title: Tumor proximity to the recurrent laryngeal nerve in patients with primary hyperparathyroidism undergoing parathyroidectomy.
abstract: BACKGROUND
  Recurrent laryngeal nerve (RLN) injury is a rare complication for patients undergoing neck exploration for primary hyperparathyroidism (pHPT). Distances between RLNs and parathyroid adenomas have not been previously published. In this study we used a RLN monitor to identify the RLN and to measure the proximity to parathyroid tumors.
  
  
  METHODS
  Patients with pHPT (n = 136) underwent neck exploration and had the clinical data recorded prospectively. Adenomas were recorded in 1 of 4 locations (right upper, right lower, left upper, left lower). Measurement of RLN to adenoma distances were recorded intraoperatively with the gland in situ. The RLN location was confirmed with a RLN monitor.
  
  
  RESULTS
  The average RLN to adenoma distance was 0.52 ± 0.52 cm. Adenomas in the right upper position were significantly closer to the nerve (0.25 ± 0.39 cm) compared with adenomas in the left upper (0.48 ± 0.61 cm, p = .03), left lower (0.70 ± 0.53 cm, p < .001), and right lower position (1.02 ± 0.56 cm, p < .001). Left upper adenomas were also significantly closer to the nerve compared with right lower adenomas (p < .001). Adenomas in the right upper position abutted the nerve more often (47 %) compared with adenomas in other positions (p = .001). There were no perioperative characteristics that predicted tumor abutment. There were no permanent RLN injuries.
  
  
  CONCLUSIONS
  In patients with sporadic pHPT, parathyroid adenomas in the right upper location have, on average, greater proximity to the RLN and are more often directly abutting compared with adenomas in other locations.
authors: Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA. untchb@mskcc.org
authors: Brian R
authors: BR
authors: Untch
authors: Mohamed A
authors: MA
authors: Adam
authors: Melissa E
authors: ME
authors: Danko
authors: Michael E
authors: ME
authors: Barfield
authors: Darshana
authors: D
authors: Dixit
authors: Randall P
authors: RP
authors: Scheri
authors: John A
authors: JA
authors: Olson
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000150:complications / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010282:Parathyroid Neoplasms / Q000175:diagnosis* / Q000209:etiology; D016105:Parathyroidectomy / Q000009:adverse effects*; D011183:Postoperative Complications; D011379:Prognosis; D011446:Prospective Studies; D012009:Recurrent Laryngeal Nerve / Q000473:pathology*; D061226:Recurrent Laryngeal Nerve Injuries / Q000175:diagnosis* / Q000209:etiology