nach oben

Erschienen in:

08.02.2024 | Anatomic Variations

Anatomical variations of recurrent laryngeal nerve: a systematic review and meta-analyses

verfasst von: Gabriel Valentim dos Santos Menezes Siqueira, Marcos Henrique dos Santos Rodrigues, Caio Nemuel Nascimento Santos, Paulo Eduardo Gonçalves, Diogo Costa Garção

Erschienen in: Surgical and Radiologic Anatomy | Ausgabe 3/2024

Einloggen, um Zugang zu erhalten

Abstract

Purpose

The aim of this systematic review and meta-analysis was to systematically review and perform a meta-analysis on the anatomical variations of the RLN.

Methods

We performed online research for studies that addressed anatomical variations of the RLN and laterality, published between 2015 and 2021. We found 230 articles, and nine were included.

Results

Eight variations were found, with Type I prevailing (41.17%; 95% CI 19.44–64.88), extra laryngeal divergence of the RLN. The other types were: II—fan shape; III—distance greater than 5 mm to the cricothyroid joint; IV—thickening and adipopexy in the elderly; V—non-recurrent laryngeal nerve; VI—intracranial branch; VII—tortuous ascending RLN; and VIII—combination between the inferior branch of the NV and the ascending trunk of the RLN. Types I (p = 0) and III (p < 0.01) prevailed on the left and types II (p < 0.01) and V (p < 0.01) on the right.

Conclusions

It was observed that variations occurred due to the path of the RLN to the entrance to the larynx, its shape, and the age of the evaluated individual. The most frequent variation and side were, respectively, Type I, extra laryngeal divergence and left.

Ardito G, Revelli L, D’Alatri L, Lerro V, Guidi ML, Ardito F (2004) Revisited anatomy of the recurrent laryngeal nerves. Am J Surg 187:249–253. https://doi.org/10.1016/j.amjsurg.2003.11.001CrossRefPubMed

Beneragama T, Serpell JW (2006) Extralaryngeal bifurcation of the recurrent laryngeal nerve: a common variation. ANZ J Surg 76:928–931. https://doi.org/10.1111/j.1445-2197.2006.03899.xCrossRefPubMed

Beutler WJ, Sweeney CA, Connolly PJ (2001) Recurrent laryngeal nerve injury with anterior cervical spine surgery. Spine 26:1337–1342. https://doi.org/10.1097/00007632-200106150-00014CrossRefPubMed

Cannon CR (1999) The anomaly of nonrecurrent laryngeal nerve: identification and management. Otolaryngol Head Neck Surg 120:769–771. https://doi.org/10.1053/hn.1999.v120.a84675CrossRefPubMed

Casella C, Pata G, Nascimbeni R, Mittempergher F, Salerni B (2009) Does extralaryngeal branching have an impact on the rate of postoperative transient or permanent recurrent laryngeal nerve palsy? World J Surg 33:261–265. https://doi.org/10.1007/s00268-008-9832-1CrossRefPubMed

Cetin F, Gürleyik E, Dogan S (2016) Morphology and functional anatomy of the recurrent laryngeal nerve with extralaryngeal terminal bifurcation. Anat Res Int 2016:1–5. https://doi.org/10.1155/2016/9503170CrossRef

Dionigi G, Wu C-W, Kim HY, Rausei S, Boni L, Chiang F-Y (2016) Severity of recurrent laryngeal nerve injuries in thyroid surgery. World J Surg 40(6):1373–1381. https://doi.org/10.1007/s00268-016-3415-3CrossRefPubMed

Dolezel R, Jarosek J, Hana L, Ryska M (2015) Clinical relevance and surgical anatomy of non-recurrent laryngeal nerve: 7 year experience. Surg Radiol Anat 37:321–325. https://doi.org/10.1007/s00276-014-1369-4CrossRefPubMed

Fatogoma Issa K, Sidiki D, Naouma C, Kassim D, N’Faly K, Djibril S, Neuilly T, Abdoul Wahab H, Boubacary G, Siaka S, Kadidiatou S, Samba Karim T, Mohamed Amadou K (2019) Superior approach of recurrent laryngeal nerve: review of the literature. J Thyroid Res 2019:1–5. https://doi.org/10.1155/2019/5671816CrossRef

10.

Forde R, Williams E (2015) The non recurrent laryngeal nerve—a rare phenomenon which requires vigilance. West Indian Med J. https://doi.org/10.7727/wimj.2014.223CrossRefPubMedPubMedCentral

11.

Gurleyik E (2015) Location of motor fibers within branches of the recurrent laryngeal nerve with extralaryngeal terminal bifurcation; Functional identification by intraoperative neuromonitoring. Surgery 158:1339–1344. https://doi.org/10.1016/j.surg.2015.04.019CrossRefPubMed

12.

Gurleyik E, Gurleyik G (2016) Nonrecurrent Laryngeal nerve in the era of intraoperative nerve monitoring. Adv Med 2016:1–4. https://doi.org/10.1155/2016/1606029CrossRef

13.

Henry BM, Sanna S, Graves MJ, Vikse J, Sanna B, Tomaszewska IM et al (2017) The non-recurrent laryngeal nerve: a meta-analysis and clinical considerations. PeerJ 5:e3012. https://doi.org/10.7717/peerj.3012CrossRefPubMedPubMedCentral

14.

Henry BM, Tomaszewski KA, Ramakrishnan PK, Roy J, Vikse J, Loukas M et al (2017) Development of the anatomical quality assessment (AQUA) tool for the quality assessment of anatomical studies included in meta-analyses and systematic reviews. Clin Anat 30:6–13. https://doi.org/10.1002/ca.22799CrossRefPubMed

15.

