The Esophageal Branches of the Recurrent Laryngeal Nerve

Abstract

Objective: 1) To identify and define the cervical esophageal branches (CEB) of the recurrent laryngeal nerve (RLN), in vivo. 2) To study the feasibility of positively identifying the nonlaryngeal, distinct cervical esophageal branches of the RLN during thyroid surgery.

Method: Prospective and in vivo study of the CEB of the RLN, in a tertiary academic center. Inraoperative RLN monitoring was used. RLN and its cervical esophageal branches were identified visually. Nerve stimulation coupled with monitoring of the action potentials from the RLN, and direct observation of the cervical esophageal contractions were used for nerve confirmation.

Results: Fifty-one RLNs (25 right and 26 left) were dissected in 31 patients undergoing thyroidectomy. In 17/25 (68%) right RLNs and 20/26 (77%) left RLNs, 1 or more distinct branches of the RLN to the cervical esophagus was identified and confirmed by nerve stimulation. These branches were distinct from the laryngeal branches of the RLN confirmed by direct visualization of esophageal contractions and laryngeal action potentials produced by nerve stimulation at different positions of the RLN and CEB. Overall, in 73% of all RLNs examined, functional esophageal branches could be identified.

Conclusion: Although the cervical esophageal branches of the RLN are well described in the basic anatomic literature, it is not referenced in thyroid surgery literature. It is important for the thyroid surgeon to be aware of these branches and preserve them, as they likely play an important role in swallowing.