Recurrent laryngeal nerve
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RE VIE W AR T I CL E
Recurrent Laryngeal Nerve. Surgical Anatomy and Perioperative Visualization I.M. Koutelidakis, A. Doundis, G. Chatzimavroudis, J. Makris
Abstract Recurrent laryngeal nerve (RLN) injury is considered to be the most severe complication in thyroid surgery. Overall incidence of transient RLNP is reported to be 0.4-12%, and that of permanent RLNP can reach up to 5–6%. In order to decrease the rates of RLNP and to determine clinical practice guidelines for the advancement of thyroid surgery, a thorough knowledge of the surgical anatomy of the neck, assessment of current guidelines and evaluation of the new techniques are required. Intraoperative neuromonitoring (IONM) of the RLN has been proposed for the identification and protection of the RLN. Preoperative and postoperative laryngoscopy is indispensable for reliable functional nerve assessment and RLNP management in thyroid surgery, with or without the usage of IONM. The international standards guideline statement of the International Intraoperative Monitoring Study Group focuses on the use of IONM as this new technique appears to be gaining a pivotal role in the identification, protection and management of the RLN. RLN injury is the most severe complication in thyroid surgery. In order to eliminate this complication, apart from a profound knowledge of the regional anatomy, thyroid surgeons should also take into account current clinical practice guidelines and enhance them with their clinical experience and new data published in the literature. Key words: Recurrent laryngeal nerve injury, intraoperative neuromonitoring
Introduction “The surgeon who deals with pathological conditions of the neck, particularly of the thyroid, encounters one structure of vital importance, i.e., the recurrent laryngeal nerve. Only those who have seen injuries of the nerve so severe as to require tracheotomy, and have realized that the impairment of the voice might be permanent, can appreciate its vital importance” [1]. Recurrent laryngeal nerve (RLN) injuryis considered to be the most severe complication in thyroid surgery. The ratesof RLN palsy (RLNP) vary in the literature.The overall incidence of transient RLNP is reported to be 0.4-12%, and that of permanent RLNP can reach up to 5–6% [2]. Risk factors for RLN injury include malignancy, particularly cancer justifying an extensive surgical procedure with lymph node dissection, voluminous inflammatory goitre, reoperative surgery, especially for bleeding complications, a history of neck irradiation, anatomical variants of the nerve, the absence of identification of this variant, absence of identification of the RLN and limited operator experience [3]. I.M. Koutelidakis, A. Doundis,. G. Chatzimavroudis, J. Makris 2nd Department of Surgery, Medical School, Aristoteleio University of Thessaloniki, Greece Corresponding author: I. Koutelidakis e-mail: [email protected] Received 15 Oct 2014; Accepted 30 Oct 2014
Hellenic Journal of Surgery 87
RLN section, always responsible for permanent RLNP, is a very rare event (0.4
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