Meticulous anatomy of the recurrent laryngeal nerve and its extra<b>-</b>laryngeal branching in dogs_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHANG Wenchao , CHENG Ruochuan ,  DIAO Chang

Center for Diagnosis and Treatment of Thyroid Diseases, the First Affiliated Hospital of Kunming Medical University, Kunming 650032, P. R. China;

Corresponding author：

DIAO Chang, Email: dccom2006@qq.com

Keywords：

recurrent laryngeal nerve; extra-laryngeal branch; meticulous anatomy

DOI：

10.7507/1007-9424.202308034

Video：

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Objective To master the morphological characteristics of the recurrent laryngeal nerve (RLN) and extra-laryngeal branching (ELB) in dogs, and to provide an anatomical basis for the establishment of an animal model of injury to the ELB in dogs as well as for functional studies. Methods Six adult healthy Beagles were selected, completely dissected the thyroid gland, the full length of the cervical segment of the RLN and the ELB. Then, the location, size and morphology of the thyroid gland and the morphological features of the RLN and ELB were observed. The length of the RLN and its ELB were measured. The incidence and number of ELB and their relationship with trachea, esophagus and peripheral blood vessels were recorded. Results Six Beagles (12 sides) all had ELB. In 9 sides the main trunk of the RLN divided into internal and external branches on its way up into the larynx and converged before them entering the larynx. The total number of ELB was 48, and the number of branches on each side were ranging from 1 to 7. There were 38 ELB were located below the lowest level of the thyroid gland. Conclusions The Beagles included in this study all have ELB. The ELB were widely distributed in the cervical trachea and esophagus after branching from the internal branch of RLN. It is speculated that the ELB may be involved in the function of the cervical esophagus and trachea. In thyroid surgery, the tracheal branch and esophageal branch of the ELB should be preserved as much as possible.

Citation： ZHANG Wenchao, CHENG Ruochuan, DIAO Chang. Meticulous anatomy of the recurrent laryngeal nerve and its extra-laryngeal branching in dogs. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2023, 30(11): 1319-1322. doi: 10.7507/1007-9424.202308034 Copy

1.	Davey MG, Cleere EF, Lowery AJ, et al. Intraoperative recurrent laryngeal nerve monitoring versus visualisation alone —A systematic review and meta-analysis of randomized controlled trials. Am J Surg, 2022, 224(3): 836-841.
2.	Huang HY, Lien CF, Wang CC, et al. Necessity of routinely testing the proximal and distal ends of exposed recurrent laryngeal nerve during monitored thyroidectomy. Front Endocrinol (Lausanne), 2022, 13: 923804.
3.	Kuryga D, Wojskowicz P, Szymczuk J, et al. Training in intraoperative neuromonitoring of recurrent laryngeal nerves reduces the risk of their injury during thyroid surgery. Arch Med Sci, 2019, 17(5): 1294-1302.
4.	刘昆鹏, 代文杰. 甲状腺再次手术中喉返神经实时监测与常规显露临床对比研究. 中国实用外科杂志, 2016, 36(12): 1322-1326.
5.	赵俊, 孙善全. 甲状腺手术区喉返神经及其分支的应用解剖研究. 中华外科杂志, 2001, 39(4): 317-319.
6.	赵俊, 孙善全. 狗喉返神经袢的形态及纤维性质的鉴别. 中国临床解剖学杂志, 2005, 23(5): 509-512.
7.	Gregg RL. Avoiding injury to the extralaryngeal nerves. Ann Otol Rhinol Laryngol, 1957, 66(3): 656-678.
8.	Reed AF. The relations of the inferior laryngeal nerve to the inferior thyroid artery. Anatomical Record, 1943, 85(1): 17-23.
9.	Thomas AM, Fahim DK, Gemechu JM. Anatomical variations of the recurrent laryngeal nerve and implications for injury prevention during surgical procedures of the neck. Diagnostics (Basel), 2020, 10(9): 670.
10.	刁畅, 苏艳军, 杞灵斌, 等. 甲状腺癌根治术中喉返神经的保护策略. 2014第六届全国甲状腺肿瘤学术大会论文集, 天津, 2014: 75-76.
11.	钱军, 苏艳军, 张建明, 等. 甲状腺术中喉返神经喉外分支观察及其临床意义探讨. 中国实用外科杂志, 2013, 33(3): 221-223.
12.	赵俊, 孙善全. 喉返神经及其分支的变异与临床意义. 中国临床解剖学杂志, 2005, 23(6): 609-611.
13.	杨朝鲜, 周玲, 曾昭明, 等. 喉返神经在颈部解剖的应用. 黑龙江医学, 2003, 27(7): 508.
14.	Liebermann-Meffert DM, Walbrun B, Hiebert CA, et al. Recurrent and superior laryngeal nerves: a new look with implications for the esophageal surgeon. Ann Thorac Surg, 1999, 67(1): 217-223.
15.	Scott AR, Chong PS, Brigger MT, et al. Serial electromyography of the thyroarytenoid muscles using the NIM-response system in a canine model of vocal fold paralysis. Ann Otol Rhinol Laryngol, 2009, 118(1): 56-66.
16.	Puram SV, Chow H, Wu CW, et al. Vocal cord paralysis predicted by neural monitoring electrophysiologic changes with recurrent laryngeal nerve compressive neuropraxic injury in a canine model. Head Neck, 2016, 38 Suppl 1: E1341-E1350. doi: 10.1002/hed.24225.
17.	Henry BM, Vikse J, Graves MJ, et al. Extralaryngeal branching of the recurrent laryngeal nerve: a meta-analysis of 28 387 nerves. Langenbecks Arch Surg, 2016, 401(7): 913-923.
18.	Katz AD, Nemiroff P. Anastamoses and bifurcations of the recurrent laryngeal nerve-report of 1 177 nerves visualized. Am Surg, 1993, 59(3): 188-191.
19.	Fisahn C, Yilmaz E, Iwanaga J, et al. Avoiding the esophageal branches of the recurrent laryngeal nerve during retractor placement: precluding postoperative dysphagia during anterior approaches to the cervical spine. Global Spine J, 2019, 9(4): 383-387.
20.	黄小勇, 李艳, 邓义波, 等. 人食管壁内血管和神经的分布特点. 解剖学报, 2014, 45(2): 242-247.
21.	Dia A, Valleix D, Dixneuf B, et al. The recurrent laryngeal nerve (RLN): application to transhiatal oesophagectomy. Surg Radiol Anat, 1998, 20(1): 31-34.

