Recurrent Laryngeal Nerve

In a recent study 19 of recurrent laryngeal nerves based on the dissection of 100 cadavers, it was found that of the 200 nerves 57 per cent entered the larynx without having branched at any point, whereas 43 per cent were divided trunk nerves with from two to as many as six branches. Furthermore, in 35 per cent of the cadavers, both recurrent laryngeal nerves were single-trunk nerves in 24 per cent, both were divided-trunk nerves and in 41 per cent, one nerve had a divided trunk and the other did not. No consistency of patterns between the right and left sides was found. 

The complications following surgery include haemorrhage, wound infection, recurrent laryngeal nerve damage, and transient (up to 20% of cases) or permanent (2%) hypocalcaemia. After near-total thyroidectomy relapse of hyperthyroidism should be rare, and this operation has largely replaced the older approach of sub-total thyroidectomy which had higher relapse rates. 

Brachial plexus paresis has been reported (358). Accidental block of the recurrent laryngeal nerve can cause hoarseness and occasionally aspiration of saliva (359). 

Harris RJ, Benveniste G. Recurrent laryngeal nerve blockade in patients undergoing carotid endarterectomy under cervical plexus block. Anaesth Intensive Care 2000 28(4) 431-3. 

There have been several reports of isolated vincristine-induced recurrent laryngeal nerve paralysis (38,43-47). 

Manelis G, Aderka D, Manelis J, Horn I. [Recurrent laryngeal nerve palsy and dysphagia for liquids due to vincristine.] Harefuah 1976 91(3 ) 84-5. 

Tobias JD, Bozeman PM. Vincristine-induced recurrent laryngeal nerve paralysis in children. Intensive Care Med 1991 17(5) 304-5. 

Whittaker JA, Griffith IP. Recurrent laryngeal nerve paralysis in patients receiving vincristine and vinblastine. BMJ 1977 l(6071) 1251-2. 

H3. Hirsch, P. F., Gauthier, G. F., and Munson, P. L., Thyroid h3q)ocalcaemic principle and recurrent laryngeal nerve injury as factors affecting the response to parathyroidectomy in rats. Endocrinology 73, 244-252 (1963). 

Surgery Rapid, effective treatment, especially in patients with large goiters Most invasive Potential complications (recurrent laryngeal nerve damage, hypoparathyroidism) Most costly Permanent hypothyroidism Pain, scar Potential in pregnancy if major side-effect from antithyroid Useful when coexisting suspicious nodule present Option for patients who refuse radioiodine... 

De Silva. H. J., Sanmugianathan, P. S., and Senanayake. N. (1994). Isolated bilateral recurrent laryngeal nerve paralysis A delayed complication of organophnsphorus poisoning. Hum. Exp. Toxicxd. 13,171-173. 

Acute complications include hypocalcaemia (40%), hematomas (2%) and recurrent laryngeal nerve paresis (2%) (Terris et al, 2006 Lai et al, 2005 Miccoli et al, 1996). Long-term reported complications include permanent hypoparathyroidism in 1% of patients, which is treatable with vitamin D or vitamin D analogs, and recurrent laryngeal nerve injury in 2% (Harrison, 1970). 

Tobias JK, Santiago SM, Williams AJ. Sarcoidosis as a cause of left recurrent laryngeal nerve palsy. Arch Otolaryngol Head Neck Surg 1990 116 971-972. 

Vasculitis of recurrent laryngeal nerve Bronchiectasis Bronchiolitis obliterans Follicular bronchiolitis Diffuse panbronchiolitis Pleural disease... 

Recurrent laryngeal nerve from the vagus nerve. 

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