Henry BM, Tomaszewski KA, Walocha JA (2016) Methods of Evidence-based anatomy: a guide to conducting systematic reviews and meta-analysis of anatomical studies. Ann Anat Anatomischer Anzeiger 205(205):16–21. https://doi.org/10.1016/j.aanat.2015.12.002CrossRefPubMed

16.

Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ et al Cochrane handbook for systematic reviews of interventions. Version 6.2.2021

17.

Jeannon J-P, Orabi AA, Bruch GA, Abdalsalam HA, Simo R (2009) Diagnosis of recurrent laryngeal nerve palsy after thyroidectomy: a systematic review. Int J Clin Pract 63:624–629. https://doi.org/10.1111/j.1742-1241.2008.01875.xCrossRefPubMed

18.

Medina-Ruíz BA, Osorio-Fleitas M, Persano MB, Dami HR, Vega RB, Ottone NE (2018) Prevalence of the right nonrecurrent inferior laryngeal nerve in a series of 100 total thyroidectomies. Int J Morphol 36:149–158. https://doi.org/10.4067/S0717-95022018000100149CrossRef

19.

Moradi A, Hajian A (2021) The intracranial branch; a rare anatomical variation of the recurrent laryngeal nerve; case report. Int J Surg Case Rep 78:9–11. https://doi.org/10.1016/j.ijscr.2020.12.009CrossRefPubMed

20.

Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, The PRISMA et al (2020) statement: an updated guideline for reporting systematic reviews. BMJ 2021:n71. https://doi.org/10.1136/bmj.n71CrossRef

21.

Richer SL, Randolph GW (2009) Management of the recurrent laryngeal nerve in thyroid surgery. Oper Tech Otolaryngol Head Neck Surg 20:29–34. https://doi.org/10.1016/j.otot.2009.02.006CrossRef

22.

Santos CMC, Pimenta CA M, Nobre MRC (2007) The PICO strategy for the research question construction and evidence search. Rev Lat Am Enfermagem 15:508–511. https://doi.org/10.1590/S0104-11692007000300023

23.

Schwarzer G, Carpenter JR, Rücker G (2015) Meta-analysis with R. Springer International Publishing, Cham. https://doi.org/10.1007/978-3-319-21416-0

24.

Shao T, Qiu W, Yang W (2016) Anatomical variations of the recurrent laryngeal nerve in Chinese patients: a prospective study of 2,404 patients. Sci Rep 6:25475. https://doi.org/10.1038/srep25475CrossRefPubMedPubMedCentral

25.

Shao T, Qiu W, Yang W (2016) Confirmation of an anatomic variation of the recurrent laryngeal nerve at site of entry into the larynx in Chinese population. Am J Otolaryngol 37:351–355. https://doi.org/10.1016/j.amjoto.2015.10.011CrossRefPubMed

26.

Tang WJ, Sun SQ, Wang XL, Sun YX, Huang HX (2012) An applied anatomical study on the recurrent laryngeal nerve and inferior thyroid artery. Surg Radiol Anat SRA 34:325–332. https://doi.org/10.1007/s00276-011-0905-8CrossRefPubMed

27.

Thomas AM, Fahim DK, Gemechu JM (2020) Anatomical Variations of the recurrent laryngeal nerve and implications for injury prevention during surgical procedures of the neck. Diagnostics 10:670. https://doi.org/10.3390/diagnostics10090670CrossRefPubMedPubMedCentral

28.

Thompson N, Mastitskaya S, Holder D (2019) Avoiding off-target effects in electrical stimulation of the cervical vagus nerve: Neuroanatomical tracing techniques to study fascicular anatomy of the vagus nerve. J Neurosci Methods 325:108325. https://doi.org/10.1016/j.jneumeth.2019.108325CrossRefPubMedPubMedCentral

29.

Toniato A, Boschin IM, Pagetta C, Casalide E, Pelizzo M (2010) A ‘“Pilot light”’ of the right non-recurrent laryngeal nerve. Acta Otorhinolaryngol Ital 30:107–109PubMedPubMedCentral

30.

Uludag M, Aygun N, Isgor A (2016) Motor function of the recurrent laryngeal nerve: sometimes motor fibers are also located in the posterior branch. Surgery 160:153–160. https://doi.org/10.1016/j.surg.2016.02.003CrossRefPubMed

31.

Uludag M, Yetkin G, sen Oran E, Aygun N, Celayir F, Isgor A (2017) Extralaryngeal division of the recurrent laryngeal nerve: a common and asymmetric anatomical variant. Turk J Surg 33:164–168. https://doi.org/10.5152/UCD.2016.3321

32.

Yin C, Song B, Wang X (2021) anatomical variations in recurrent laryngeal nerves in thyroid surgery. Ear Nose Throat J 100:930S-936S. https://doi.org/10.1177/0145561320927565CrossRefPubMed

Titel: Anatomical variations of recurrent laryngeal nerve: a systematic review and meta-analyses
verfasst von: Gabriel Valentim dos Santos Menezes Siqueira
Marcos Henrique dos Santos Rodrigues
Caio Nemuel Nascimento Santos
Paulo Eduardo Gonçalves
Diogo Costa Garção
Publikationsdatum: 08.02.2024
Verlag: Springer Paris
Erschienen in: Surgical and Radiologic Anatomy / Ausgabe 3/2024
Print ISSN: 0930-1038
Elektronische ISSN: 1279-8517
DOI: https://doi.org/10.1007/s00276-023-03293-7

Update Radiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Anatomical variations of recurrent laryngeal nerve: a systematic review and meta-analyses