A right nonrecurrent laryngeal nerve coursing near the superior pole vessels. Anatomy, head and neck, larynx recurrent laryngeal nerve. This paper attempts to redescribe in extreme detail the anatomy of this nerve in the right and left chests, as seen through the eyes of a thoracic surgeon. Relationship between the recurrent laryngeal nerve and the inferior. Right nonrecurrent inferior laryngeal nerve discovered. If you would like a large, unwatermarked image for your web page or blog, please purchase the appropriate license. Anatomy of recurrent laryngeal nerve rln dent1 pbl 3. The recurrent laryngeal nerve was first identified and named by galen in the second century. The head and neck anatomy is considered one of the toughest chapters when it comes to studying gross anatomy of 2nd year mbbs. Berke, md losangeles, california ming ye, md joel a. Anatomy of the recurrent laryngeal nerve 921 laryngeal nerve, external laryngeal and pharyngeal plexus du plessis, 1975. The recurrent inferior laryngeal nerve, more commonly the right, tends to lie anterior to the inferior thyroid artery 50% of cases.
The left recurrent laryngeal nerve is more susceptible to injury than the right nerve being more superficial and longer running from the chest up through the neck. Laryngeal nerve palsy or paralysis anatomy, physiology, classification, causes, pathophysiology video laryngeal nerve palsy usually refers to the palsy of the recurrent largyngeal nerve. The book is visually oriented with color illustrations and photomicrographs embracing all aspects of recurrent laryngeal nerve anatomy including branching. Laryngeal nerve, recurrent article about laryngeal nerve. The presence of a nonrecurrent laryngeal nerve fig. The presence of an nrln significantly increases the risk of iatrogenic injury and operative complications. You have to memorize everything pertaining to each bony structure and soft part and all the subtle details relationships etc related to them. The aim of this paper was to present our experience with rln liberations and. Recurrent laryngeal nerve rln palsy rates vary from 0.
Recurrent laryngeal nerve an overview sciencedirect topics. You may not embed one of our images on your web page without a link back to our site. The left recurrent laryngeal, three times more frequently than the right, lies behind the inferior thyroid artery. Accurate diagnosis can be made only by visualizing the vocal cords while the patient is awake. Our aim was to provide a comprehensive metaanalysis of the overall prevalence of the nrln, its origin, and its association with an aberrant subclavian artery. In the ideal donor larynx, these branches would be easily identified, large enough to permit reanastomosis, predictable in location, and singular. Motor innervation of the cricopharyngeus muscle by the.
The anatomy of the nerve appears more constant along its distal segment near the cricothyroid joint, which is our surgical approach to the initial identification of the nerve. As the recurrent nerve hooks around the subclavian artery or aorta, it gives off several cardiac filaments to. Review cuttingedge topics such as recurrent laryngeal nerve monitoring, minimally invasive surgery, management of rln paralysis, radioguided parathyroid surgery, and much more. The upper pole of the thyroid is retracted downward and laterally by a kelly clamp to expose the cricothyroid space. Enumerate the contents of anterior, middle and posterior cranial fossa. Historically, the rln has been considered to branch after it enters the larynx, but numerous studies have demonstrated that it often branches before. Recurrent laryngeal nerve rln dysfunction has been associated with laryngeal dysfunction, although swallowing dysfunction in patients with rln paresis 8, 21 has been reported. We present a 62yearold woman presented with neck pain, hoarseness, crepitus over the larynx, and what appeared to be a necrotic mass of the right true vocal cord on laryngoscopy. Injury to the recurrent laryngeal nerve is one of the most severe complications of thyroid surgery. Surgical anatomy and monitoring of the recurrent laryngeal. The superior laryngeal nerve descends, by the side of the pharynx, behind the internal carotid artery, and divides into two branches the external laryngeal nerve and the internal laryngeal nerve the external laryngeal nerve is the smaller, external branch.
