Identification of the Recurrent Laryngeal Nerve

  • In order to limit any bleeding or tissue distortion that may compromise the identification of the parathyroid glands:
    • The RLN is identified ONLY after all parathyroid glands have been exposed AND a decision made as to which one to remove
  • The RLN is identified in the inferior portion of the neck caudal to the ITA:
    • The angle between the trachea and the ITA is visually bisected, and careful blunt dissection is performed along this line to identify the nerve (Figure)
  • Further dissection on the perineurium of the nerve toward the ITA can be performed to approximate the course of the RLN
Identification of the recurrent laryngeal nerve allows for safe and confident dissection and ligation of the vascular pedicle supplying the parathyroid gland. The angle between the inferior thyroid artery and the trachea is visually bisected, and areola tissue along this angle is spread with a fine hemostat to identify the nerve

#Arrangoiz #ParathyroidSurgeon #HeadandNeckSurgeon #Surgeon #EndocrineSurgery #MSMC #Teacher #ParathyroidExpert #Hyperparathyroidism #MountSinaiMedicalCenter #Miami #Mexico

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