Variable relationship of the recurrent laryngeal nerve to the inferior thyroid artery: A meta‐analysis and surgical implications

Background The relationship between the recurrent laryngeal nerve (RLN) and inferior thyroid artery (ITA) is highly variable and traceable back to embryological life. Methods Comprehensive database searches were conducted, followed by judgment of eligibility, assessment, and extraction of data conce...

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Published in:Head & neck 2017-01, Vol.39 (1), p.177-186
Main Authors: Henry, Brandon Michael, Vikse, Jens, Graves, Matthew J., Sanna, Silvia, Sanna, Beatrice, Tomaszewska, Iwona M., Hsieh, Wan Chin, Tubbs, R. Shane, Tomaszewski, Krzysztof A.
Format: Article
Language:English
Subjects:
anatomy
Humans
inferior thyroid artery
meta‐analysis
Recurrent Laryngeal Nerve
Thyroid Gland - blood supply
Thyroid Gland - innervation
Thyroid Gland - surgery
Thyroidectomy
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Summary:Background The relationship between the recurrent laryngeal nerve (RLN) and inferior thyroid artery (ITA) is highly variable and traceable back to embryological life. Methods Comprehensive database searches were conducted, followed by judgment of eligibility, assessment, and extraction of data concerning the RLN/ITA relationship. The data were pooled into a meta‐analysis and subjected to sex, side‐based, geographic origin of study, and study modality subgroup analyses. Results Seventy‐nine studies (n = 14,269 nerves) reported data on the relationship of the RLN to the ITA. The left versus right‐sided comparison revealed stark differences: RLNs were predominantly posterior (62.6% vs 37.0%) and anterior (17.2% vs 37.1%) on the left and right sides, respectively. Conclusion Symmetry of neurovascular relationships should not be assumed. Extra care should be taken during procedures on the right side, because the nerves are significantly more likely to present in patterns (anterior and between) associated with greater risk of iatrogenic injury. © 2016 Wiley Periodicals, Inc. Head Neck 39: 177–186, 2017
ISSN:1043-3074
1097-0347
DOI:10.1002/hed.24582