Ann Surg Treat Res.  2024 Feb;106(2):63-67. 10.4174/astr.2024.106.2.63.

The use of superior parathyroid gland as an anatomical landmark in identifying recurrent laryngeal nerve during total thyroidectomy: a prospective single-surgeon study

• Gurluler E

• KMID: 2552386
• DOI: http://doi.org/10.4174/astr.2024.106.2.63

Abstract

Purpose
This study was performed to determine the anatomical position of recurrent laryngeal nerve (RLN) relative to superior parathyroid gland (SPG) in a consecutive total thyroidectomy series.
Methods
A total of 421 patients (mean age, 45.6 years; female, 76.0%) who had total thyroidectomy accompanied with intraoperative exposure of RLN in relation to SPG were included in this prospective single-surgeon thyroidectomy series study. The relation of RLN to SPG was assessed based on the measurement of the natural distance between the RLN and SPG, which was categorized as 0–5 mm, 6–10 mm, and ≥11 mm.
Results
Most of the thyroidectomy indications (69.1%) were related to malignant disease including papillary carcinoma in 54.9% of cases. Overall, in 90.7% of patients RLN was identified within 5 mm of the SPG, and in 65.1% of cases, it was found within 1 mm of the SPG. The RLN was found between 6 and 10 mm from the SPG in 8.5% of cases, while it was at least 11 mm away from the SPG in 0.7% of cases.
Conclusion
In conclusion, this prospective single-surgeon thyroidectomy series study indicates the likelihood of localizing the RLN in close proximity to SPG during total thyroidectomy operations. Hence, the SPG can be used as a landmark to identify RLN, and as part of routine parathyroid-sparing thyroidectomy, it may represent a convenient complementary approach to minimize the risk of iatrogenic injury to RLN in patients with an intact SPG.

Keyword

Anatomic landmarks; Parathyroid glands; Peripheral nerve injury; Recurrent laryngeal nerve; Thyroidectomy

Figure

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  Fig. 1 The categories used for the assessment of the distance recorded between the recurrent laryngeal nerve and superior parathyroid gland.

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  Fig. 2 The recorded distance between recurrent laryngeal nerve and superior parathyroid gland in total thyroidectomy patients.

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