DOI: http://dx.doi.org/10.18203/issn.2454-5929.ijohns20190967

Tracheoesophageal groove: a reliable landmark

Nitika Gupta, Rohan Gupta, Inderpal Singh, Sunil Kotwal

Abstract


Background: Galen first described the recurrent laryngeal nerve (RLN) as a nerve that descended from the brain to the heart, then reversed the course and ascended to the larynx and caused the vocal cords to move. Tracheoesophageal groove is useful for identifying the RLN. In the present study we studied the course of RLN in tracheoesophageal groove and its anatomical position, in patients undergoing thyroid surgery.

Methods: The study was conducted in the Department of ENT and Head and Neck Surgery, SMGS Hospital, for a period of two years, on the patients who underwent thyroid surgeries. Tracheoesophageal groove was considered first landmark to identify RLN position and only after meticulous dissection in the groove, the nerve could be identified. The nerve was carefully dissected and its position evaluated in relation with trachea and esophagus.  

Results: Trajectory of the nerves studied in the patients was mostly in the tracheoesophageal groove (TEG), seen in 113 (69.75%) nerves. 16.05% of the nerves were seen in the posterior half of the trachea while 4.94% of the nerves were seen to travel from TEG to anterior half of trachea and 1.85% from TEG to posterior half of trachea. 6.17% of nerves travelled from oesophagus to the TEG.

Conclusions: A uniform dissection procedure should be followed and the recurrent laryngeal nerve must be first looked for in the TEG, which serves as important landmark and later any deviation must be considered.

 


Keywords


RLN, Tracheoesophageal, Groove, Thyroid

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References


Kaplan EL, Salti GI, Roncella M, Fulton N, Kadowaki M. History of the recurrent laryngeal nerve: from Galen to Lahey. World J Surg. 2009;33(3):386-93.

Saunders J, Malley CDO. The anatomical drawings of Andreus Vesalius. New York: WB Saunders; 1982: 152.

Campos BA, Henriques PRF. Relationship between the recurrent laryngeal nerve and the inferior thyroid artery: A study in corpses. Rev Hosp Clín Fac Med S Paulo. 2000;55(6):195-200.

Monfared A, Gorti G, Kim D. Microsurgical anatomy of the laryngeal nerves as related to thyroid surgery. Laryngoscope. 2002;112:386-92.

Lahey FH. A technique of thyroidectomy. Surg Gynecol Obstet. 1923;22:825-29.

Dralle H, Sekulla C, Lorenz K, Brauckhoff M, Machens A. Intraoperative monitoring of the recurrent laryngeal nerve in thyroid surgery. World J Surg. 2008;32:1358-66.

Henry BM, Sanna B, Graves MJ, Sanna A, Vikse J, Tomaszewska IM, et al. The Reliability of the Tracheoesophageal Groove and the Ligament of Berry as Landmarks for Identifying the Recurrent Laryngeal Nerve: A Cadaveric Study and Meta-Analysis. BioMed Res International. 2017;2017.

Sunanda H, Tilakeratne S, De Silva KPVR. Surgical anatomy of the recurrent laryngeal nerve; A cross-sectional descriptive study. Galle Med J. 2010;15(1):14-6.

Hunt PS. A reappraisal of the surgical anatomy of thyroid and parathyroid glands. Br J Surg. 1968;55:63.

Al-Salihi AR, Dabbagh AW. Anatomy of the recurrent laryngeal nerve in normal Iraqis. Acta Anat. 1989;135:245-7.

Lieberman-Meffert D, Walbrun B, Hiebert CA. Recurrent and superior laryngeal nerves: a new look with implications for the esophageal surgeon. Ann Thorac Surg. 1999;67:217.

Hisham AN, Lukman MR. Recurrent laryngeal nerve in thyroid surgery: A critical appraisal. ANZ J Surg. 2002;72(12):887-9.

Ardito G, Revelli L, Alatri LD, Lerro V, Guidi ML, Ardito F. Revisited anatomy of the recurrent laryngeal nerves. Am J Surg. 2004;187:249-53.

Skandalakis JE, Droulias C, Harlaftis N, Tzinas S, Gray SW, Akin Jr JT. The recurrent laryngeal nerve. American Surgeon. 1976;42(9):629–34.

Chang S, Tang HH, Wang CC, Zhou LD, Li JD, Huang Y, et al. A standard approach to expose the recurrent laryngeal nerve during endoscopic thyroidectomy. J Laparoendoscopic Advanced Surg Tech. 2012;22(3):259–63.