title: Recurrent laryngeal nerve: a plexus rather than a nerve?
abstract: OBJECTIVE
  To analyze the frequency of extralaryngeal branching (ELB) of the recurrent laryngeal nerve (RLN) in a consecutive series of patients undergoing thyroidectomy by the same group of surgeons during an extended period and to compare our findings with the data available in the literature.
  
  
  METHODS
  Retrospective medical record study.
  
  
  METHODS
  Academic research.
  
  
  METHODS
  From March 1, 1983, to September 30, 2008, 2677 patients underwent thyroidectomy. Of these, 1638 patients had surgical information about at least 1 RLN. A total of 1081 patients underwent bilateral operations. During the last 5 years of the study, intraoperative laryngeal nerve monitoring was performed in selected patients using a commercially available system.
  
  
  METHODS
  Information was obtained regarding 2154 RLNs.
  
  
  RESULTS
  A total of 1390 RLNs (64.53%) had ELB. Among 447 patients in whom intraoperative laryngeal nerve monitoring was used, the anterior branches usually exhibited more electrophysiologic activity.
  
  
  CONCLUSIONS
  Extralaryngeal branching was found in 64.53% of RLNs in this case series. In recent patients with intraoperative laryngeal nerve monitoring, electrophysiologic activity was observed in the branches, particularly the anteriorly situated ones. Recognition of this frequent anatomical configuration and meticulous preservation of all branches are of paramount importance to decrease postoperative morbidity associated with thyroidectomy.
authors.affiliation: Department of Head and Neck Surgery, University of São Paulo Medical School, São Paulo, Brazil. cerneamd@uol.com.br
authors.forename: Claudio R
authors.initials: CR
authors.lastname: Cernea
authors.forename: Flávio C
authors.initials: FC
authors.lastname: Hojaij
authors.forename: Dorival
authors.initials: D
authors.lastname: De Carlucci
authors.forename: Renato
authors.initials: R
authors.lastname: Gotoda
authors.forename: Caio
authors.initials: C
authors.lastname: Plopper
authors.forename: Felipe
authors.initials: F
authors.lastname: Vanderlei
authors.forename: Lenine G
authors.initials: LG
authors.lastname: Brandão
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D055724:Electrophysiological Phenomena / Q000502:physiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods; D012009:Recurrent Laryngeal Nerve / Q000033:anatomy & histology* / Q000502:physiology*; D012189:Retrospective Studies; D013959:Thyroid Diseases / Q000601:surgery; D013965:Thyroidectomy / Q000379:methods*; D014826:Vocal Cord Paralysis / Q000517:prevention & control; D055815:Young Adult