Clinical Factors Associated with Difficulty in Identifying the Recurrent Laryngeal Nerve in Thyroid Surgery

Background: An objective assessment of the difficulty in identifying the recurrent laryngeal nerve (RLN) in thyroid surgery is hard because it can be affected by the surgeon's experience and skills. Although several factors such as body habitus, size of the tumor, and operated side have been believed to be associated with the difficulty in finding the RLN, no reports have objectively validated the idea. Visual inspection over the visceral layer of pretracheal fascia is one of the safe approaches for identifying the RLN in thyroid surgery. Because this "visual inspection method" does not need dissection within the paratracheal adipolymphatic tissue, the success of the RLN identification is not affected by the surgeon's skill. This study aimed to disclose the factors associated with the difficulty finding RLN in thyroid surgery by assessment of the "visual inspection method."

Methods: A retrospective study was conducted on patients who underwent thyroid surgery. We evaluated the association between the failure of the "visual inspection method" and clinical variables, including gender, age, body mass index (BMI), operated side, nodule size, mediastinal extension of goiter, and cricoid position.

Results: In total, 147 RLNs in 115 patients were included in this study. Overall, 35 RLNs could not identified by the "visual inspection method" and required additional manipulation within the paratracheal adipose tissue. Multivariate analysis showed that high BMI and low cricoid position were independently associated with failure of the "visual inspection method."

Conclusion: High BMI and low cricoid position were independently associated with difficulty in identifying the RLN during thyroid surgery.

Cite this article as: Honda K. Clinical factors associated with difficulty in identifying the recurrent laryngeal nerve in thyroid surgery. Balkan ORL-HNS 2024;1(2):51-55.