Laryngeal nerve palsy or paralysis anatomy, physiology. Elizabeth davis, in equine internal medicine fourth edition, 2018. Background the non recurrent laryngeal nerve nrln is a rare embryologicallyderived variant of the recurrent laryngeal nerve rln. The recurrent and superior laryngeal nerves pdf download. The recurrent laryngeal nerve thyroid surgery wiley online. There are two recurrent laryngeal nerves, right and left, in the human body. Aug 17, 2016 recurrent laryngeal nerve paralysis 1. It descends on the larynx, beneath the sternothyroid muscle, to supply the cricothyroid muscle. Factors lead to injury of the recurrent laryngeal nerve. We hope this picture recurrent laryngeal nerve anatomy can help you study and research. It then branches into the superior and recurrent laryngeal nerves rln, of which the latter is remarkably interesting from the point of view of evolutionary biology. Its peculiar route results from evolutionary lengthening of the neck. Recurrent laryngeal nerve radiology reference article.
Nov 29, 2011 the aim of this study was to provide some important information about the morphology and topography of the recurrent laryngeal nerve rln and inferior thyroid artery ita, which significantly helps localize and protect the rln in neck surgery, especially in thyroid surgery. Jul 26, 2019 we are pleased to provide you with the picture named recurrent laryngeal nerve anatomy. The recurrent and superior laryngeal nerves 1st ed. The recurrent laryngeal nerve rln is a branch of the vagus nerve cranial nerve x that supplies all the intrinsic muscles of the larynx, with the exception of the cricothyroid muscles. The book is visually oriented with color illustrations and photomicrographs embracing all aspects of recurrent laryngeal nerve anatomy including branching patterns, relationship of the nerve and the inferior thyroid artery and the nonrecurrent recurrent laryngeal nerve. Searching for the recurrent laryngeal nerve was done while slowly moving along the capsule of the figure 1a. From there, like the recurrent laryngeal nerve on the right, it moves upward to the larynx. Although there are others more terrible and frightening. Chapter 33 surgical anatomy and monitoring of the recurrent laryngeal nerve gregory w. The recurrent and superior laryngeal nerves gregory w. The recurrent laryngeal nerve is responsible for both abduction opening and adduction closing of the vocal fold.
Recurrent laryngeal nerve rln palsy is the most common and serious complication after thyroid surgery. Anatomical variations of the rln, such as extra laryngeal branches, distorted rln, intertwining between branches of the rln and inferior thyroid artery, and non recurrent laryngeal nerve, can be a potential cause of nerve injury due to visual misidentification. As the recurrent nerve hooks around the subclavian artery or aorta, it gives off several cardiac filaments to the deep part of the cardiac plexus. We report two types of anatomical variations of the recurrent laryngeal nerve in two patients. Find out information about laryngeal nerve, recurrent. A common claim by evolutionists is that the mammalian left recurrent laryngeal nerve was poorly designed because it travels downward past the larynx, then around the aorta and, last, back up to the larynx. The recurrent laryngeal nerve rln, also known as the inferior laryngeal nerve, is a branch of the vagus nerve cn x which has a characteristic loop around the right subclavian artery on the right and the aortic arch on the left before returning up to achieve the tracheoesophageal groove and then the larynx. Several anatomic variations of the nerve increase the likelihood of iatrogenic damage. Anatomy of the thoracic recurrent laryngeal nerves from a. Eighty adult cadavers 160 sides fixed with formalin were dissected, analyzed and measured. Recurrent laryngeal nerve injury produces an abductor laryngeal paralysis.
As for good reasons owen did not draw evolutionary conclusions, there are several. Visual identification of the rln during thyroid surgery has been shown to be associated with lower rates of palsy, and although it has been recommended as the gold standard for. Previous anatomic studies of the recurrent laryngeal nerves rlns have described the variability in the course of the rln. The relationship of the recurrent laryngeal nerve to the inferior thyroid artery varies, and it is said that the recurrent laryngeal nerve ascends in the neck between the branches of. Injury can be due to surgery, trauma, bacterial or viral infection, neurotoxic drugs, and tumors. The recurrent laryngeal nerve may be traumatized during surgery on the thyroid and parathyroid glands. An aneurysm of the aorta, or another mass lesion, can apply traction to the nerve, resulting in recurrent laryngeal nerve palsy. Recurrent laryngeal nerve request pdf researchgate.
