Gender, race, and electrophysiologic characteristics of the branched recurrent laryngeal nerve.
OBJECTIVE
The extralaryngeal branching of recurrent laryngeal nerves (RLN) conveys an increased risk of nerve injury during thyroid surgery. We hypothesized that racial and gender variations in prevalence of branched RLN exist.


METHODS
A retrospective review of all patients who underwent thyroid surgery in a 4-year period in a single surgeon practice.


METHODS
The RLN was routinely identified during thyroid surgery. Presence of RLN branching, its distance from the laryngeal nerve entry point (NEP), and functionality of the branches were ascertained. Patient demographics, rates of neural branching, and distance of bifurcation from the NEP were evaluated using statistical analysis.


RESULTS
We identified 719 RLNs at risk in 491 patients who underwent central neck surgery. Four hundred and five (82.5%) patients were female and 86 (17.5%) patients were male. There were 218 (44.4%) African American patients and 251 (51.1 %) Caucasian patients. In African American patients, 42.1% RLNs bifurcated compared to 33.2% RLNs in Caucasian (P = 0.017) patients. The RLNs of African American and Caucasian patients bifurcated at comparable distances (P = 0.30). In male patients, 39.1% RLNs bifurcated; whereas in female patients 36.2% RLNs bifurcated (P = 0.53). On average, RLN bifurcation in female patients was at a longer distance from NEP compared to that of male patients (P = 0.012). Electrophysiologic testing found motor fibers in all anterior branches and three posterior extralaryngeal RLN branches.


CONCLUSIONS
African American patients have a higher rate of RLN bifurcation compared to Caucasian patients but no statistically significant difference in distance from NEP. Female patients tend to have longer branching variants of bifid RLNs. RLN motor fibers reside primarily in the anterior branch but may occur in the posterior branch.
Department of Otolaryngology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana.
Tatyana E
TE
Fontenot
Gregory W
GW
Randolph
Paul L
PL
Friedlander
Hammad
H
Masoodi
Ibrahim M
IM
Yola
Emad
E
Kandil
D055724:Electrophysiological Phenomena; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D037981:Neck Dissection / Q000009:adverse effects*; D011183:Postoperative Complications / Q000208:ethnology*; D015995:Prevalence; D044469:Racial Groups; D012009:Recurrent Laryngeal Nerve / Q000002:abnormalities* / Q000503:physiopathology; D061226:Recurrent Laryngeal Nerve Injuries / Q000208:ethnology* / Q000209:etiology / Q000503:physiopathology; D012189:Retrospective Studies; D017678:Sex Distribution; D012737:Sex Factors; D013965:Thyroidectomy / Q000009:adverse effects*; D013997:Time Factors; D014481:United States / Q000453:epidemiology
Thyroid surgery; recurrent laryngeal nerve; vocal cord dysfunction