Anatomic approaches of the recurrent laryngeal nerve in reoperative thyroidectomy: 55 clinical cases reporter

Objective To investigate the anatomic method of recurrent laryngeal nerve (RLN) in thyroid operation again.Methods From Jun.2002 to Sep.2012,55 patients who had received reoperative thyroidectomy were enrolled in this retrospective study.We analyzed the protection of RLN at the time of thyroidectomy reoperation,reasons for recurrent thyroid disease.Results Reoperative thyroidectomy was performed in 55 patients.Of whom,16 cases with benign and 39 cases with malignant were for second operation and 4 cases with malignant were underwent the third operation.Thyroidectomy was done under general anesthesia through a horizontal incision at the original collar line.Separating and cutting the Strap Muscles (sternohyoid,omohyoid and sternothyroid muscles) and exposing the anterior surface of the thyroid were performed.It is the most important anatomic sign,including the trachea,residual thyroid tissue,the inferior comu of thyroid cartilage and carotid artery,and then identified the RLN.Laryngeal nerve monitoring was performed in 5 of these 55 cases.We separated the RLN respectively by the sign of trachea and residual thyroid tissue for 32 cases.9 cases were underwent the inferior cornu of thyroid cartilage(from up to down),and 14 cases were performed at the carotid artery from outside to inside.We analyzed the all cases with good postreoperative outcomes.Forty-seven cases are alive with no complication,and 8 cases with voice changing,in which 3 cases occurred unintentional RLN paralysis and get recovery within 2 months.Conclusion More care should be taken while separating the tissue so as to avoid injury to the external laryngeal nerve.The trachea,residual thyroid tissue,the inferior comu of thyroid cartilage and Carotid artery are the important anatomic signs to identify the RLN. Key words: Thyroid;  Reoperative thyroidectomy;  Recurrent laryngeal nerve;  Anatomy