Comprehensive Comparison and Surgical Implications of Right and Left Recurrent Laryngeal Nerve Location in the Tracheoesophageal Groove
Macy Cottrell, Michael J. Herr, Madison Kahl, Darryl S. Weiman.
University of Tennessee Health Center, Memphis, TN, USA.
A left-sided cervical approach to esophageal mobilization is considered safer given the perceived oblique path and more lateral orientation of the right recurrent laryngeal nerve (RLN) in the tracheoesophageal groove. Based on this, we hypothesized that the right RLN is farther from the tracheal midline than the left RLN, making the right RLN less prone to injury during a blind circumferential mobilization of the cervical esophagus.
Right and left RLNs were carefully exposed in human cadavers. Comparison of location was determined using three parameters at tracheal rings 2, 4, and 6: depth of the RLN from the anterior margin of the tracheal ring, lateral distance of the RLN from the posterior margin of the tracheal ring, and distance of the RLN to the anterior midline trachea following the curvature of the trachea. Statistical analysis was used to determine variation.
Compared to the right RLN, the left RLN was slightly over one millimeter deeper at the second tracheal ring. Despite this trend, there was no significant difference in RLN location between individual sides or as an aggregate for any of the three parameters at tracheal rings 2, 4, or 6.
Careful characterization of RLN location preclude avoiding hoarseness, aphonia, and vocal cord paralysis. Counter to common surgical perception and educational beliefs, this study demonstrated that right and left RLN anatomical courses do not significantly differ along the trachea. Therefore, ensnarement on either side during a blind mobilization of the cervical esophagus is equally likely to occur.
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