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The "false" nonrecurrent inferior laryngeal nerve
M Raffaelli1, M Iacobone, J F Henry
1Department of Endocrine Surgery, University Hospital La Timone, Marseilles, France.
Surgery
|December 15, 2000
Summary
A large sympathetic-inferior laryngeal anastomotic branch (SILAB) can mimic a nonrecurrent inferior laryngeal nerve (ILN). Awareness of SILAB variations originating from the superior cervical ganglion or sympathetic trunk is crucial during neck surgery to prevent ILN injury.
Area of Science:
- Anatomy
- Surgical Anatomy
- Nerve Anatomy
Background:
- Communicating branches between the cervical sympathetic system and the inferior laryngeal nerve (ILN) are known.
- These branches, termed sympathetic-inferior laryngeal anastomotic branches (SILAB), typically arise from the middle cervical sympathetic ganglion (MCSG).
- SILABs can vary in size, sometimes equaling the diameter of the ILN.
Purpose of the Study:
- To prospectively evaluate the frequency of SILABs.
- To assess the surgical implications of SILABs during neck exploration.
Main Methods:
- Prospective evaluation of 791 patients undergoing surgical neck exploration from November 1998 to October 1999.
- Dissection of 1253 inferior laryngeal nerves (ILNs), with 656 on the right and 597 on the left.
- Documentation of anomalous branches and their origins.
Main Results:
- On the right side, a nonrecurrent ILN was identified in 0.46% of cases (3/656).
- A large SILAB was found in 1.5% of cases (10/656) on the right side.
- SILABs originated from the superior cervical sympathetic ganglion (2 cases) or directly from the sympathetic trunk above the MCSG (8 cases); none were found on the left.
Conclusions:
- The SILAB can originate from the superior cervical sympathetic ganglion or the sympathetic trunk, not solely the MCSG.
- A large SILAB may be mistaken for a nonrecurrent ILN.
- Recognizing this anatomical variation during neck dissection is vital to prevent inadvertent injury to the true ILN.