Institution / Department

Wayne State University, St. George's University

Document Type

Research Abstract

Research Type

clinicalresearch

Graduate Level Research

no

Abstract

Objective

Anatomical variations in the recurrent laryngeal nerve (RLN), namely extra-laryngeal terminal bifurcation and non-recurrent inferior laryngeal nerve, are known risk factors for RLN injury during surgery and represent a considerable jeopardy for iatrogenic damage like vocal cord paralysis. This systematic review aims to identify strategies for protecting RLN during thyroid surgery from nerve damage.

Methods

A search was conducted using EMBASE, MEDLINE, and PUBMED for articles published till February 2023 while strictly adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Subject headings and keywords related to anatomical variations, recurrent laryngeal nerve, and surgical prevention strategies were included in the search to identify studies specific to this topic.

Results After total of 269 records were identified, 28 studies were included following deduplication and two levels of screening (title and abstract screening; full-text screening). Prevention strategies were grouped into two primary categories. The first category was preoperative strategies, which comprised the utility of intraoperative neuromonitoring, intraoperative neuromonitoring in continuous mode, routine X-ray, and ultrasonography. The second category was operative strategies, which included fusion surgery, left sided approaches for anterior cervical discectomy, and dissection based on anatomical landmarks such as inferior laryngeal nerves, tubercle of Zuckerkand, and the ligament of Berry.

Conclusions Extensive knowledge on prevention strategies is essential to mitigate complications associated with surgical procedures in the neck and ultimately guide improved clinical and surgical practices. Employing the summarized preoperative and operative strategies could prevent RLN injury in patients undergoing surgery involving the neck

Disciplines

Medical Anatomy | Medicine and Health Sciences | Nervous System | Otolaryngology

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