Yin Chuanchang, Song Bin, Wang Xiaoyan
Department of Thyroid Surgery, Jingzhou No. 1 People's Hospital and First Affiliated Hospital of Yangtze University, Hubei Province, China.
Department of Pathology, Jingzhou No. 1 People's Hospital and First Affiliated Hospital of Yangtze University, Hubei Province, China.
Ear Nose Throat J. 2021 Dec;100(10_suppl):930S-936S. doi: 10.1177/0145561320927565. Epub 2020 Jun 4.
To study terminal bifurcation of recurrent laryngeal nerves (RLNs) with original direction to larynx entry and to decrease the risk of vocal cord paralysis in thyroid patients.
The RLNs of 294 patients (482 sides) were dissected according to the branches into the larynx, and the original direction of each RLN trunk in thyroid surgery was recorded.
(1) About 30.9% of the RLNs gave off multiple branches into the larynx. (2) Two and 3 branches of RLNs into the larynx were found in 25.5% and 5.4% of the cases, respectively. (3) In 0.4% or 2 cases, the RLN trunk combined with the inferior branch of the vagus nerve. (4) Nonrecurrent laryngeal nerve appeared in 2 cases. (5) On the left side, 68.0%, 25.6%, and 6.4% of cases were found with 1, 2, and 3 bifurcations of RLN to larynx entry, respectively. On the right side, 69.8%, 25.8%, and 4.4% cases were identified with 1, 2, and 3 bifurcations of RLN to larynx entry, respectively. (6) The combining dissection approach was proved as successful and safe for protecting the RLN with no permanent RLN paresis.
Because of the anatomical variation in RLNs with extralaryngeal bifurcation, it is necessary to increase the awareness of surgeons about these variations so as to protect bifurcated nerves in thyroid surgery.
研究喉返神经（RLNs）向喉入口的原始走行方向的终末分支情况，以降低甲状腺手术患者声带麻痹的风险。
对294例患者（482侧）的喉返神经按其入喉分支进行解剖，并记录甲状腺手术中各喉返神经主干的原始走行方向。
（1）约30.9%的喉返神经发出多支入喉。（2）分别有25.5%和5.4%的病例中发现喉返神经有2支和3支入喉。（3）在0.4%（2例）中，喉返神经主干与迷走神经下支合并。（4）发现2例非喉返神经。（5）左侧，分别有68.0%、25.6%和6.4%的病例喉返神经至喉入口处有1、2和3个分支。右侧，分别有69.8%、25.8%和4.4%的病例喉返神经至喉入口处有1、2和3个分支。（6）联合解剖方法被证明对保护喉返神经是成功且安全的，无永久性喉返神经麻痹。
由于喉返神经存在喉外分支的解剖变异，有必要提高外科医生对这些变异的认识，以便在甲状腺手术中保护分支神经。
