Relationship of recurrent laryngeal nerve with inferior thyroid artery

Abstract

Background: Recurrent laryngeal nerve (RLN) injury is a major concern in thyroid surgery as the effects can vary from hoarseness of voice to life-threatening complications like stridor. Hence, identification and preservation of the nerve is of utmost importance. The landmarks for identification are tracheoesophageal groove, inferior thyroid artery (ITA), ligament of berry, and tubercle of Zuckerkandl. The ITA is noted to be a constant landmark in identifying the RLN. The main aim of the study is to identify the relationship of the ITA with the RLN during thyroid surgery. Materials and methods: A total of 91 patients who underwent total thyroidectomy, completion, and hemithyroidectomy from January 2018 to December 2018 were included in the study. The position of the RLN with respect to the ITA was noted being as superficial, deep, or between the branches. Results: Among a total of 150 RLNs, 140 (93.3%) were identified and 10 were not identified. In 125 (89%) dissections, the ITA was superficial to the RLN and in 15 dissections it was noted to be deep to the RLN. Conclusion: Even though the RLN can be identified by various landmarks, the relationship with the ITA is consistent. However, as the nerve may be either superficial or deep to the ITA, knowledge of anatomy and variations of the RLN is necessary to ensure its preservation. Clinical significance: The knowledge of relationship of the RLN with the ITA helps in identification and preservation of nerve, thus avoiding injury to the nerve and consequent complications.