The novel variation of the recurrent laryngeal nerve may challenge the current concept of the anatomy of the nerve. Anatomy of recurrent laryngeal nerveanatomy of recurrent. Extralaryngeal branching of the recurrent laryngeal nerve. Ta the terminal branch of the recurrent laryngeal nerve as the latter passes deep to the inferior pharyngeal constrictor. The recurrent and superior laryngeal nerves springerlink. Recurrent laryngeal nerve definition of recurrent laryngeal. A window is created between the superior pole of the thyroid pole and the cricothyroid muscle. Recurrent laryngeal nerve rln injury is considered to be the most severe complication in thyroid surgery. Treatment of recurrent laryngeal nerve injury jama. The recurrent laryngeal nerve provides motor innervation to the intrinsic muscles of the larynx, which provide the majority of movement of the vocal cords see. The anatomical position, composition, associated musculature and innervation of. Randolph the accident of hemorrhage is a minor evil. The recurrent laryngeal nerve rln, also known as the inferior laryngeal nerve, is a branch of the vagus nerve cn x which has a characteristic loop around the right subclavian artery on the right and the aortic arch on the left before returnin.
A new classification system for recurrent laryngeal nerve anatomy is proposed. Recurrent laryngeal nerve injury causes and surgery. Badran,2 21department of surgery and department of anatomy and histology, faculty of medicine, university of jordan, amman, jordan. The aim of this study was to provide some important information about the morphology and topography of the recurrent laryngeal nerve rln and inferior thyroid artery ita, which significantly helps localize and protect the rln in neck surgery, especially in thyroid surgery. An applied anatomical study on the recurrent laryngeal nerve. Kendall the interpretation of laryngeal imaging in the evaluation of patients with voice problems requires a strong foundation in the anatomy and physiology of the larynx. A very rare mechanism of recurrent laryngeal nerve palsy relates to severe coughing spasms, during which the heart and great vessels can create. Vagus nerve and pharyngeal plexus name the muscles involved in facial expression. The left recurrent laryngeal nerve curves medially around the aortic arch during development and is approximately 1 m long. We are pleased to provide you with the picture named recurrent laryngeal nerve anatomy. Oct 15, 2014 vocal cord paralysis may be the first presentation of severe pathology. The recurrent laryngeal nerve is an often cited example of unintelligent design in biology, especially in the giraffe.
Intralaryngeal anatomy of the recurrent laryngeal nerve. Radiologists must be aware of imaging characteristics and mimics of vocal cord paralysis. The recurrent and superior laryngeal nerves will be of great value to otolaryngologists and general surgeons, endocrine surgeons, fellows in endocrine, head and neck surgery, general surgery and otolaryngology residents. The laryngeal nerve is a nerve branching down from the vagus nerve towards the larynx. Lesions along the vagal nerves and recurrent laryngeal nerves can cause vocal cord paralysis. Laryngeal scca usually presents with hoarseness when the glottis is involved, dysphagia if the supraglottis is involved, and difficulty of breathing and stridor in subglottic invovlement. Reputable anatomy books describe the rln in cadavers, and this doesnt pay a great service to the surgical practice on living humans 11,12. All chapters are written by world class us and international experts in anatomy, surgery and nerve monitoring. Sercarz, md functional laryngeal reinnervation depends upon theprecise reinnervation ofthe laryngeal abductor and adductor muscle groups. This book is distributed under the terms of the creative commons attribution. B right nonrecurrent laryngeal nerve loops around the inferior thyroid artery.
