ANATOMICAL PRINCIPLES BEHIND PRESERVATION OF LARYNGEAL NERVES DURING THYROIDECTOMY
O. Fabian, Emilia Pătruţ, I. Şimon, V. Muntean
Surgery Clinic IV
„Iuliu Haţieganu” University of Medicine and Pharmacy Cluj-Napoca
Jurnalul de chirurgie 2011; 7 (3): 460-475
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Abstract:

This paper presents the anatomical principles behind preservation of inferior laryngeal nerve and of the external branch of superior laryngeal nerve during thyroidectomy. The embryological development of thyroid and recurrent laryngeal nerves explains the constant relationship between Zuckerkandl’s tuberculum and the recurrent laryngeal nerve, while anomalies in development of the aortic arches explain the presence of rare anatomical variants, with a high risk of nerve injury, of non-recurrent course of the inferior laryngeal nerve. Good knowledge of the relationship between the external branch of superior laryngeal nerve and the superior thyroid artery makes possible to avoid transection of this branch during ligature around superior thyroid artery and vein. Anatomical landmarks used to identify the recurrent laryngeal nerve (tracheo-oesophageal sulcus, the cross-over with the inferior thyroid artery, Berry’s ligament, Zuckerkandl’s tuberculum) and variations in the extra-laryngeal branching of the nerve are discussed based on data from the literature. The anatomical variants when the inferior laryngeal nerve doesn’t have a recurrent course are also discussed.

KEY WORDS: RECURRENT NERVE, EXTERNAL BRANCH OF SUPERIOR LARYNGEAL NERVE, THYROIDECTOMY

Correspondence to: Fabian Ovidiu, MD, PhD, CF University Hospital Cluj-Napoca, Surgery Clinic IV, str. Republicii, no 18, cod 400015, e-mail: