Variations in Recurrent Laryngeal Nerve in Thyroidectomy

The aim of this study was to identify and evaluate variations in anatomy and the course of Recurrent. Laryngeal nerve (RLN) with respect to various landmarks. A retrospective study was conducted in the department of ENT and head and neck surgery in our institute including 52 eu-thyroid cases who had undergone primary thyroid surgery over a period of 1 year. 48 cases underwent hemi-thyroidectomy and 4 had total thyroidectomy. During the surgery the anatomy and relationship to surrounding structures of the RLN that were observed were recorded and compiled among the 56 sides that were operated on, RLN was identified as a single trunk in 47 cases (83.9%). The nerve showed extra-laryngeal branches in 6 cases (10.7%) while 3 cases were found to have degenerated RLN. None of the cases were found with a non-recurrent laryngeal nerve. With respect to inferior thyroid artery (ITA), 82% cases had the nerve passing deep to it and in the rest 18% the nerve passed anterior to the artery. While in none of the cases the nerve passed in between the branches of the artery. With respect to the tracheo-esophageal groove, RLN was found within the groove in 44 cases, while in 12 cases RLN was located lateral to the trachea-oesophageal groove. In the current study, variations in the anatomy of RLN was found less frequently, owing to the comparatively small sample size. The ITA and trachea-esophageal groove were both found as reliable landmarks for tracking the RLN.