A new and easy landmark for RLN in thyroid surgery: midpoint of first tracheal ring height

Introduction and Aim: Recurrent laryngeal nerve paralysis is one of the most serious complications of thyroid surgery. To reduce this complication, its characteristics and the anatomy at the entry to the larynx and around the Berry ligament, which is the most frequent location of injuries, must be established well. With this purpose, we studied the relation between the first tracheal ring and the recurrent nerve in this study. Material and Method: One hundred and twenty-six females and 30 males who had undergone thyoroidectomy were included in the study. THV, RRVH, LRVH, RRAD, LRAD parameters were measured on all the patients. Patients were divided into two groups as females and males and statistical analysis was carried out using t-test and Pearson’s correlation test. Results: No statistically significant differences were found between males and females as regards the THV (p<0.432), RRVH (p<0.412), LRVH (p<0.061), RRAD (p<0.087) and LRAD (p=0.064) parameters. Strong positive correlations were found between RRAD and LRAD (p<0.001; Pearson r=0.722) and between RRVH and LRVH (p<0.001; Pearson r=0.812). Conclusion: We saw that the vertical RLN height remained under the vertical height of the midpoint of the first tracheal ring (akil point) in all the cases, including males and females. This will ensure easier identification RLN during thyroid surgery and advancing from the anterior towards the posterior till the midpoint of the height at the level of the first ring of the trachea. In this regard, we think that this point is an important landmark.