Recurrent laryngeal nerve and spinal accessory nerve anatomic safety dissections with Intraoperative Nerve Integrity Monitoring: Immediate and follow up results

  • Introduction. In thyroid cancer (TC) operations most frequently damaged vital structures are recurrent laryngeal nerve (RLN), spinal accessory nerve (SAN).

    Material and methods.27253patients were operated on Thyroid (1973-2012). Unilateral RLN injury took place in0.78%, bilateral– in0.28%. In 2390 TC patients RLN injury were observed in 0.31% (in general group) despite or to thank for it dissection. This motivated us to perform RLN dissection in every thyroid and parathyroid patient. Surgical anatomy we investigated on autopsy material (30RLN, 20SAN) and Surgery (1717RLNs and 177SANs).Intraoperative Nerve Integrity Monitor we have used since2001.

    Results. There were about 30 variations of RLN and inferior thyroid artery attitude and three the most common points for beginning of RLN visualization: 1 – subclavicular point, 2 – RLN “cross point” with the inferior thyroid artery, 3 – RLN entry point. 

    Since 2001for lateral neck dissections (LND) we used the serpentinous incision, Mac Fee or lateral approaches. The supper third of sternocleidomastoid muscle’s is the preferable point for beginning of SAN search, and protection during LND. In 85.18%SAN laid laterally, in 11.11% – behind and in 3.71% – medially to jugular vein. During 40years of surgical practice our anatomic technic of RLN and SAN preparation has guaranteed relief of postoperative rates to 0.6% and 0.79% accordingly. Since 2000RLN and SAN functional safety after Thyroidectomy and LND were controlled with IONIM. 

    Conclusion. Permanent using of RLN, SAN dissection andIONIMtechnique,has decreased postoperative morbidity rates significantly and has improved the functional and cosmetic results of TC patient’s treatment.

 

Leave a Reply