Anatomical variations of recurrent laryngeal nerve. A novel variation of the recurrent laryngeal nerve gaosong wu1,2 and kun wang2 abstract background. An applied anatomical study on the recurrent laryngeal. A novel variation of the recurrent laryngeal nerve bmc. Anatomical variations of the recurrent laryngeal nerve in. If you would like a large, unwatermarked image for your web page or. Pdf microneuroanatomy of the vagus, superior laryngeal, and recurrent. B right nonrecurrent laryngeal nerve loops around the. Anatomy, head and neck, larynx recurrent laryngeal nerve ncbi. Sometimes this nerve can assume an unusual pathway, coursing directly into the larynx. The patient was discharged on the third postoperative day with the diagnoses of papillary thyroid carcinoma and congenital left vocal cord paralysis.
The recurrent laryngeal nerve rln is a branch of the vagus nerve, which carries motor, sensory and parasympathetic fibers to the larynx. Background the nonrecurrent laryngeal nerve nrln is a rare embryologicallyderived variant of the recurrent laryngeal nerve rln. A designer would not make such an unnecessary diversion, and indeed it. The recurrent inferior laryngeal nerve riln origins from the vagus trunk and, recurring into the mediastinum, courses then into the larynx. This anomaly is the socalled nonrecurrent inferior laryngeal nerve nriln and represents a rare entity, with an incidence between 0. The vocal cord assumes a median or paramedian position. The cricopharyngeus muscle cpm is the most inferior pharyngeal muscle and it inserts on the lamina of the thyroid. Anatomical variations of recurrent laryngeal nerve during. Surgical anatomy of the recurrent laryngeal nerve revisited. Access surgery of the thyroid and parathyroid glands online at. May 05, 2016 the recurrent laryngeal nerve rln is a branch of the vagus nerve, which carries motor, sensory and parasympathetic fibers to the larynx.
Pdf the recurrent laryngeal nerve can be a real challenge to the surgeon operating in its area. The anatomical relationship between the recurrent laryngeal nerve rln and the. Overall incidence of transient rlnp is reported to be 0. The cricopharyngeus muscle cpm is the most inferior pharyngeal muscle. Galen found that vagal sectioning in a pig resulted in aphonia.
The left recurrent laryngeal nerve branches from the vagal nerve just below the ligamentum arteriosum at the level of the aortopulmonary ap window and moves dorsally under the aortic arch in the direction of the left te groove fig. Practitioners interested in maximizing the information obtained from laryngeal imaging must be familiar with laryngeal anatomy. Most authors, beyond the classic anatomy textbooks, recognize 3 types of. Through these two patients we wanted to highlight our surgical approach of the recurrent nerve in an unusual position and to describe the surgical implication of these almost rare variations. Recurrent laryngeal nerve the recurrent laryngeal nerve is a myelinated nerve. We present one case of herpetic laryngitis by reactivation of varicella zoster, with central nervous system spreading, and discuss the relevant literature on the pathophysiology, diagnosis, evaluation, and management of this disease. Dec, 2014 anatomy of recurrent laryngeal nerveanatomy of recurrent laryngeal nerveanatomy of recurrent laryngeal 1. The left recurrent laryngeal nerve design in mammals is not poor design. Summary the recurrent laryngeal nerve was first identified and named by galen in the second century. The presumed course of the recurrent laryngeal nerve in sauropod. The wide variability of this extralaryngeal branching elb has significant implications for the risk of.
The rln is consistently present superior to the inferior thyroid artery before it ascends behind the inferior constrictor to the nerves entry point into the larynx. Surgical anatomy and monitoring of the recurrent laryngeal nerve. The recurrent laryngeal nerve rln, also known as the inferior laryngeal nerve, is a branch of the vagus nerve cn x which has a characteristic loop around the right subclavian artery on the right and the aortic arch on the left before returning up to achieve the tracheoesophageal groove and then the larynx summary. The recurrent laryngeal nerves rln are branches of the vagus nerve that go on to innervate most of the intrinsic muscles of the larynx.
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