The wide variability of this extralaryngeal branching elb has significant implications for the risk of. Recurrent laryngeal nerve rln injury is considered to be the most severe complication in thyroid surgery. The non recurrent laryngeal nerve nrln is a rare variant of the recurrent laryngeal nerve rln that takes an aberrant course, not descending into the thorax as is usual. The recurrent laryngeal nerve rln branches off the vagus nerve and supplies function to some muscles of the larynx voice box. Chapter 33 surgical anatomy and monitoring of the recurrent laryngeal nerve gregory w. The recurrent laryngeal nerve rln, also known as the inferior laryngeal nerve, is a branch of the vagus nerve cn x which has a characteristic loop around the right subclavian artery on the right and the aortic arch on the left before returning up to achieve the tracheoesophageal groove and then the larynx. This article highlights the normal anatomy, anatomical variants and ways to identify the nerve as the.
The recurrent and superior laryngeal nerves download. Anatomical variations of recurrent laryngeal nerve during. Recurrent laryngeal nerve the recurrent laryngeal nerve is a myelinated nerve. The recurrent laryngeal nerve rln is a branch of the vagus nerve cranial nerve x that supplies all the intrinsic muscles of the larynx, with the exception of the. Berke, md losangeles, california ming ye, md joel a. May 17, 20 recurrent laryngeal nerve rln injury is commonly encountered by thyroid surgeons and may carry with it great morbidity.
Careful dissection of the rln during surgery reduces the risk of damage. Intralaryngeal anatomy of the recurrent laryngeal nerve. Finally, it ascends within the visceral compartment of the neck, behind the thyroid gland, between the esophagus and trachea. Reputable anatomy books describe the rln in cadavers, and this doesnt pay a great service to the surgical practice on living humans 11,12. Elizabeth davis, in equine internal medicine fourth edition, 2018. Because of the inefficiencies of the routing the nerve takes, its often hailed as one of.
A branch of the vagus nerve curving upward, on the right side around the root of the subclavian artery, on the left side around the arch of the aorta, then passing superiorly, posterior to the common carotid artery between the trachea and the esophagus to the larynx. The recurrent laryngeal nerve can be a real challenge to the surgeon operating in its area. Recurrent laryngeal nerve injury produces an abductor laryngeal paralysis. The recurrent and superior laryngeal nerves springerlink. The left recurrent laryngeal nerve design in mammals is not poor design. Aug 06, 2015 the vagus nerve exists within the body as a pair, one on the right side and the other on the left. Objectiveshypothesis to determine the position and anatomic variability of the thyroarytenoid ta branch of the recurrent laryngeal nerve. The recurrent and superior laryngeal nerves pdf download. A novel variation of the recurrent laryngeal nerve gaosong wu1,2 and kun wang2 abstract background. The branches provide both sensory and motor fibers. Inferior laryngeal nerve definition of inferior laryngeal. The recurrent laryngeal nerve may be traumatized during surgery on the thyroid and parathyroid glands. The left recurrent laryngeal nerve curves medially around the aortic arch during development and is approximately 1 m long. The recurrent laryngeal nerve rln is a branch of the vagus nerve cranial nerve x that supplies all the intrinsic muscles of the larynx, with the exception of the cricothyroid muscles.
There are two recurrent laryngeal nerves, right and left, in the human body. It then branches into the superior and recurrent laryngeal nerves rln, of which the latter is remarkably interesting from the point of view of evolutionary biology. A variant nerve that mimics the left recurrent laryngeal. She had no history of surgery or radiation to the head or neck. Anatomy of recurrent laryngeal nerve rln dent1 pbl 3. Practitioners interested in maximizing the information obtained from laryngeal imaging must be familiar with laryngeal anatomy. The morbidity of these complications has led to the investigation of the impact of sidedness in anterior cervical spine surgery.