1. Davey MG, Cleere EF, Lowery AJ, et al. Intraoperative recurrent laryngeal nerve monitoring versus visualisation alone —A systematic review and meta-analysis of randomized controlled trials. Am J Surg, 2022, 224(3): 836-841.
2. Huang HY, Lien CF, Wang CC, et al. Necessity of routinely testing the proximal and distal ends of exposed recurrent laryngeal nerve during monitored thyroidectomy. Front Endocrinol (Lausanne), 2022, 13: 923804.
3. Kuryga D, Wojskowicz P, Szymczuk J, et al. Training in intraoperative neuromonitoring of recurrent laryngeal nerves reduces the risk of their injury during thyroid surgery. Arch Med Sci, 2019, 17(5): 1294-1302.
4. 刘昆鹏, 代文杰. 甲状腺再次手术中喉返神经实时监测与常规显露临床对比研究. 中国实用外科杂志, 2016, 36(12): 1322-1326.
5. 赵俊, 孙善全. 甲状腺手术区喉返神经及其分支的应用解剖研究. 中华外科杂志, 2001, 39(4): 317-319.
6. 赵俊, 孙善全. 狗喉返神经袢的形态及纤维性质的鉴别. 中国临床解剖学杂志, 2005, 23(5): 509-512.
7. Gregg RL. Avoiding injury to the extralaryngeal nerves. Ann Otol Rhinol Laryngol, 1957, 66(3): 656-678.
8. Reed AF. The relations of the inferior laryngeal nerve to the inferior thyroid artery. Anatomical Record, 1943, 85(1): 17-23.
9. Thomas AM, Fahim DK, Gemechu JM. Anatomical variations of the recurrent laryngeal nerve and implications for injury prevention during surgical procedures of the neck. Diagnostics (Basel), 2020, 10(9): 670.
10. 刁畅, 苏艳军, 杞灵斌, 等. 甲状腺癌根治术中喉返神经的保护策略. 2014第六届全国甲状腺肿瘤学术大会论文集, 天津, 2014: 75-76.
11. 钱军, 苏艳军, 张建明, 等. 甲状腺术中喉返神经喉外分支观察及其临床意义探讨. 中国实用外科杂志, 2013, 33(3): 221-223.
12. 赵俊, 孙善全. 喉返神经及其分支的变异与临床意义. 中国临床解剖学杂志, 2005, 23(6): 609-611.
13. 杨朝鲜, 周玲, 曾昭明, 等. 喉返神经在颈部解剖的应用. 黑龙江医学, 2003, 27(7): 508.
14. Liebermann-Meffert DM, Walbrun B, Hiebert CA, et al. Recurrent and superior laryngeal nerves: a new look with implications for the esophageal surgeon. Ann Thorac Surg, 1999, 67(1): 217-223.
15. Scott AR, Chong PS, Brigger MT, et al. Serial electromyography of the thyroarytenoid muscles using the NIM-response system in a canine model of vocal fold paralysis. Ann Otol Rhinol Laryngol, 2009, 118(1): 56-66.
16. Puram SV, Chow H, Wu CW, et al. Vocal cord paralysis predicted by neural monitoring electrophysiologic changes with recurrent laryngeal nerve compressive neuropraxic injury in a canine model. Head Neck, 2016, 38 Suppl 1: E1341-E1350. doi: 10.1002/hed.24225.
17. Henry BM, Vikse J, Graves MJ, et al. Extralaryngeal branching of the recurrent laryngeal nerve: a meta-analysis of 28 387 nerves. Langenbecks Arch Surg, 2016, 401(7): 913-923.
18. Katz AD, Nemiroff P. Anastamoses and bifurcations of the recurrent laryngeal nerve-report of 1 177 nerves visualized. Am Surg, 1993, 59(3): 188-191.
19. Fisahn C, Yilmaz E, Iwanaga J, et al. Avoiding the esophageal branches of the recurrent laryngeal nerve during retractor placement: precluding postoperative dysphagia during anterior approaches to the cervical spine. Global Spine J, 2019, 9(4): 383-387.
20. 黄小勇, 李艳, 邓义波, 等. 人食管壁内血管和神经的分布特点. 解剖学报, 2014, 45(2): 242-247.
21. Dia A, Valleix D, Dixneuf B, et al. The recurrent laryngeal nerve (RLN): application to transhiatal oesophagectomy. Surg Radiol Anat, 1998, 20(1): 31-34.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Meticulous anatomy of the recurrent laryngeal nerve and its extra-laryngeal branching in dogs

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