Revisited anatomy of the recurrent laryngeal nerves.
BACKGROUND
The most frequent postthyroidectomy complication is recurrent laryngeal nerve (RLN) damage with subsequent vocal cord palsy.


METHODS
We have undertaken an intraoperative study aimed to determine the course, distribution, and RLN's anatomical relationships with adjacent structures. Only its identification and its careful exposure allow prevention of iatrogenic injuries.


RESULTS
The RLN was always routinely exposed and identified in 1,543 thyroidectomies. All patients underwent laryngoscopic evaluation before surgery and at the time of discharge. A total of 2,626 RLN were observed. The number of nerves exposed to risk was 673 (25.6%). In the whole series, of 2626 nerves controlled, there were 11 (0.4%) permanent palsies.


CONCLUSIONS
Our study confirms that damage to the RLN or to one of its branches may be avoided only by identification and careful exposure of the nerve itself. An experienced surgeon with good knowledge of the anatomy of the RLN and its anatomical variations is required for uncomplicated treatment of thyroid disease.
Ardito
Guglielmo
G
Department of Surgery, Catholic University of Sacred Heart, Rome, Italy. arditog@libero.it
Revelli
Luca
L
D'Alatri
Lucia
L
Lerro
Valentina
V
Guidi
Maria Lavinia
ML
Ardito
Francesco
F
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012009:Recurrent Laryngeal Nerve / Q000033:anatomy & histology* / Q000601:surgery; D013959:Thyroid Diseases / Q000601:surgery; D013965:Thyroidectomy / Q000009:adverse effects / Q000379:methods*; D014826:Vocal Cord Paralysis / Q000209:etiology / Q000517:prevention & control*