Nerve at risk: anatomical variations of the left recurrent laryngeal nerve and implications for thoracic surgeons
Autor: | Florian Augustin, Walter Rabl, Caecilia Ng, Verena-Maria Schmidt, Herbert Maier, Paolo Lucciarini, Dietmar Öfner, Claudia Woess |
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Rok vydání: | 2020 |
Předmět: |
Pulmonary and Respiratory Medicine
Aortic arch medicine.medical_specialty Variation Autopsy Lymph node dissection medicine.artery Translational Research medicine.ligament Cadaver Recurrent laryngeal nerve Humans Medicine Eacts/153 Surgeons Ligamentum arteriosum AcademicSubjects/MED00920 Recurrent Laryngeal Nerve business.industry Dissection Mediastinum General Medicine Anatomy Nerve injury Cardiothoracic surgery Mediastinal lymph node Surgery medicine.symptom Cardiology and Cardiovascular Medicine business |
Zdroj: | European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery |
ISSN: | 1873-734X 1010-7940 |
Popis: | OBJECTIVES Recurrent laryngeal nerve (RLN) injury during thoracic surgery may result in life-threatening postoperative complications including recurrent aspiration and pneumonia. Anatomical details of the intrathoracic course are scarce. However, only an in-depth understanding of the anatomy will help reduce nerve injury. The aim of this study was to assess the anatomic variations of the intrathoracic left RLN. METHODS Left-sided vagal nerves and RLN were dissected in 100 consecutive Caucasian cadavers during routine autopsy. Anatomical details were documented. Available demographic data were assessed for possible correlations. RESULTS All nerves were identified during dissection. Variant courses were classified in 3 different groups according to the level at which the RLN separated from the vagal nerve: above the aortic arch, level with the aortic arch and below the aortic arch. We found 11% of RLN separating above the aortic arch and crossing the aortic arch at a considerable distance to the vagal nerve. In 48% of the RLN, the nerve split off when it was level with the aortic arch, and 41% of the RLN leave the vagal nerve in a perpendicular direction below the aortic arch. All nerves crossed the ligamentum arteriosum on the posterior side. No gender-specific differences were observed. CONCLUSIONS Mediastinal lymph node dissection in left-sided lung cancer patients puts the RLN at risk. With more detailed anatomical knowledge about its course, it is possible to avoid risking the nerve. Visualization will help protect the nerve. Left recurrent laryngeal nerve (L-RLN) palsy is a severe complication following various thoracic surgical procedures. |
Databáze: | OpenAIRE |
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