Endocrine Abstracts

Background: Recurrent laryngeal nerve palsy (RNLP) is an established morbidity in thyroidectomy with a variable prevalence. Many risk factors are associated with RNLP and several common mechanisms of injury need to be considered by surgeons. Various anatomical landmarks are used to identify the recurrent laryngeal nerve (RLN) intraoperatively with differing levels of prevalence and significance. Variations of the nerve can complicate the procedure for many surgeons and are associated with nerve injury. Preventative methods can be used to mitigate against RNLP, although considerable controversy exists as to the most effective method.

Methods: A literature search was carried out using PubMed, to identify relevant papers using Boolean operators, such as AND and OR. Key words were utilised, for example, “variations”, “landmarks” and “preventative methods”.

Results: Repeat goiter operations and malignancy have the highest rates of palsy and the most common mechanisms of injury are traction and thermal injuries. The tracheooesphageal groove (TOG) and inferior thyroid artery (ITA) have a higher variability in their relationship to the nerve, whereas the Zuckerkandl tubercle (ZT) and Berry’s ligament (BL) have higher consistent relationships. Extralaryngeal branching poses a high risk of palsy due to their high prevalence. Intraoperative visualisation (IOV) is the gold standard currently for preserving the nerve, but certain injuries can only be detected by intraoperative neuromonitoring (IONM). However, there are no statistically significant differences in palsy rates between either method.

Conclusions: The ZT and BL are effective landmarks to identify the nerve by surgeons. IOV is still the main method to preserve the nerve but IONM may play a role as an adjunct. Further studies with larger sample sizes are needed to reduce biases.