OBJECTIVE: To describe the anatomic relationship of the recurrent laryngeal nerve and the inferior thyroid artery in adult cadavers in the Philippines and to compare the proportions of these anatomic relationships with those reported in the foreign literature.

METHODS:
Design: Descriptive, cross-sectional
Setting: University of the Philippines College of Medicine Anatomy Laboratory
Subjects: Fifty-four (54) preserved cadavers (108 sides) dissected within a period from June 2008 to Aug 2010. The anatomy and position of both the right and the left recurrent laryngeal nerves (RLN) and inferior thyroid arteries (ITA) were noted. The RLN was further classified into two variations: non-branching or branching prior to insertion at the cricothyroid joint under the inferior constrictor muscle. The ITA was also classified into non-branching and branching. The results were compared to two foreign studies using a Z-test for two proportions.

RESULTS: Fifty four (54) cadavers (108 sides) were dissected. Among the cadavers, both the recurrent laryngeal nerves and inferior thyroid arteries had a maximum of two branches although both the RLNs and ITAs for both the right and left sides were mostly non-branching. The right side of one cadaver was noted to have both a branching RLN and a branching ITA. There were no non-recurrent laryngeal nerves seen among the 54 cadavers. For both left and right sides, the RLN was mostly dorsal to the ITA. Branching RLNs was mostly dorsal to a non-branching ITAs. Most of the non-branching RLNs were dorsal to the ITAs. Non-branching RLNs were usually dorsal to the ITA. The local patterns of the course of the RLN in relation to the ITA approximates those of Chinese where there is predominance of the RLN dorsal to the ITA but differs from those of Brazilians where the RLN is usually between ITA branches.

CONCLUSION: There are multiple anatomical variations regarding the relationship of the RLN and the ITA. The anatomic variation among Asians may be different from Brazilians. The surgeon's knowledge of the possible various configurations of the RLN and ITA should be able to help in identification and preservation of the RLN and prevention of complications in thyroid surgery.

Human ; Male ; Female ; Adult ; LARYNGEAL NERVES ; CADAVERS-anatomy and histology ; DISSECTION ; surgery ; Thyroid Gland ; anatomy ;

OBJECTIVE: To explore the application of meticulous capsular dissection techique in thyroidectomy. METHOD: Forty four cases of thyroid operation in 38 patients were analyzed retrospectively. Meticulous capsular dissection in thyroidectomy could protect recurrent laryngeal nerve and parathroid gland. RESULT: Of all the 44 cases, no one experienced postoperatively hypocalcemia. The recurrent laryngeal nerves were found. No one suffered from laryngeal nerve injury except 1 case with postoperative horseness. CONCLUSION The meticulous capsular dissection techique plays a key role in ensuring the safety of thyroidectomy.
Adult ; Female ; Humans ; Male ; Middle Aged ; Recurrent Laryngeal Nerve ; surgery ; Retrospective Studies ; Thyroid Gland ; anatomy & histology ; surgery ; Thyroidectomy ; methods

OBJECTIVE: To investigate the effect of VI region neck dissection in thyroid papillary carcinoma surgery and to prompt the key matters in such surgery. METHOD: Retrospectively analyzed 213 cases of thyroid papillary carcinoma treated by Renji ENT Department from 2003 to 2009. Under each case, we implemented the VI region neck dissection after marking recurrent laryngeal nerve with middle thyroid vein. RESULT: Among the 213 cases of thyroid papillary carcinoma performed with VI region neck dissection, 82 cases were positive, 3 cases incurred recurrent laryngeal nerve injury with 2 cases of permanent RLN injury and 2 case of temporary injury, 2 cases showed permanent Hypoparathyroidism, and 6 cases showed temporary Hypoparathyroidism. In 3 cases the metastasis of neck lymph arose within 3 years. CONCLUSION Marking recurrent laryngeal nerve with middle thyroid vein not only helps to lower the possibility of injuring RLN and parathyroid glands in thyroidectomy, but also makes the VI region neck dissection an feasible treatment for thyroid papillary carcinoma.
Adolescent ; Adult ; Aged ; Carcinoma ; Carcinoma, Papillary ; Female ; Humans ; Male ; Middle Aged ; Neck Dissection ; methods ; Recurrent Laryngeal Nerve ; anatomy & histology ; surgery ; Retrospective Studies ; Thyroid Cancer, Papillary ; Thyroid Gland ; blood supply ; Thyroid Neoplasms ; surgery ; Veins ; anatomy & histology ; Young Adult

Thyroid ultrasonography (US) plays a key role in the diagnosis and management of thyroid-related diseases. The aim of this article was to illustrate various pitfalls that can occur in utilizing thyroid US and techniques to prevent them. In this article, we present cases demonstrating the common pitfalls associated with US equipment, performance, normal thyroid structures, misinterpretations, and surrounding structures. Knowledge of these areas is essential to avoid misdiagnosis or improper disease management.
Adult ; Artifacts ; Diagnostic Errors/*prevention & control ; Female ; Humans ; Male ; Middle Aged ; Thyroid Diseases/*ultrasonography ; Thyroid Gland/anatomy & histology/*ultrasonography ; Ultrasonography/instrumentation

