Branching Patterns of Recurrent Laryngeal Nerve in Thyroidectomy Patients

Background: Historically, the Recurrent laryngeal nerve (RLN) has been considered to branch after it enters the larynx, but numerous studies have demonstrated that it often branches before. The wide variability of this extra laryngeal branching (ELB) has significant implications for the risk of iatrogenic injury. Accurate knowledge of anatomical variations of the recurrent laryngeal nerve (RLN) provides information to prevent inadvertent intraoperative injury.Objectives: Our study aimed to assess extra laryngeal branching of recurrent laryngeal nerve to find out branching patterns of RLN and to study whether there is any correlation between right and left side branching of RLN.Materials and Methods: This was a retrospective analysis conducted on patients of Thyroid surgeries that is total and Near-total thyroidectomies. This cross-sectional study was conducted in Hayatabad Medical Complex Peshawar from 1st Jan 2014 till 31st Dec 2020, with total of 269 patients. We excluded hemi thyroidectomies and recurrent cases.Results: The prevalence of single branching RLN was found to be 29.3% with 79 out of 269 patients. The branching pattern was found not statistically significant with age and gender. Surgeons need to pay special attention to the branching pattern of RLN so as to preserve it during surgery.Conclusion: The anatomy of the RLN is highly variable, and ELB is likely to have been underreported in intraoperative studies. Because of its high likelihood, the possibility of ELB needs to be assessed in patients to prevent iatrogenic injury and long-term postoperative complications.Key Words: Total thyroidectomy, Recurrent laryngeal nerve.Extralaryngeal branching.