Relation between the Parathyroid Glands and the Recurrent Laryngeal Nerve

Emphasis has been placed on the relationship of the parathyroid glands and the recurrent laryngeal nerve. A predictable relation of both the superior and inferior parathyroid glands to the recurrent laryngeal nerve is noted within a rectangular area that can be imagined visually when the lobe of the thyroid is rotated medially. The superior boundary of this rectangle is the most cephalad portion of the thyroid lobe; the inferior boundary is a point on the trachea 4 cm below the inferior pole of the thyroid gland; posteriorly, the esophagus; and anteriorly, the surface of the thyroid lobe and trachea. The usual course of the recurrent laryngeal nerve should divide this rectangle into two triangles, one lying ventral and the other dorsal to the nerve. After analyzing 100 autopsy specimens, Pyrtek and Painter13 found that 93%

of parathyroid glands were situated in a predictable relation to the recurrent laryngeal nerve (i.e., superior glands lying posterior and superior to the nerve and inferior glands lying anterior to the nerve). This supports the reliability of the recurrent laryngeal nerve as a guide for locating the parathyroid glands.

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