The recurrent laryngeal then passes below and behind the aorta, at the level of the ligamentum arteriosum. Whether the injury is accidental or due to deliberate resection for oncologic soundness, the surgeon must be prepared to offer the best available treatment to patients, either at the time of injury or early in the recovery process. Previous anatomic studies of the recurrent laryngeal nerves rlns have described the variability in the course of the rln. Dec, 2014 recurrent laryngeal nerve the recurrent laryngeal nerve is a myelinated nerve. As the heart migrates from the region of the pharynx to the. The cricothyroid muscles are innervated by the superior laryngeal nerve. Injury to the recurrent laryngeal nerve rln andor external branch of the superior. Dawkins complains about the recurrent laryngeal nerve.
We think this is the most useful anatomy picture that you need. External branch of the superior laryngeal nerve monitoring. Extralaryngeal branching of the recurrent laryngeal nerve. The interpretation of laryngeal imaging in the evaluation of patients with voice problems requires a strong foundation in the anatomy and physiology of the larynx. Surgical management of the recurrent laryngeal nerve in. Injury to the recurrent laryngeal nerve is one of the most severe complications of thyroid surgery. A 50yearold woman was presented to our department with a nodule in the right thyroid lobe, and she reported no voice changes. This means that there is also a right and left recurrent laryngeal nerve. Recurrent laryngeal nerve radiology reference article. Anatomical variations of the recurrent laryngeal nerve in.
Clinically relevant anatomy of recurrent laryngeal nerve. The rln is consistently present superior to the inferior thyroid artery before it ascends behind the inferior constrictor to the nerve s entry point into the larynx. Recurrent laryngeal nerve request pdf researchgate. Learn vocabulary, terms, and more with flashcards, games, and other study tools. The anatomy of the recurrent laryngeal nerve is variable. Routine exposure of recurrent laryngeal nerve in thyroid surgery can. Setubal, portugal a r t i c l e i n f o article history. You have two, one on each side, as you do with other nerves. A case study in human anatomy dickran altounian1, cathy tran2, christina tran1, allison spencer1, alexandra shendrik3, brian p. Surgical anatomy of the recurrent laryngeal nerve revisited. Recurrent laryngeal nerve definition of recurrent laryngeal. Non recurrent nerve is a very rare variation of the inferior laryngeal nerve. There are two recurrent laryngeal nerves right and left in the human body both arising from the vagus. Ta the terminal branch of the recurrent laryngeal nerve as the latter passes deep to the inferior pharyngeal constrictor.
The sln external branch innervates the cricothyroid muscle, which tenses and adducts the vocal cords. Contrary to routine dissection of the rln, most surgeons tend to avoid rather than routinely expose and identify the external branch of the superior laryngeal nerve ebsln during thyroidectomy or parathyroidectomy. The recurrent laryngeal nerves rln are branches of the vagus nerve that go on to innervate most of the intrinsic muscles of the larynx. The rln is consistently present superior to the inferior thyroid artery before it ascends behind the inferior constrictor to the nerves entry point into the larynx. The recurrent laryngeal nerve rln and the superior laryngeal nerve sln are branches of the vagus nerve cn x. The recurrent laryngeal nerve exits the caudal brainstem as part of the vagus nerve cranial nerve x and descends along the trachea dorsal to the common carotid artery with a different course between the left and right recurrent laryngeal nerves. A new classification system for recurrent laryngeal nerve anatomy is proposed. The book is visually oriented with color illustrations and photomicrographs embracing all aspects of recurrent laryngeal nerve anatomy including branching patterns, relationship of the nerve and the inferior thyroid artery and the nonrecurrent recurrent laryngeal nerve. The right recurrent laryngeal nerve leaves the vagus nerve at the level of the second rib turning around the costocervical trunk before ascending toward the larynx.
