RLN Triangle and Triangle of Concern

  • RLN Triangle:
    • This is an inverted triangle with:
      • Apex formed inferiorly by:
        • Thoracic inlet
      • Medially:
        • Trachea
      • Lateral Margin:
        • The medial edge of retracted strap muscles
      • The superior border is:
        • The lower edge of the inferior pole of the gland
  • Recurrent laryngeal nerve exits as a single trunk here at thoracic inlet
  • Triangle of Concern:
    • The commonest site for bleeding in thyroidectomy:
      • Is the ‘triangle of concern’, comprising the:
        • Trachea medially
        • RLN nerve laterally
        • With the thyrothymic ligament and loose fat above the sternum at the base
        • Berry’s ligament at the apex
  • This triangle has the small branches of the inferior thyroid artery that require meticulous hemostasis with in the vicinity of RLN, which can cause injury to nerve

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