Baltimore), 96, pp.e6674~ (2017)
- Beneragama T, "Extralaryngeal bifurcation of the recurrent laryngeal nerve : a common variation", ANZ J Surg, 76, pp.928~931 (2006)
- Henry BM, "Extralaryngeal branching of the recurrent laryngeal nerve : a meta-analysis of 28, 387 nerves", Langenbecks Arch Surg, 401, pp.913~923 (2016)
- Calzolari F, "Non-recurrent inferior laryngeal nerves and sympathetic-inferior laryngeal anastomotic branches : 6 years' personal experience", Chir Ital, 60, pp.221~225 (2008)