The vocal cord assumes a median or paramedian position. The recurrent laryngeal nerve branches off the vagus nerve and is present by the sixth gestational week, associated with the sixth branchial arch. All other intrinsic laryngeal muscles are innervated by the recurrent laryngeal nerve the superior laryngeal nerve consists of two branches. One of the cranial nerves, the vagus the name means wandering and is apt, has various branches, two of which go to the heart, and two on each side to the. The nonrln nrln is a rare anatomical anomaly of the rln, with an incidence of 0. The most common complications of anterior neck surgery are dysphagia and rln palsy. Wedel1, 3 1 college of osteopathic medicine of the pacific, western university of health sciences, pomona, ca usa. The nonrecurrent laryngeal nerve a rare phenomenon. A common claim by evolutionists is that the mammalian left recurrent laryngeal nerve was poorly designed because it travels downward past the larynx, then around the aorta and, last, back up to the larynx. Sercarz, md functional laryngeal reinnervation depends upon theprecise reinnervation ofthe laryngeal abductor and adductor muscle groups. The recurrent and superior laryngeal nerves gregory w.
The recurrent laryngeal nerve rln innervates all the important laryngeal muscles except the cricothyroid. Anatomical variations of the rln, such as extra laryngeal branches, distorted rln, intertwining between branches of the rln and inferior thyroid artery, and non recurrent laryngeal nerve, can be a potential cause of nerve injury due to visual misidentification. Eleven adult cadavers 5 male6 female were dissected bilaterally to expose the path of the recurrent laryngeal nerve. Jul 26, 2019 we hope this picture recurrent laryngeal nerve anatomy can help you study and research. The recurrent laryngeal nerve rln is a branch of the vagus nerve, which carries motor, sensory and parasympathetic fibers to the larynx. The anatomy of the nerve appears more constant along its distal segment near the cricothyroid joint, which is our surgical approach to the initial identification of the nerve. May 05, 2016 the recurrent laryngeal nerve rln is a branch of the vagus nerve, which carries motor, sensory and parasympathetic fibers to the larynx. Randolph the accident of hemorrhage is a minor evil.
It is a branch of one of the cranial nerves, those nerves that lead directly from the brain rather than from the spinal cord. The recurrent laryngeal nerve carries somatic efferent axons to the larynx while the phrenic nerve carries somatic efferent fibers to the diaphragm. The laryngeal nerve is a nerve branching down from the vagus nerve towards the larynx. Because of the anatomical variations of the nerve, preservation of the nerve is the optimal strategy during surgery. The book is visually oriented with color illustrations and photomicrographs embracing all aspects of recurrent laryngeal nerve anatomy including branching.
Anatomy of the thoracic recurrent laryngeal nerves from a. The recurrent laryngeal nerve rln, also known as the inferior laryngeal nerve, is a branch of the vagus nerve cn x which has a characteristic loop around the right subclavian artery on the right and the aortic arch on the left before returning up to achieve the tracheoesophageal groove and then the larynx summary. The connection between the vagus nerve and the pharyngeal arches that give rise to the larynx is established early in development. Treatment of recurrent laryngeal nerve injury jama surgery. The importance of the recurrent laryngeal nerve in surgery on the anterior region of the neck has motivated many published papers on critical points of its pathway, relationship with the inferior. A variant nerve that mimics the left recurrent laryngeal nerve peerj. A novel variation of the recurrent laryngeal nerve bmc. The left recurrent laryngeal nerve arises from the vagus trunk, as it passes in front of the aortic arch. There were 12 cases of recurrent laryngeal nerve injury following recurrent laryngeal nerve dissection injury rate of 2.
Overall incidence of transient rlnp is reported to be 0. Optimal management of acute recurrent laryngeal nerve injury. Anatomy of recurrent laryngeal nerveanatomy of recurrent. Recurrent laryngeal nerve an overview sciencedirect topics. Full text is available as a scanned copy of the original print version. Get a printable copy pdf file of the complete article 4. Anatomical course of the thyroarytenoid branch of the recurrent.
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