International Journal of Head and Neck Surgery

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VOLUME 3 , ISSUE 1 ( January-April, 2012 ) > List of Articles


Teaching Recurrent Laryngeal Nerve Dissection to Residents in Head and Neck Endocrine Surgery

Krishnamurthi Sundaram, Behrad Ben Aynehchi

Citation Information : Sundaram K, Aynehchi BB. Teaching Recurrent Laryngeal Nerve Dissection to Residents in Head and Neck Endocrine Surgery. Int J Head Neck Surg 2012; 3 (1):5-7.

DOI: 10.5005/jp-journals-10001-1080

Published Online: 01-04-2013

Copyright Statement:  Copyright © 2012; The Author(s).



Various approaches can be employed when teaching thyroidectomy. Delivery of the gland prior to complete dissection and identification of the recurrent laryngeal nerve (RLN) is sometimes utilized in the absence of laryngeal nerve monitoring (LNM), while identification and dissection of the RLN from the gland is more feasible in the presence of LNM. We hypothesized that teaching RLN dissection technique to residents as primary surgeons (using loupes and nerve monitoring) did not increase postoperative morbidity in head and neck endocrine surgery.

Materials and methods

In 101 consecutive patients who underwent thyroidectomies/parathyroidectomies, we have modified our technique to teach our residents consistent early identification of the RLN in the paratracheal region by direct visualization (loupe magnification) and nerve stimulation. All patients had preoperative fiberoptic laryngoscopy and a repeat laryngoscopy 1 week after surgery. Presence or absence of true vocal fold paralysis/paresis was documented.


One hundred and nineteen surgical procedures were available for study. One patient developed a permanent vocal fold paralysis (1/119 or 0.84%). There was another patient with a vocal fold paresis which recovered in 4 weeks (1/119 or 0.84%).


The RLN dissection technique with early identification, dissection and preservation of the nerve using magnification combined with nerve monitoring has emerged as an important resident teaching tool. The morbidity rate is acceptable. Notably in light of the increasing rates of thyroid surgery and LNM utilization, resident physicians may benefit from exposure to this technique as a component of their training.

How to cite this article

Sundaram K, Aynehchi BB. Teaching Recurrent Laryngeal Nerve Dissection to Residents in Head and Neck Endocrine Surgery. Int J Head and Neck Surg 2012;3(1):5-7.

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  1. Neuromonitoring in thyroid surgery: Attitudes, usage patterns and predictors of use among endocrine surgeons. World J Surg 2009;33:417-25.
  2. Prevalence and patterns of intraoperative nerve monitoring for thyroidectomy. Otol Head Neck Surg 2007;136:952-56.
  3. Recurrent laryngeal nerve monitoring versus identification alone on post-thyroidectomy true vocal fold palsy: A meta-analysis. Laryngoscope 2011;121:1009-17.
  4. Incidence of vocal cord paralysis with and without recurrent laryngeal nerve monitoring during thyroidectomy. Arch Otolaryngol Head Neck Surg 2007; 133:481-85.
  5. With the international intraoperative monitoring study group, electrophysiologic recurrent laryngeal nerve monitoring during thyroid and parathyroid surgery: International standards guideline statement. Laryngoscope 2011;121:S1-16.
  6. Surgical anatomy of the external branch of the superior laryngeal nerve. Head Neck 1992;14(5):380-83.
  7. Surgical anatomy of the recurrent laryngeal nerve. Randolph GW (Ed). Surgery of the thyroid and parathyroid glands 2003 Elsevier Science (USA). Chapter 25, 300-42.
  8. Laryngeal branching pattern of the inferior laryngeal nerve, before entering the larynx. Surg Radiol Anat 2006;28:339-42.
  9. Systematic review of laryngeal reinnervation techniques. Otol Head Neck Surg 2010;143:749-59.
  10. Intraoperative neurophysiology testing of the recurrent laryngeal nerve: Plaudits and pitfalls. Surgery 2005;138:1183-92.
  11. Prevention of main-stem bronchus intubation with the EMG endotracheal tube. Letters to the editor. Otol Head Neck Surg 2010;142:152.
  12. Continuous laryngeal nerve integrity monitoring during thyroidectomy: Does it reduce risk of injury? Otol Head Neck Surg 2004;596-600.
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