PATTERN OF ANATOMICAL VARIATIONS OF RECURRENT LARYNGEAL NERVE IN RELATION TO INFERIOR THYROID ARTERY

Abstract

BACKGROUND: The recurrent laryngeal nerve (RLN) is a critical anatomical structure at risk during thyroidectomy. Its anatomical relationship with the inferior thyroid artery (ITA) is variable and can significantly impact surgical outcomes, particularly the risk of RLN injury.

Objectives: To analyze anatomical variations in the relationship between the RLN and ITA and evaluate their demographic and clinical correlations.

Study Settings: Department of Surgery, Allied Hospital 1 Faisalabad/Faisalabad Medical University

Duration of Study: From: 17/11/2024 to 16/05/2025.

DATA COLLECTION: A descriptive cross-sectional study included 554 participants undergoing surgery involving the ITA. Demographic and clinical data, including RLN side and position relative to the ITA, were documented intraoperatively. Variations were categorized as anterior, posterior, or in-between. Data were analyzed using SPSS 25.0, with stratification for age, gender, BMI, and surgical indications. A p-value ≤ 0.05 was considered significant. RESULTS: The mean age was 39.59 ± 12.22 years, with males (50.7%) and females (49.3%) equally represented. Most participants were overweight or obese (54.2%). The RLN predominantly assumed a posterior position (48.2%), followed by anterior (41.2%) and intermediate (10.6%) positions. No significant differences in RLN side or position were observed across demographic or clinical variables, highlighting the nerve's stable anatomical relationships. CONCLUSION: The anatomical variability of the RLN in relation to the ITA highlights the need for careful surgical planning and tailored strategies during thyroidectomy. Preoperative imaging and intraoperative neuromonitoring may improve surgical safety and reduce the chance of recurrent laryngeal nerve damage.