Medial Approach for Identification of Recurrent Laryngeal Nerve in Locally Advanced Differentiated Thyroid Carcinoma: Revisited

Recurrent laryngeal nerve injury is a well-recognized and potentially catastrophic complication of thyroidectomy. In literature, four approaches have been described for identification of RLN, the superior, lateral, medial, and inferior approaches. But medial approach is lesser known amongst surgeons. Locally infiltrative thyroid cancer with extensive lymph nodal metastasis in central and lateral compartment sometimes makes it difficult to identify RLN by any of these standard approaches described above. A medial approach was described where RLN is identified as it extends up to interdigitate with the trunk or the branches of the inferior thyroid artery. We present here a new alternative technique for identification of recurrent laryngeal nerve through modified medial approach that was used in difficult thyroidectomies.