A systematic approach to the recurrent laryngeal nerve dissection at the cricothyroid junction
Abstract Background To describe and evaluate a four step systematic approach to dissecting the recurrent laryngeal nerve (RLN) starting at the cricothyroid junction during thyroid surgery (subsequently referred to as the retrograde medial approach). Methods All thyroidectomies completed by the senio...
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SAGE Publishing
2018-09-01
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| Series: | Journal of Otolaryngology - Head and Neck Surgery |
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| Online Access: | http://link.springer.com/article/10.1186/s40463-018-0306-7 |
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| author | Oleksandr Butskiy Brent A. Chang Kimberly Luu Robert M. McKenzie Donald W. Anderson |
| author_facet | Oleksandr Butskiy Brent A. Chang Kimberly Luu Robert M. McKenzie Donald W. Anderson |
| author_sort | Oleksandr Butskiy |
| collection | DOAJ |
| description | Abstract Background To describe and evaluate a four step systematic approach to dissecting the recurrent laryngeal nerve (RLN) starting at the cricothyroid junction during thyroid surgery (subsequently referred to as the retrograde medial approach). Methods All thyroidectomies completed by the senior author between August 2014 and January 2016 were retrospectively reviewed. Patients were excluded if concurrent lateral or central neck dissection was performed. A follow up period of 1 year was included. Results Surgical photographs and illustrations demonstrate the four steps in the retrograde medial approach to dissection of the RLN in thyroid surgery. Three hundred forty-two consecutive thyroid surgeries were performed in 17 months, including 213 hemithyroidectomies, 91 total thyroidectomies, and 38 completion thyroidectomies. The rate of temporary and permanent hypocalcemia was 13% (95% confidence interval [CI]: 8–20%) and 3% (95% CI: 1–8%) respectively. The rate of temporary and permanent vocal cord palsy was 9% (95% CI: 6–12%) and 0.3% (95%CI: 0.01–2%) respectively. The median surgical times for hemithyroidectomy, total thyroidectomy, and completion thyroidectomy were 39 min (Interquartile range [IQR]: 33–47 min), 48 min (IQR: 40–60 min), and 40 min (IQR: 35–51 min) respectively. 1% of cases required conversion to an alternative surgical approach. Conclusion In a tertiary endocrine head and neck practice, the routine use of the retrograde medial approach to RLN dissection is safe and results in a short operative time, and a low conversion rate to other RLN dissection approaches. |
| format | Article |
| id | doaj-art-8a76a855f55b42b8937d48d241ec8c19 |
| institution | Kabale University |
| issn | 1916-0216 |
| language | English |
| publishDate | 2018-09-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Journal of Otolaryngology - Head and Neck Surgery |
| spelling | doaj-art-8a76a855f55b42b8937d48d241ec8c192025-02-03T00:22:57ZengSAGE PublishingJournal of Otolaryngology - Head and Neck Surgery1916-02162018-09-014711910.1186/s40463-018-0306-7A systematic approach to the recurrent laryngeal nerve dissection at the cricothyroid junctionOleksandr Butskiy0Brent A. Chang1Kimberly Luu2Robert M. McKenzie3Donald W. Anderson4Division of Otolaryngology – Head & Neck Surgery, University of British ColumbiaDivision of Otolaryngology – Head & Neck Surgery, University of British ColumbiaDivision of Otolaryngology – Head & Neck Surgery, University of British ColumbiaDivision of Otolaryngology – Head & Neck Surgery, University of British ColumbiaDivision of Otolaryngology – Head & Neck Surgery, University of British ColumbiaAbstract Background To describe and evaluate a four step systematic approach to dissecting the recurrent laryngeal nerve (RLN) starting at the cricothyroid junction during thyroid surgery (subsequently referred to as the retrograde medial approach). Methods All thyroidectomies completed by the senior author between August 2014 and January 2016 were retrospectively reviewed. Patients were excluded if concurrent lateral or central neck dissection was performed. A follow up period of 1 year was included. Results Surgical photographs and illustrations demonstrate the four steps in the retrograde medial approach to dissection of the RLN in thyroid surgery. Three hundred forty-two consecutive thyroid surgeries were performed in 17 months, including 213 hemithyroidectomies, 91 total thyroidectomies, and 38 completion thyroidectomies. The rate of temporary and permanent hypocalcemia was 13% (95% confidence interval [CI]: 8–20%) and 3% (95% CI: 1–8%) respectively. The rate of temporary and permanent vocal cord palsy was 9% (95% CI: 6–12%) and 0.3% (95%CI: 0.01–2%) respectively. The median surgical times for hemithyroidectomy, total thyroidectomy, and completion thyroidectomy were 39 min (Interquartile range [IQR]: 33–47 min), 48 min (IQR: 40–60 min), and 40 min (IQR: 35–51 min) respectively. 1% of cases required conversion to an alternative surgical approach. Conclusion In a tertiary endocrine head and neck practice, the routine use of the retrograde medial approach to RLN dissection is safe and results in a short operative time, and a low conversion rate to other RLN dissection approaches.http://link.springer.com/article/10.1186/s40463-018-0306-7Surgical techniqueThyroidectomyRecurrent laryngeal nerveRetrograde dissectionSurgical anatomy |
| spellingShingle | Oleksandr Butskiy Brent A. Chang Kimberly Luu Robert M. McKenzie Donald W. Anderson A systematic approach to the recurrent laryngeal nerve dissection at the cricothyroid junction Journal of Otolaryngology - Head and Neck Surgery Surgical technique Thyroidectomy Recurrent laryngeal nerve Retrograde dissection Surgical anatomy |
| title | A systematic approach to the recurrent laryngeal nerve dissection at the cricothyroid junction |
| title_full | A systematic approach to the recurrent laryngeal nerve dissection at the cricothyroid junction |
| title_fullStr | A systematic approach to the recurrent laryngeal nerve dissection at the cricothyroid junction |
| title_full_unstemmed | A systematic approach to the recurrent laryngeal nerve dissection at the cricothyroid junction |
| title_short | A systematic approach to the recurrent laryngeal nerve dissection at the cricothyroid junction |
| title_sort | systematic approach to the recurrent laryngeal nerve dissection at the cricothyroid junction |
| topic | Surgical technique Thyroidectomy Recurrent laryngeal nerve Retrograde dissection Surgical anatomy |
| url | http://link.springer.com/article/10.1186/s40463-018-0306-7 |
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