OBJECTIVE: To discuss the method of recurrent laryngeal nerve anatomy of thyroid surgery, for avoiding recurrent laryngeal nerve injury. METHOD: Recurrent laryngeal nerve of all 247 cases were found along tracheoesophageal groove or angle of thyroid cartilage, in front of the recurrent laryngeal nerve showed up next to the thyroid cartilage angle and cricothyroid membrane, or down to thyroid anatomy revealed under the lower pole artery and vein, and not have to deliberately look for a branch of the recurrent laryngeal nerve, a total of 258 recurrent laryngeal nerve were found. RESULT: Among two hundred and forty-seven cases, the recurrent laryngeal nerve injury was two cases, injury rate was 0.8%. And the two cases were incomplete injury, which about a month were back to normal, and significant deviation was found with no pre-conventional anatomy of of recurrent laryngeal nerve of 276 cases (P < 0.05). CONCLUSION Conventional recurrent laryngeal nerve anatomy in thyroid surgery could effectively avoiding recurrent laryngeal nerve injury.
Adolescent ; Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Recurrent Laryngeal Nerve ; anatomy & histology ; surgery ; Thyroid Cartilage ; surgery ; Thyroid Gland ; surgery ; Young Adult

OBJECTIVE: To discuss the application of anatomization of the recurrent laryngeal nerve under the microscope in thyroid surgery. METHOD: 292 patients with different types of thyroid diseases who underwent surgical intervention were discussed by regression analysis. For all patients, the movement of both vocal cords was normal before the surgery by laryngoscope. And routine anatomization of the recurrent laryngeal nerve under the microscope was conducted during thyroid surgery. RESULT: The total number of recurrent laryngeal nerve exposure in this study was 402. Only three of them got temporary injury. None had permanent damage. CONCLUSION The recurrent laryngeal nerve can be visualized more clearly by dissection under the microscope, which can best avoid the recurrent laryngeal nerve injury. Particularly it is beneficial for the patients who have prior thyroid surgery history or have thyroid gland cancer.
Adolescent ; Adult ; Aged ; Female ; Humans ; Male ; Microscopy ; Middle Aged ; Recurrent Laryngeal Nerve ; anatomy & histology ; Thyroid Gland ; surgery ; Thyroidectomy ; methods ; Young Adult

Ultrasonography (US)-guided procedures such as ethanol ablation, radiofrequency ablation, laser ablation, selective nerve block, and core needle biopsy have been widely applied in the diagnosis and management of thyroid and neck lesions. For a safe and effective US-guided procedure, knowledge of neck anatomy, particularly that of the nerves, vessels, and other critical structures, is essential. However, most previous reports evaluated neck anatomy based on cadavers, computed tomography, or magnetic resonance imaging rather than US. Therefore, the aim of this article was to elucidate US-based thyroidal and perithyroidal anatomy, as well as its clinical significance in the use of prevention techniques for complications during the US-guided procedures. Knowledge of these areas may be helpful for maximizing the efficacy and minimizing the complications of US-guided procedures for the thyroid and other neck lesions.
Biopsy, Large-Core Needle/methods ; Catheter Ablation/methods ; Humans ; Laser Therapy/methods ; Neck/*anatomy & histology/blood supply/*ultrasonography ; Surgery, Computer-Assisted/*methods ; Thyroid Gland/*anatomy & histology/blood supply/*ultrasonography

BACKGROUND: Before iodination of Swedish table salt in 1936, iodine deficiency resulting in goitre and hypothyroidism was common. Sweden has become iodine sufficient, as shown in a national survey in 2007, proving its iodination fortification programme effective for the general population. The objective of this study was to collect drinking water from water treatment plants nationally and test if water iodine concentration (WIC) correlated to urinary iodine concentration (UIC) of school-aged children in a national survey 2007 to former goitre frequency in 1929 and to thyroid volume data in 2007. METHODS: In 2012, 166 treatment plants, located in 57% (166 of 290) of all Swedish municipalities, were asked to collect drinking water samples of approximately 10 ml. In 2007, tap water samples of the same volume were collected from 30 randomly selected schools for the national survey. Analysis of WIC was done in both treatment plants in 2012 (n = 166) and tap water in 2007 (n = 30). The correlation of WIC to the children's UIC and thyroid volume after iodination was tested based on data from the national survey in 2007. The association of WIC to former goitre frequency was tested based on pre-iodination data, derived from a map of goitre frequency drawn in 1929. RESULTS: The median WIC from water treatment plants was 4.0 μg/L (range 0-27 μg/L). WIC was similar in coastal and inland areas, for both ground and surface water. WIC correlated with historical goitre areas and was lower in the goitre areas than in non-goitre areas (p < 0.001). WIC in the same municipalities as the schools correlated with the UIC of children (p < 0.01), but not with their thyroid volume. CONCLUSIONS WIC still contributes to iodine nutrition in Sweden, but iodination overrides the goitre effect.
Adolescent ; Child ; Drinking Water ; chemistry ; Female ; Food, Fortified ; analysis ; Goiter ; epidemiology ; history ; History, 20th Century ; History, 21st Century ; Humans ; Iodine ; analysis ; urine ; Male ; Sodium Chloride, Dietary ; analysis ; Sweden ; epidemiology ; Thyroid Gland ; anatomy & histology