title: [Anatomic and surgical study of the recurrent laryngeal nerve and its involvement with the ligament of Berry].
abstract: OBJECTIVE
  To study the anatomical relations of the recurrent laryngeal nerve (RLN) with the ligament of Berry (LB), and point out the different ways of presenting the relationship between these two structures.
  
  
  METHODS
  We conducted a study with anterior cervical dissection of 22 corpses, in the years 2009 and 2010, with attention towards the frequency of presentation of anatomical relations between the NLR and Berry ligament, with the following classification: Type I or intraligamentary: the nerve and / or its branches were visualized in the ligament substance conjunctiva; Type IIA or lateral: nerve and / or its branches lateral to the ligament; Type IIB or lateral paraligamentary: nerve and / or its side branches and in contact with the ligament without penetrating it; Type III or medial: nerve and / or its branches visualized after complete dissection of the ligament, in lateral-medial position.
  
  
  RESULTS
  The study analyzed 41 RLNs, which comprised eight (19.5%) of type I, 20 (48.8%) Type II, five (12.2%) Type IIB and eight (19.5%) type III. Of the 19 (86.3%) RLNs dissected bilaterally in the same cadaver, 11 (57.8%) displayed a classification in one side of the neck different from the one of the other side.
  
  
  CONCLUSIONS
  Due to its proximity to the RLN and the anatomical variability, the Berry ligament should not be considered a reliable parameter for repair and preservation of the recurrent laryngeal nerve. Hence, the indiscriminate latero-medial dissection of the ligament is not recommended without direct visualization of the nerve.
authors.affiliation: Doutor Honoris Causa da Universidade Toulouse, França. joaoboscobotelho@gmail.com
authors.forename: João Bosco
authors.initials: JB
authors.lastname: Botelho
authors.forename: Danilo  Monteiro
authors.initials: D
authors.lastname: Vieira
authors.forename: Diego
authors.initials: D
authors.lastname: Monteiro de Carvalho
authors.forename: Marcus Brunner Pereira
authors.initials: MB
authors.lastname: Batista
mesh_terms: D000293:Adolescent; D000328:Adult; D002102:Cadaver; D004210:Dissection; D005260:Female; D006801:Humans; D008022:Ligaments / Q000033:anatomy & histology* / Q000294:innervation / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012009:Recurrent Laryngeal Nerve / Q000033:anatomy & histology* / Q000473:pathology / Q000601:surgery*; D013961:Thyroid Gland; D055815:Young Adult