Erfan Saba, Saha Somnath, Guha Ruma, Sen Indranil, Kulkarni Shubhankar
Department of ENT, College of Medicine, Sagore Dutta Hospital Kamarhati, Kamarhati, Kolkata, West Bengal 700058 India.
Department of ENT, Bankura Sammilani Medical College and Hospital, Bankura, West Bengal India.
Indian J Otolaryngol Head Neck Surg. 2024 Apr;76(2):1959-1964. doi: 10.1007/s12070-023-04465-y. Epub 2024 Jan 8.
Surgical management of a diseased thyroid depends on sonological and pathological evaluation and thereby, planning of the surgery. The definite surgery has two objectives: removal of the diseased gland and preservation of the nerves, namely EBSLN (External Branch of Superior Laryngeal Nerve) and RLN (Recurrent Laryngeal Nerve) and the Parathyroid glands. The objectives of the study were: (1) To identify the course of the RLN and EBSLN of both sides, during Thyroidectomy. (2) To discern various anatomical landmarks, the relations of the two nerves with them and anatomical variations, if any. In this Prospective observational study, fifty selected goitre patients underwent various types of thyroidectomies based on sonological and cytological criteria. The course and anatomical variations of EBSLN and RLN were photo-documented and results were analysed. Most of the EBSLN were found as Cernea type 1 type (25 out of 50), followed by Cernea type 2a (comprising 36%). The least common was type 2b. It was found that 36 out of 50 (72%) of RLN passed posterior to Inferior Thyroid Artery (ITA). Moreover, before piercing cricothyroid joint, the RLN showed bifurcation in 13 out of 50 subjects (26%), 1 participant had trifurcation and the remaining 36 (72%) had a single trunk. The EBSLN shows relation to the horizontal plane passing through the upper pole of the thyroid gland and it is more prone to get damaged when it passes within less than 1 cm to the plane. The RLN has various relations to the distinct anatomical landmarks thereby helping in safe dissection of the nerve. The study also noted the RLN in relation to ITA and branching before entering into the cricothyroid joint.
病变甲状腺的手术管理取决于超声和病理评估，进而取决于手术规划。确定性手术有两个目标：切除病变腺体以及保留神经，即喉上神经外支（EBSLN）、喉返神经（RLN）和甲状旁腺。本研究的目的是：（1）在甲状腺切除术中确定双侧RLN和EBSLN的走行。（2）识别各种解剖标志、两条神经与它们的关系以及解剖变异（如有）。在这项前瞻性观察研究中，50例选定的甲状腺肿患者根据超声和细胞学标准接受了各种类型的甲状腺切除术。对EBSLN和RLN的走行及解剖变异进行了拍照记录并分析结果。大多数EBSLN为塞尔内亚1型（50例中有25例），其次是塞尔内亚2a型（占36%）。最不常见的是2b型。发现50例中有36例（72%）的RLN走行于甲状腺下动脉（ITA）后方。此外，在穿入环甲关节之前，50例中有13例（26%）的RLN出现分叉，1例出现三叉，其余36例（72%）为单干。EBSLN与穿过甲状腺上极的水平面有关，当它在距该平面不到1厘米的范围内通过时更容易受损。RLN与不同的解剖标志有多种关系，从而有助于安全地解剖该神经。该研究还记录了RLN与ITA的关系以及在进入环甲关节之前的分支情况。
