A topographical description of the recurrent laryngeal nerve in paediatric cadavers

Keywords: recurrent laryngeal nerve, inferior thyroid artery, trachea-oesophageal groove, extra-laryngeal branches

Abstract

Background: The risk of injury to the recurrent laryngeal nerve (RLN) during thyroidectomy is higher in children. The aim of the study was to document the anatomy of the RLN in paediatric cadavers.

Methods: A midline incision from the mandible to the sternal notch was used to expose the structures. Exposed tissues were photographed at 15–30 cm and 45⁰ angle to the neck. The relationship of the RLN to the inferior thyroid artery (ITA) and trachea-oesophageal groove (TEG) was documented. Extra-laryngeal branching of the RLN was noted. The angles which the RLN made relative to the longitudinal axis of the TEG were documented.

Results: A total of 31 cadavers with a mean age of 39.7 ± 51.7 post-natal weeks, totalling 61 RLNs were studied. Of the right RLNs, 66.7% were within 0–15⁰ of the TEG compared to 96% on the left. Around 66.7% (20/30) of the RLNs passed anterior to the ITA on the right compared to 58.1% (18/31) on the left. Extra-laryngeal branching of the RLN was observed in 29.0% of specimens and the greatest number of branches noted were two.

Conclusion: The RLN on the left side ran within 0–15⁰ of the TEG in 96% of the cases. Around 68% of RLNs on the right side passed anterior to the ITA. Close to 30% of the RLNs gave branches. The course of the paediatric RLN is highly variable and findings on the contralateral side should not be relied on to guide dissection on the opposite side during thyroidectomy in children.

Author Biographies

J B L Kiluba, University of the Witwatersrand

School of Anatomical Sciences, Faculty of Health Sciences, University of the Witwatersrand, South Africa

C Small, University of the Witwatersrand

School of Anatomical Sciences, Faculty of Health Sciences, University of the Witwatersrand, South Africa

T E Luvhengo, University of the Witwatersrand

School of Anatomical Sciences, Faculty of Health Sciences, University of the Witwatersrand, South Africa

P Mazengenya, University of the Witwatersrand

School of Anatomical Sciences, Faculty of Health Sciences, University of the Witwatersrand, South Africa and College of Medicine, Ajman University and Center of Medical and Bio-allied Health Sciences Research, Ajman University, United Arab Emirates

Published
2022-09-21
How to Cite
Kiluba, J., Small, C., Luvhengo, T., & Mazengenya, P. (2022). A topographical description of the recurrent laryngeal nerve in paediatric cadavers. South African Journal of Surgery, 60(3), S50-S54. Retrieved from http://sajs.redbricklibrary.co.za/index.php/sajs/article/view/3718
Section
Paediatric Surgical Special Edition