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Spinal Nerves: Plexus I01:22

Spinal Nerves: Plexus I

Nerve plexuses are networks of interlacing nerves that serve as communication hubs to distribute and organize nerve action across various body regions. The nerve plexuses are organized into the cervical plexus located in the neck region, brachial plexus in the shoulder area, lumbar plexus found in the lower back, sacral plexus situated in the pelvis, and coccygeal plexus located in the coccygeal region.
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Cranial Nerves: Types Part II01:22

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Cranial nerves are responsible for transmitting motor and sensory information between the brain and various parts of the body. There are twelve pairs of cranial nerves. While the first six innervate the head and neck, the latter six nerves innervate the head and neck, as well as organs and tissues in the thoracic and abdominal cavities. They facilitate communication, expression, and autonomic control within the human body.
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Identification and Protection of the Recurrent Laryngeal Nerve during Transoral Robotic Thyroidectomy
05:25

Identification and Protection of the Recurrent Laryngeal Nerve during Transoral Robotic Thyroidectomy

Published on: October 24, 2025

Recurrent laryngeal nerve: a plexus rather than a nerve?

Claudio R Cernea1, Flávio C Hojaij, Dorival De Carlucci

  • 1Department of Head and Neck Surgery, University of São Paulo Medical School, São Paulo, Brazil. cerneamd@uol.com.br

Archives of Otolaryngology--Head & Neck Surgery
|November 18, 2009
PubMed
Summary

Extralaryngeal branching (ELB) of the recurrent laryngeal nerve (RLN) is common, occurring in 64.53% of thyroidectomy patients. Recognizing and preserving all RLN branches is crucial for reducing surgical complications.

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Area of Science:

  • Anatomy
  • Surgical Procedures
  • Nerve Monitoring

Background:

  • The recurrent laryngeal nerve (RLN) is vital for vocal cord function.
  • Extralaryngeal branching (ELB) of the RLN is an anatomical variation that can complicate thyroidectomy.
  • Understanding the frequency and characteristics of RLN ELB is important for surgical safety.

Purpose of the Study:

  • To determine the frequency of extralaryngeal branching (ELB) of the recurrent laryngeal nerve (RLN) in patients undergoing thyroidectomy.
  • To compare these findings with existing literature.
  • To assess the electrophysiologic activity of RLN branches during intraoperative monitoring.

Main Methods:

  • Retrospective medical record review of 2677 thyroidectomy patients between 1983 and 2008.
  • Analysis of surgical information for 2154 recurrent laryngeal nerves (RLNs).
  • Intraoperative laryngeal nerve monitoring used in selected patients during the last 5 years.

Main Results:

  • Extralaryngeal branching (ELB) was identified in 1390 out of 2154 analyzed recurrent laryngeal nerves (RLNs), representing a frequency of 64.53%.
  • In patients with intraoperative laryngeal nerve monitoring, anteriorly situated branches typically showed greater electrophysiologic activity.

Conclusions:

  • Extralaryngeal branching (ELB) of the recurrent laryngeal nerve (RLN) is a frequent anatomical variation in thyroidectomy patients, observed in 64.53% of cases.
  • Intraoperative laryngeal nerve monitoring can help identify active nerve branches, particularly those located anteriorly.
  • Awareness of frequent RLN ELB and careful preservation of all its branches are essential to minimize postoperative morbidity following thyroidectomy.