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Anatomic Relationship Between Right Recurrent Laryngeal Nerve and Cervical Fascia and Its Application Significance in Anterior Cervical Spine Surgical Approach

Shan, Jianlin MS; Jiang, Heng MS; Ren, Dajiang MD; Wang, Chongwei BS

doi: 10.1097/BRS.0000000000001881

Study Design. An anatomic study of anterior cervical dissection of 42 embalmed cadavers.

Objective. The aim was to study the anatomic relationship between recurrent laryngeal nerve (RLN) and cervical fascia combined with the requirements in anterior cervical spine surgery (ACSS).

Summary of Background Data. There has been no systematic research about how to avoid RLN injury in anterior cervical spine surgical approach from the aspect of the anatomic relationship between RLN and cervical fascia.

Methods. Forty-two adult cadavers were dissected to observe the relationships between RLN and different cervical fascia layers.

Results. RLN pierced out the alar fascia from the inner edge of the carotid sheath in all cases, and the piercing position in 22 cases (52.4%) was located at the lower segment of T1. The enter point into visceral fascia of RLN was located at C7-T1 in 25 cases (59.5%). The middle layer of deep cervical fascia exhibited the most stable anatomic relationship with RLN at the carotid sheath confluence site. Pulling visceral sheath leftwards would significantly increase the RLN tension.

Conclusion. Using the close and stable relationship between RLN and cervical fascia could help to avoid RLN injury in anterior cervical spine surgical approach.

Level of Evidence: 4

*Department of Orthorpaedics, Beijing General Hospital of PLA, Beijing, China

Department of Anatomy, Chengdu Medical College, Chengdu, China.

Address correspondence and reprint requests to Jianlin Shan, MD, Department of Orthopaedics, Beijing General Hospital of PLA, No. 28 Fuxing Road, Haidian District, Beijing 100700, China; E-mail:

Received 27 April, 2016

Revised 1 July, 2016

Accepted 1 August, 2016

J.S. and H.J. contributed equally to this work and should be considered cofirst authors.

The device(s)/drug(s) is/are FDA-approved or approved by corresponding national agency for this indication.

No funds were received in support of this work.

No relevant financial activities outside the submitted work.

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