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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 12/2012

01-11-2012 | Endocrine Tumors

Tumor Proximity to the Recurrent Laryngeal Nerve in Patients with Primary Hyperparathyroidism Undergoing Parathyroidectomy

Authors: Brian R. Untch, MD, Mohamed A. Adam, MD, Melissa E. Danko, MD, Michael E. Barfield, MD, Darshana Dixit, MA, Randall P. Scheri, MD, John A. Olson, MD, PhD

Published in: Annals of Surgical Oncology | Issue 12/2012

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Abstract

Background

Recurrent laryngeal nerve (RLN) injury is a rare complication for patients undergoing neck exploration for primary hyperparathyroidism (pHPT). Distances between RLNs and parathyroid adenomas have not been previously published. In this study we used a RLN monitor to identify the RLN and to measure the proximity to parathyroid tumors.

Methods

Patients with pHPT (n = 136) underwent neck exploration and had the clinical data recorded prospectively. Adenomas were recorded in 1 of 4 locations (right upper, right lower, left upper, left lower). Measurement of RLN to adenoma distances were recorded intraoperatively with the gland in situ. The RLN location was confirmed with a RLN monitor.

Results

The average RLN to adenoma distance was 0.52 ± 0.52 cm. Adenomas in the right upper position were significantly closer to the nerve (0.25 ± 0.39 cm) compared with adenomas in the left upper (0.48 ± 0.61 cm, p = .03), left lower (0.70 ± 0.53 cm, p < .001), and right lower position (1.02 ± 0.56 cm, p < .001). Left upper adenomas were also significantly closer to the nerve compared with right lower adenomas (p < .001). Adenomas in the right upper position abutted the nerve more often (47 %) compared with adenomas in other positions (p = .001). There were no perioperative characteristics that predicted tumor abutment. There were no permanent RLN injuries.

Conclusion

In patients with sporadic pHPT, parathyroid adenomas in the right upper location have, on average, greater proximity to the RLN and are more often directly abutting compared with adenomas in other locations.
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Metadata
Title
Tumor Proximity to the Recurrent Laryngeal Nerve in Patients with Primary Hyperparathyroidism Undergoing Parathyroidectomy
Authors
Brian R. Untch, MD
Mohamed A. Adam, MD
Melissa E. Danko, MD
Michael E. Barfield, MD
Darshana Dixit, MA
Randall P. Scheri, MD
John A. Olson, MD, PhD
Publication date
01-11-2012
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 12/2012
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-012-2495-z

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