The Recurrent Laryngeal Nerve does not lie in the Tracheo-esophageal Groove

Main Article Content

Vijay Naraynsingh Aryaa Ramnarine Sandeep Maharajh Samara Hassranah Shamir O Cawich

Abstract

Traditional anatomic textbooks suggest that the recurrent laryngeal nerve (RLN) ascends in the tracheoesophageal groove (TEG). However, during thyroid and parathyroid surgery, we have noted that the RLN is often not in the groove. In this study, we objectively measured the course of 41 RLNs in relation to the TEG. We found that the RLN was in the groove in only one case. On the right, the angle ranged from 0 – 50°(mean 27.5°) and on the left the range was 15 – 45°, (mean 25.5°) away from the TEG. In conclusion, it was unusual for the RLN to lie in the tracheo-esophageal groove. Thus, in mobilizing the thyroid lobe medially during thyroidectomy, one must exercise care as it is likely that one will encounter the RLN well lateral to the groove. We propose a new technique of objectively measuring the deviation of the RLN from the TEG.

Article Details

How to Cite
NARAYNSINGH, Vijay et al. The Recurrent Laryngeal Nerve does not lie in the Tracheo-esophageal Groove. Medical Research Archives, [S.l.], v. 10, n. 8, aug. 2022. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/2949>. Date accessed: 07 oct. 2022. doi: https://doi.org/10.18103/mra.v10i8.2949.
Section
Research Articles

References

1. Vesalius A. De Humani Corporis Fabrica Libri Septem. First.; 1543.
2. Gray H. Anatomy : Descriptive and Surgical. First. J.W. Parker; 1958.
3. Snell RS. Clinical Anatomy by Regions. Lippincott Williams & Wilkins; 2012.
4. Harold Ellis, Mahadevan V. Clinical Anatomy: Applied Anatomy for Students and Junior Doctors. 14th ed. Wiley-Blackwell; 2018.
5. Keith L Moore, Arthur F Dalley, AMR Agur. Clinically Oriented Anatomy. 7th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2014.
6. O. James Garden, Rowan W Parks, Stephen J. Wigmore. Principles and Practice of Surgery. 8th ed. Elsevier; 2022.
7. Gremillion G, Fatakia A, Dornelles A, Amedee RG. Intraoperative recurrent laryngeal nerve monitoring in thyroid surgery: is it worth the cost? Ochsner J. 2012;12(4):363-366.
8. Kaplan EL, Salti GI, Roncella M, Fulton N, Kadowaki M. History of the recurrent laryngeal nerve: from Galen to Lahey. World J Surg. 2009;33(3):386-393. doi:10.1007/s00268-008-9798-z
9. Wojtczak B, Barczyński M. The evolution and progress of studies of the anatomy & electrophysiology of the laryngeal nerves in thyroid surgery. Ann Thyroid. 2018;3(0). Accessed May 21, 2022. https://aot.amegroups.com/article/view/4537
10. Hannan SA. The magnificent seven: a history of modern thyroid surgery. Int J SurgLond Engl. 2006;4(3):187-191. doi:10.1016/j.ijsu.2006.03.002
11. Konturek A, Barczyński M. The evolution and progress of mechanism and prevention of recurrent laryngeal nerve injury. Ann Thyroid. 2018;3(0). Accessed May 21, 2022. https://aot.amegroups.com/article/view/4607
12. Courtney Townsend, R. Daniel Beauchamp, Kenneth L. Mattox, B. Mark Evers. Sabiston Textbook of Surgery The Biological Basis of Modern Surgical Practice. 21st ed.; 2021.
13. Menck J, Grüber J, Lierse W. Vorderer Zugangzur HWS und die Lage des N. laryngeusrecurrens Anterior approach to the cervical vertebrae and the location of the recurrent laryngeal nerve. Unfallchirurg. 1990;93(8):384-386.
14. Chen X, Xie L, Guo X. The regional dissection and clinical application in pars cervicalis of recurrent laryngeal nerve. Sichuan Journal of Anatomy. 2002; 10(3), 150-152.
15. Henry BM, Sanna B, Graves MJ, Sanna S, Vikse J, Tomaszewska IM, Tubbs RS, Tomaszewski KA. The Reliability of the Tracheoesophageal Groove and the Ligament of Berry as Landmarks for Identifying the Recurrent Laryngeal Nerve: A Cadaveric Study and Meta-Analysis. BioMed Res Int. 2017;2017:4357591. doi:10.1155/2017/4357591
16. Gupta N, Gupta R, Singh I, Kotwal S. Tracheoesophageal groove: a reliable landmark. Int J Otorhinolaryngol Head Neck Surg. 2019;5(3):545-548. doi:10.18203/issn.2454-5929.ijohns20190967
17. Wheeler MH. The technique of thyroidectomy. J R Soc Med. 1998;91 Suppl 33(Suppl 33):12-16. doi:10.1177/014107689809133s04
18. Brinch FA, Døssing H, Nguyen N, Bonnema SJ, Hegedüs L, Godballe C, Sorensen JR. The Impact of Esophageal Compression on Goiter Symptoms before and after Thyroid Surgery. Eur Thyroid J. 2019;8(1):16-23. doi:10.1159/000493542
19. Crile G. Diagnosis and treatment of diseases of the thyroid gland. WB Saunders, Philadelphia (1932),p401-409