title: Variable relationship of the recurrent laryngeal nerve to the inferior thyroid artery: A meta-analysis and surgical implications.
abstract: The relationship between the recurrent laryngeal nerve (RLN) and inferior thyroid artery (ITA) is highly variable and traceable back to embryological life.
  
  
  
  Comprehensive database searches were conducted, followed by judgment of eligibility, assessment, and extraction of data concerning the RLN/ITA relationship. The data were pooled into a meta-analysis and subjected to sex, side-based, geographic origin of study, and study modality subgroup analyses.
  
  
  
  Seventy-nine studies (n = 14,269 nerves) reported data on the relationship of the RLN to the ITA. The left versus right-sided comparison revealed stark differences: RLNs were predominantly posterior (62.6% vs 37.0%) and anterior (17.2% vs 37.1%) on the left and right sides, respectively.
  
  
  
  Symmetry of neurovascular relationships should not be assumed. Extra care should be taken during procedures on the right side, because the nerves are significantly more likely to present in patterns (anterior and between) associated with greater risk of iatrogenic injury. © 2016 Wiley Periodicals, Inc. Head Neck 39: 177-186, 2017.
authors.affiliation: International Evidence-Based Anatomy Working Group, Krakow, Poland.|Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland.
authors.forename: Brandon Michael
authors.identifier: 0000-0002-8047-338X
authors.initials: BM
authors.lastname: Henry
authors.affiliation: International Evidence-Based Anatomy Working Group, Krakow, Poland.|Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland.
authors.forename: Jens
authors.initials: J
authors.lastname: Vikse
authors.affiliation: International Evidence-Based Anatomy Working Group, Krakow, Poland.|Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Graves
authors.affiliation: Department of Surgical Sciences, University of Cagliari, Sardinia, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Sanna
authors.affiliation: Faculty of Medicine and Surgery, University of Cagliari, Sardinia, Italy.
authors.forename: Beatrice
authors.initials: B
authors.lastname: Sanna
authors.affiliation: Department of Medical Education, Jagiellonian University Medical College, Krakow, Poland.
authors.forename: Iwona M
authors.initials: IM
authors.lastname: Tomaszewska
authors.affiliation: International Evidence-Based Anatomy Working Group, Krakow, Poland.|First Faculty of Medicine, Charles University, Prague, Czech Republic.
authors.forename: Wan Chin
authors.initials: WC
authors.lastname: Hsieh
authors.affiliation: Seattle Science Foundation, Seattle, Washington.
authors.forename: R Shane
authors.initials: RS
authors.lastname: Tubbs
authors.affiliation: International Evidence-Based Anatomy Working Group, Krakow, Poland.|Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland.
authors.forename: Krzysztof A
authors.initials: KA
authors.lastname: Tomaszewski
mesh_terms: D006801:Humans; D012009:Recurrent Laryngeal Nerve; D013961:Thyroid Gland / Q000098:blood supply* / Q000294:innervation* / Q000601:surgery; D013965:Thyroidectomy
keywords: anatomy; inferior thyroid artery; meta-analysis; recurrent laryngeal nerve; thyroidectomy