CRICOARYTENOID JOINT AS A CONSISTENT ANATOMICAL LANDMARK FOR INTRAOPERATIVE IDENTIFICATION OF THE RECURRENT LARYNGEAL NERVE DURING THYROIDECTOMY: A PROSPECTIVE OBSERVATIONAL STUDY
Main Article Content
Keywords
Cricoarytenoid joint, recurrent laryngeal nerve, thyroidectomy, anatomical landmark, nerve injury prevention.
Abstract
Introduction: The risk of injury to the recurrent laryngeal nerve (RLN) during thyroidectomy is still a point of focus because of its effects on the voice. This is important in the dissection of consistent anatomical landmarks to ensure safety.
Objective: To establish the relevance of the cricoarytenoid joint (CAJ) as a reliable landmark of RLN on the surgical bed, as far as correcting a RLN is concerned, during thyroidectomy.
Material and Method: The research was a prospective observational study conducted at Al-Tibri medical college and hospital, Isra University Karachi, from July 2024 and December 2024. These patients were assessed on 100 patients who experienced thyroidectomy. The RLN visibility, distance, and trajectory with reference to the CAJ were estimated. The laryngoscopy was used to assess postoperative vocal cord status.
Results: CAJ was manifested in 92 per cent of the cases. The RLN was placed at 3.1 to 3.4 mm from the CAJ and exhibited predictable angles. RLN injury incidence was witnessed when the CAJ could not be determined. No permanent injuries were found at the time when the cases were detected by the CAJ.
Conclusion: CAJ is a good landmark for safe RLN identification in the thyroidectomy.
References
2- Mathew J. A novel way of identification of recurrent laryngeal nerve during thyroid surgeries. International Surgery Journal. 2021 Sep 28;8(10):2956-60.
3- Dündar Y, Schwartz CM, Lierly M, Nguyen TQ, Gilbert KK, Smith DH, Tello N, Cordero J. A Novel Surgical Landmark to Identify the Recurrent Laryngeal Nerve. Balkan Medical Journal. 2024 Jul 5;41(4):280.
4- Sun H, Tian W, College of Surgeons CM, Chinese Thyroid Association, Chinese Research Hospital Association Thyroid Disease Committee. Chinese guidelines on intraoperative neuromonitoring in thyroid and parathyroid surgery (2023 edition). Gland surgery. 2023 Aug 2;12(8):1031.
5- Dudley S, Nezakatgoo N, Rist TM, Klug T, Shires CB. The utility of intraoperative nerve monitoring in secondary and tertiary Hyperparathyroid surgery. Clinical Case Reports. 2021 Mar;9(3):1634-40.
6- Chen J, Wang Y, Shen C, Wang J, Li X. A novel and efficient surgical procedure for pyriform sinus fistulas in children. Frontiers in Pediatrics. 2024 May 30;12:1297831.
7- Puxeddu R, Marrosu V, Filauro M, Mariani C, Parrinello G, Heathcote K, Gerosa C, Tatti M, di Villahermosa SM, Mora F, Peretti G. Bilateral selective laryngeal reinnervation in patients with bilateral vocal cord palsy. Acta Otorhinolaryngologica Italica. 2023 Jun 1;43(3):189.
8- Callaghan A, El-Hakim H, Isaac A. Iatrogenic pediatric unilateral vocal cord paralysis after cardiac surgery: a review. Frontiers in pediatrics. 2024 Sep 3;12:1460342.
9- Mat Lazim N, Mohd Ismail ZI, Ab Rahman MN, Abdullah B. Thyroid Gland Tumour and Surgical Approach with Case Illustration. InHead and Neck Surgery: Surgical Landmark and Dissection Guide 2022 Nov 22 (pp. 223-247). Singapore: Springer Nature Singapore.
10- Libke ML, Chen LW, O’Bryan R, Takacs S, Calcagno H, Zhang L, Halum S. Nerve Conduction Studies of the Larynx: Porcine Model and Human Application. Journal of Voice. 2024 Apr 25.
11- Puxeddu R, Marrosu V, Filauro M, Mariani C, Parrinello G, Heathcote K, Gerosa C, Tatti M, di Villahermosa SM, Mora F, Peretti G. Bilateral selective laryngeal reinnervation in patients with bilateral vocal cord palsy. Acta Otorhinolaryngologica Italica. 2023 Jun 1;43(3):189.
12- Zbar A. The Neck Viscera: Thyroid, Parathyroids and Salivary Glands. InAnatomy--Head and Neck: A Pocket Book for the Clinician 2024 Nov 22 (pp. 33-71). Cham: Springer Nature Switzerland.
13- Callaghan A, El-Hakim H, Isaac A. Iatrogenic pediatric unilateral vocal cord paralysis after cardiac surgery: a review. Frontiers in pediatrics. 2024 Sep 3;12:1460342.
14- Elias N, Thomas J, Cheng A. Management of laryngeal trauma. Oral and Maxillofacial Surgery Clinics. 2021 Aug 1;33(3):417-27.
15- Rapoport SK, Courey MS. Type I Thyroplasty and Arytenoid Adduction: Review of the Literature and Current Clinical Practice. International Journal of Head and Neck Surgery. 2022 May 21;12(4):166-71.
16- Taleb A, Guigou C, Leclerc S, Lalande A, Bozorg Grayeli A. Image-to-patient registration in computer-assisted surgery of head and neck: state-of-the-art, perspectives, and challenges. Journal of Clinical Medicine. 2023 Aug 19;12(16):5398.
17- Nicolai EN, Larco JA, Madhani SI, Asirvatham SJ, Chang SY, Ludwig KA, Savastano LE, Worrell GA. Vagus nerve stimulation using an endovascular electrode array. Journal of neural engineering. 2023 Jul 14;20(4):046008.
18- Lancini D, Paderno A, Piazza C. Tracheal and Cricotracheal Resection and Anastomosis for Subglottic and/or Proximal Tracheal Stenoses. InAtlas of Head and Neck Surgery 2024 Jun 6 (pp. 57-68). Cham: Springer International Publishing.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Dr. Vijay Kumar
Assistant Professor, FCPS, Department of ENT, Al Tibri Medical College Isra University Karachi, Pakistan
Dr. Devi Kumari
Assistant Professor, Department of Anatomy, Al Tibri Medical College Isra University Karachi, Pakistan
Dr. Tooba Mahmud Gauhar
Associate Professor, FCPS, General Surgery, Al Tibri Medical College Karachi, Pakistan
Dr. Maham Arif
House Officer, MBBS, Jinnah Postgraduate Medical Centre Karachi, Pakistan
Dr. Jaswanti Kumari
Department of Gynecology and Obstetrics, Dow International Medical College Karachi,
Pakistan
Dr. Roop Kumar
House Officer, Jinnah Postgraduate Medical Centre Karachi, Pakistan